How Providing Cervical Cancer Screening Results via Cell Phone Affects Patient Follow-Up Rates in Western Kenya

Abstract

Purpose Human papillomavirus (HPV) testing is being more widely used in simplified cervical cancer screening protocols in low-resource settings. One challenge to successful implementation is the multiple visits necessary to provide results and follow-up. mHealth strategies may reduce visit burden by providing information through text message. Methods As part of a cluster-randomized trial to compare HPV testing in clinics and community health campaigns in western Kenya, we carried out a mixed-methods study to assess women’s preferences and experiences with different strategies to receive their results. Women could opt to receive their HPV results via text message, cell phone call, home visit, or return clinic visit. We examined overall receipt of results, follow-up rates, and acceptability by notification method. Results Among the 4,947 women who underwent HPV-based cervical cancer screening, 1,596 (32%) received results via text message, 1,181 (24%) via cell phone call, 1,563 (32%) via clinic visit, and 605 (12%) via home visit. Women opting for texts or calls were younger and had higher rates of prior cervical cancer screening, HIV testing, and modern contraceptive use ( P < .001 for all). Home visits were associated with a significantly higher rate of treatment acquisition (45%) than texts (38%), cell phone calls (38%), and clinic visits (23%; P < .001). In a model controlling for age, prior screening, HIV testing, and contraceptive use, clinic visits remained significantly associated with decreased odds of treatment (adjusted odds ratio, 0.45; 95% CI, 0.29 to 0.69) compared with texts. Among treated women, there was no difference in time to treatment by notification method. Conclusion Cell phone–based results notification strategies were preferred by women with greater health-seeking behavior; however, HPV-positive women who received results via home visit were more likely to pursue for treatment.

Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research

“…Improve the reporting of digital health strategies in the literature: in our review, only 5 studies [ 35 - 37 , 39 , 54 , 57 , 59 ] met the mERA checklist item on replicability, indicating that many of the digital health strategies identified in this review would be difficult to replicate and re-evaluate based on published information. The use of reporting checklists ensures that all relevant information is presented to readers to assist with study reproducibility.…”

“…A fifth study by Lima et al [ 41 ] used random allocation but was excluded from the review of the primary objectives because of the lack of a control group. Huchko et al [ 39 ] reported findings of a mixed methods analysis from a cluster RCT; however, the assignment of the digital health strategy was not randomized; thus, it did not meet the criteria for inclusion in the review of primary objectives. All 27 studies were included in the review of the secondary objectives, that is, to describe the digital health strategies used for cervical cancer control in LMICs and the challenges associated with their implementation.…”

“…The review focused on LMICs: 19 studies were conducted in sub-Saharan Africa [ 30 , 31 , 34 - 39 , 42 - 46 , 50 , 52 , 54 - 56 , 59 ], 7 in Asia [ 32 , 33 , 40 , 47 - 49 , 51 , 53 , 58 ], and 1 in South America [ 41 ].…”

“…Rashid et al [ 47 - 49 ] and Huchko et al [ 39 ]: direct communication through phone call encouraged more women to seek screening (both studies had a high risk of bias, limiting our confidence in their findings)…”

Iterative Development of a Mobile Phone Application to Support Community Health Volunteers during Cervical Cancer Screening in Western Kenya

“…The copyright holder for this this version posted September 25, 2020. ; https://doi.org/10.1101/2020.09.23.20200162 doi: medRxiv preprint transmission, and prevention of Human Papillomavirus (HPV). [28][29][30] Based on high reported mobile phone ownership within Kenya and past research documenting success with text message-based delivery of screening results in western Kenya, 31,32 the introduction of a mobile application-based intervention to address gaps in education and provider support appears feasible in this context. The aim of this study was to iteratively develop and refine the mSaada mobile application in consultation with key stakeholders prior to small-scale pilot testing in health facilities in western Kenya.…”