Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities

DeGregorio, Geneva; Manga, Simon; Kiyang, Edith; Manjuh, Florence; Bradford, Leslie; Cholli, Preetam; Wamai, Richard G.; Ogembo, R.; Sando, Zacharie; Liu, Yuxin; Sheldon, Lisa Kennedy; Nulah, Kathleen; Welty, Thomas K.; Welty, Edith; Ogembo, Javier Gordon

doi:10.1634/theoncologist.2016-0383

Cited by 29 publications

(48 citation statements)

References 41 publications

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“…However, there was no difference in acceptability between participants with good vs. poor knowledge scores. Fair DeGregorio 2017 [ 57 ] Evaluate a nurse-led, fee-for-service cervical cancer screening program using visual inspection with acetic acid-enhanced by digital cervicography in the setting of a large faith-based health care system Cameroon VIA, VILI, Digital imaging, Cryotherapy, LEEP, Biopsy Quality: quarterly meeting to review cervicographs with expert clinician Educate: peer educators with group lectures in the community Finance: fee-for-service sliding scale based on community demographics Restructure: integrate with family planning, breast exams, STI testing Penetration: VIA screening coverage In 8 years, 44,979 women were screened for cervical cancer. Poor Dim 2015 [ 62 ] Assess willingness to pay out-of-pocket for Pap smear among HIV positive women after provided information about cervical cancer and screening Nigeria Pap smear Educate: individual counseling on increased risk for cervical cancer, Pap smear protocol, and costs Adoption: willingness to pay for Pap smear 378 (94.5%) respondents were willing to pay for Pap smear, irrespective of the cost.…”

Section: Resultsmentioning

confidence: 99%

“…Using specificity and sensitivity rates, some studies compared VIA assessments between nurses and an expert physician [ 22 , 24 , 25 , 41 ] while others compared self- vs. physician-collected samples for HPV DNA testing [ 27 , 28 , 30 , 31 , 42 , 43 ]. Sixteen studies examined if screening coverage increases when changing service sites [ 44 – 49 ], combining screening with an already established program (i.e., HIV/STI screening) [ 50 – 57 ], or providing financial incentives [ 58 , 59 ]. Four studies evaluated the effect of educational interventions on knowledge, attitudes, and screening behaviors for patients [ 60 ] and providers [ 61 – 63 ].…”

Section: Resultsmentioning

confidence: 99%

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Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

et al. 2018

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BackgroundDeveloped countries, such as the USA, have achieved significant decreases in cervical cancer burden since the introduction of Pap smear-based programs in the 1960s. Due to implementation barriers and limited resources, many countries in sub-Saharan Africa (SSA) have been unable to attain such reductions. The purpose of this review is to evaluate implementation strategies used to improve the uptake and sustainability of cervical cancer prevention programs in SSA.MethodsA reviewer (LJ) independently searched PubMed, Ovid/MEDLINE, Scopus, and Web of Science databases for relevant articles with the following search limits: English language, peer reviewed, and published between 1996 and 2017. The 4575 search results were screened for eligibility (CJ, LJ) to identify original research that empirically evaluated or tested implementation strategies to improve cervical cancer prevention in SSA. Fifty-three articles met criteria for inclusion in the final review. AA, CJ, and LJ abstracted the included articles for implementation-related content and evaluated them for risk of bias according to study design with the National Heart, Lung, and Blood Institute’s (NHLBI) Quality Assessment Tools. Results were reported according to PRISMA guidelines.ResultsThe 53 included studies are well represented among all sub-Saharan regions: South (n = 16, 30.2%), West (n = 16, 30.2%), East (n = 14, 26.4%), and Middle (n = 7, 13.2%). There are 34 cross-sectional studies (64.2%), 10 pre-posttests (18.9%), 8 randomized control trials (15.1%), and one nonrandomized control trial (1.9%). Most studies are “fair” quality (n = 22, 41.5%). Visual inspection with acetic acid (VIA) (n = 19, 35.8%) was used as the main prevention method more frequently than HPV DNA/mRNA testing (n = 15, 28.3%), Pap smear (n = 13, 24.5%), and HPV vaccine (n = 9, 17.0%). Effectiveness of strategies to improve program implementation was measured using implementation outcomes of penetration (n = 33, 62.3%), acceptability (n = 15, 28.3%), fidelity (n = 14, 26.4%), feasibility (n = 8, 15.1%), adoption (n = 6, 11.3%), sustainability (n = 2, 3.8%), and cost (n = 1, 1.9%). Education strategies (n = 38, 71.7%) were used most often but have shown limited effectiveness.ConclusionThis systematic review highlights the need to diversify strategies that are used to improve implementation for cervical cancer prevention programs. While education is important, implementation science literature reveals that education is not as effective in generating change. There is a need for additional organizational support to further incentivize and sustain improvements in implementation.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0718-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

et al. 2018

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“…Since 2007, the WHP of the CBCHS has provided comprehensive services for women, including breast and cervical cancer screening, treatment of reproductive tract infections and family planning services, and currently supports clinics in 7 of the 10 regions of Cameroon . However, the WHP's cervical screening services were not available in many rural and remote areas, despite some outreach campaigns organized in these hard‐to‐reach settings.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa

Domgue

Futuh

Ngalla

et al. 2019

Intl Journal of Cancer

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To achieve higher coverage and effectiveness in limited-resource settings, World Health Organization (WHO) guidelines for cervical cancer prevention recommend a screen-and-treat strategy with high-risk human papillomavirus (HPV) testing. We piloted a real-word project to examine the feasibility of this approach in rural Cameroon. Nurses from the Women's Health Program (WHP) of the Cameroon Baptist Convention Health Services (CBCHS) educated women in remote villages on cervical cancer prevention. At a follow-up visit, they explained to nonpregnant women aged 30-65 how to self-collect vaginal specimens for HPV testing with the careHPV assay. The cytobrush specimens were transported in coolers to a CBCHS laboratory for analysis. The nurses returned to villages to inform women of their results, examined HPV-positive women in the primary health centers (PHCs) using visual inspection with acetic acid and Lugol's iodine (VIA/VILI) enhanced by digital cervicography (DC) to guide treatment. Of the 1,270 eligible women screened (mean age: 44.7 years), 196 (15.4%) were HPV-positive, of whom 185 (94.4%) were examined, 16 (8.6%) were VIA/VILI-positive, 8 (4.3%) were VIA/VILI-inadequate, one (0.5%) was VIA/VILI-uncertain and 161 (87.0%) were treated with thermal ablation. One woman had LEEP, and another woman with invasive cancer was treated at a referral facility. The cytobrushes broke off in the vaginas of two women (removed in the village) and in the bladder of another (surgically removed). Community-based cervical cancer screening with self-collected specimens for HPV testing is feasible in rural Cameroon. Education on the proper sampling procedure and follow-up of women who are HPV-positive are essential.

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“…We also faced a high proportion of lost to follow-up. One must recognize that in low-resource settings, implementation and conduct of clinical trials is a major challenge [ [22] , [23] , [24] , [25] ]. In general, weak health systems, poverty, low literacy rates, religious and cultural beliefs, lack of inter-sectoral collaboration, war and civil strife, shortage of trained health care professionals constitute real barriers to cutting-edge clinical research in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Impact of antiviral AV2 in the topical treatment of HPV-associated lesions of the cervix: Results of a phase III randomized placebo-controlled trial

Tozin

Kanyiki

Geertruyden

et al. 2019

Contemporary Clinical Trials Communications

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Background Non-surgical topical therapies have been assessed in the treatment of precancerous lesions of the cervix. Their use can offer logistical and feasibility advantages in low-resource settings. Antiviral AV2 ® is a mixture of natural essential oils (eugenol, carvone, nerolidol, geraniol) in olive oil, and has a broad spectrum anti-viral activity. In a phase II randomized controlled trial (RCT), AV2 ® proved effective in reducing the size of cervical lesions associated with human papillomavirus (HPV). The purpose of the present study was to further evaluate the efficacy of AV2 over placebo in the topical treatment of HPV-associated cervical lesions. Methods Women aged 25 years and older were included in this phase 3 RCT. Cytology screening, HPV testing and visual inspection of the cervix with 5% acetic acid (VIA) were performed on all participants. VIA-positive women were randomized to one of two groups to receive treatment by either AV2® or placebo. The treatment consisted of 2 puffs of spray of the investigational drug directed to the cervix. Participants were subjected to repeat examinations two months and six months later for assessment of outcomes. The primary outcome was the change of lesions on VIA at 2 months after application of the investigational drug. Secondary outcomes were: HPV clearance and cytologic regression at 2 months and 6 months, and number of participants with AEs. Results A total 327 VIA positive women were randomized in two groups (168 in AV2 group and 159 in placebo group). Women in the 2 groups were similar with respect to baseline demographics and clinical characteristics. At 2 months, regression of lesions on VIA was observed in 127 (89.4%) out of 142 women in AV2 group compared to 120 (91.6%) out of 131 women in placebo group (P = 0.7). On cytology, regression of lesions occurred in 14 (56%) out of 25 women in the AV2 arm and in 13 (48.1) out of 27 women in the placebo arm (p = 0.7), and HPV clearance rates were 34.1% and 35% in AV2 group and placebo group respectively (p = 0.8). At 6 months cytologic regression was observed in 64.7% of women in AV2 group and 45.8% in placebo group (p = 0.2), while HPV clearance occurred in 11 (51.9%) out of 17 women in AV2 arm versus 11 (34.4%) in placebo arm (p = 0.3). Some local side effects (burning, itching, irritation) were similarly noted in the 2 groups (p-values = 0.169, 0.623 and 0.172 respectively) but they were mild and transitory. Conclusion A topical application of AV2 onto the cervix can induce the regression of cervical precancerous lesions, but its efficacy does not significantly differ with that of placebo. The discrepancy between the expected and the recorded sample size as well as the huge number of lost to follow-up probably impeded the power of analyses, which could be one of the reasons for the lack of difference seen between AV2 and placebo. Further ev...

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Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities

Cited by 29 publications

References 41 publications

Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa

Impact of antiviral AV2 in the topical treatment of HPV-associated lesions of the cervix: Results of a phase III randomized placebo-controlled trial

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