Health care provider's experience and perspective of cervical cancer screening in Singapore: A qualitative study

Abstract

BackgroundIn Singapore, the current cervical cancer screening (CCS) coverage rate of 48% falls below the national target of 70%. Health care providers (HCPs) play a critical role in promoting CCS uptake. However, there is limited understanding of the perspectives of HCPs regarding CCS. Hence, we aimed to understand the challenges encountered by HCPs delivering CCS in different care settings in the Singapore health system. We also aimed to explore perspectives on newer features of CCS such as self-sampling and HPV genotyping.MethodsPhysicians, nurses, program administrators and laboratory technicians involved with CCS were invited for a one-on-one semi-structured interview conducted over Zoom between May to August 2021. The interviews were transcribed and analyzed using thematic analysis.ResultsEighteen HCPs from 12 institutions were interviewed. Most participants were women (61.1%) and worked in public health institutions (72.2%). For factors influencing CCS, nine key themes were identified and organized into four categories: (1) patient factors, (2) HCP factors, (3) health system factors and (4) health promotion factors. Key themes commonly highlighted by study participants were related to patients' preferences and acceptance for screening, the processes of delivering CCS, the national priority for cervical cancer and the effectiveness of existing health promotion efforts. Five key themes were identified for CCS innovations. Self-sampling was viewed favorably to increase CCS uptake, while primary HPV screening with HPV partial genotyping had higher sensitivities to detect pre-cancers and cancers compared to cytology. Extended HPV genotyping beyond HPV16/18 could play an important role in CCS with increasing HPV vaccination coverage, as well as in the management of persistent HPV infection.ConclusionIn Singapore, HCPs face multiple challenges for CCS in practice. Insights from this study are directly relevant to, and useful for developing policies around national CCS programs and treatment guidelines.

Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

“…Yet, the national screening program uses PGT, which provides no information on these HPV genotypes. In an interview with Singapore healthcare providers, the value of specific HPV genotyping beyond HPV16/18 was highlighted [ 19 ]. For example, with XGT, the prevalence of specific non-HPV16/18 genotypes can be established, and those that pose a lower risk can be identified for less intensive management [ 19 ].…”

“…In an interview with Singapore healthcare providers, the value of specific HPV genotyping beyond HPV16/18 was highlighted [ 19 ]. For example, with XGT, the prevalence of specific non-HPV16/18 genotypes can be established, and those that pose a lower risk can be identified for less intensive management [ 19 ]. Based on the above, we undertook a systematic evaluation of the benefits and consequences of using XGT in the national screening program.…”

Cost‐effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model‐based analysis

“…To our knowledge, our study is one of the first to explicitly quantify the efficient gains through age‐ and genotype‐specific algorithms under uniform primary HPV testing for a vaccinated cohort. We identified two studies (the United States and Singapore) that found extended genotyping (three HPV groups) was likely to be considered cost‐effective over partial genotyping; however, they did not consider the potential of age‐specific algorithms alongside extended genotyping 7,8 …”

“…Following their first adolescent‐vaccinated cohort entering screening in 2022, Norway is considering extended HPV genotyping and age‐specific triage approaches. To our knowledge, although extended genotyping has been examined, 6–8 there are no cost‐effectiveness analyses or harm–benefit evaluations that combine both age and multiple extended genotyping triage algorithms. Therefore, the aim of this study was to estimate the health impact, harms and cost‐effectiveness of novel primary HPV triage approaches for a highly vaccinated cohort of women initiating screening in 2023.…”

“…Following their first adolescent-vaccinated cohort entering screening in 2022, Norway is considering extended HPV genotyping and age-specific triage approaches. To our knowledge, although extended genotyping has been examined, [6][7][8] there are no cost-effectiveness analyses or harm-benefit evaluations that combine both age and multiple extended genotyping triage algorithms.…”