‘I’m here to save my life’: a qualitative study of experiences navigating a cryotherapy referral system for human papillomavirus-positive women in western Kenya

Abstract

BackgroundWe sought to understand the beliefs, social norms and logistical factors that affect human papillomavirus (HPV)-positive women’s uptake of cryotherapy treatment as part of a two-part cervical cancer screening strategy in rural Kenya.MethodsIn-depth interviews within a parent cluster-randomised trial.SettingGovernment-run county hospital in western Kenya.Participants273 of 372 (73.4%) HPV-positive women who underwent cryotherapyResultsMany women feared that an HPV infection meant they would develop cancer. Almost all women reported initial fear of the treatment procedure, followed by a more positive experience than anticipated. Lacking funds for transportation to the treatment site was the most common barrier. Women felt that decentralised treatment would be the most important facilitator of greater access. Spousal encouragement and financial support were key facilitators of treatment access, however many women felt that other husbands in the community would not be supportive. Women described successfully acquiring treatment as empowering, and almost all would recommend seeking cryotherapy to other women who test HPV-positive. Most felt eager to share their own experiences with others to encourage treatment.ConclusionsThe main facilitators of treatment access were understanding of the health risks and sense of empowerment. A decentralised treatment model or transportation support may facilitate access, along with improved health messaging about HPV infection, cancer and the treatment process. Focusing on women’s personal feelings of empowerment may further improve uptake and satisfaction. These data will be used to design a strategy to improve linkage to treatment.Trial RegistrationNCT02124252.

Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review

“…A study in Kenya ( Lunsford et al. , 2017 ) showed that women were willing to undergo the screening if they were given incentives or if they were reimbursed by the state for transportation ( Huchko et al. , 2019 ).…”

Understanding HPV-positive women’s needs and experiences in relation to patient-provider communication issues: a qualitative study

“…In a study conducted in Kenya, financial support was key facilitators of HPV-positive women’s treatment access [ 45 ]. Due to the high cost of colposcopy in Iran, referral of women to government-funded clinics (by HCPs) may improve women’s adherence to treatment.…”

Piloting a systems level intervention to improve cervical cancer screening, treatment and follow up in Kenya

“…Although awareness of the importance of CC screening is increasing ( 9 ), only 16–19% of eligible Kenyan women 18–69 years old are screened for CC ( 10 ). These low rates of screening contribute to 50–80% of cases identified in advanced stages of CC ( 11 – 13 ).…”

“…Kenyan guidelines call for a “screen and treat” protocol for women with pre-cancerous lesions identified by VIA/VILI (when PAP or HPV testing is unavailable), in which treatment is administered on the same clinic visit as diagnosis to minimize patient burden, treatment delay, and loss to follow-up (LTFU) ( 14 ). However, in a survey of 12 hospitals across 7 counties, only 25% of facilities had a functional cryotherapy machine ( 9 ), allowing them to offer services compliant with these guidelines. Even amongst those who offer same day services, supply stock outs, C02 shortages for the cryotherapy machine, and lack of trained providers available to perform the procedure can delay treatment and cause increased burden on patients ( 15 , 16 ).…”