Interventions to increase the uptake of cervical cancer screening in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Background To identify effective interventions to increase the uptake of cervical cancer screening (CCS) for low-and middle-income countries (LMICs). Methods We searched PubMed, CENTRAL, ISI Web of Sciences, Scopus, OVID (Medline), CINAHL, LILACS, CNKI and OpenGrey for randomized controlled trials (RCTs) and cluster RCTs conducted in LMICs from January 2000 to September 2021. Two reviewers independently screened studies, extracted data, assessed risk of bias and certainty of evidence. Meta-analyses with random-effects models were conducted for data synthesis. Results We included 38 reports of 24 studies involving 318,423 participants from 15 RCTs and nine cluster RCTs. Single interventions may increase uptake of CCS when compared with control (RR 1.47, 95% CI 1.19 to 1.82). Self-sampling of Human Papillomavirus (HPV) testing may increase uptake of CCS relative to routine Visual Inspection with Acetic Acid (RR 1.93, 95% CI 1.66 to 2.25). Reminding with phone call may increase uptake of CCS than letter (RR 1.72, 95% CI 1.27 to 2.32) and SMS (RR 1.59, 95% CI 1.19 to 2.13). Sending 15 health messages may increase uptake of CCS relative to one SMS (RR 2.75, 95% CI 1.46 to 5.19). Free subsidized cost may increase uptake of CCS slightly than $0.66 subsidized cost (RR 1.60, 95% CI 1.10 to 2.33). Community based HPV test may increase uptake of CCS slightly in compared to hospital collected HPV (RR 1.67, 95% CI 1.53 to 1.82). The evidence is very uncertain about the effect of combined interventions on CCS uptake relative to single intervention (RR 2.20, 95% CI 1.54 to 3.14). Conclusions Single interventions including reminding with phone call, SMS, community self-sampling of HPV test, and free subsidized services may enhance CCS uptake. Combined interventions, including health education interventions and SMS plus e-voucher, may be better than single intervention. Due to low-certainty evidences, these findings should be applied cautiously.

Mother–Child Approach to Cervical Cancer Prevention in a Low Resource Setting: The Cameroon Baptist Convention Health Services Story

“…The literature addresses effective ways to optimize cervical screening attendance in LMICs. In 24 studies (15 RCT and 9 cluster with RCTs including 1 study from Cameroon), self-sampling was superior to VIA (RR 1.93 95% CI 1.66–2.25); reminder phone calls or SMS texts facilitated attendance when compared to letter invitation (RR 1.72, 95%CI 1.27–2.32, RR 1.59, 95% CI 1.46–5.19); free or subsidized costs optimized attendance (RR 1.60, 95% CI 1.10–2.33); and community-based HPV testing was superior to hospital-collected HPV testing (RR 1.67, 95% CI 1.53–1.82) [ 15 ]. A recent sequential prospective study in the West Region of Cameroon showed that in the 10 months from September 2018–May 2019, there was a passive approach of community information channels with media announcements, posters in women’s associations, churches and integrated health centers [ 16 ].…”

Implications of viral infections and oncogenesis in uterine cervical carcinoma etiology and pathogenesis

“…Uterine cervical carcinoma (UCC) remains a major global health concern, accounting for significant morbidity and mortality in women worldwide. Despite considerable research efforts and advances in screening and prevention strategies, UCC continues to pose a substantial public health challenge, particularly in low- and middle-income countries ( Srinath et al, 2022 ; Ton et al, 2022 ; Dau et al, 2023 ; Tin et al, 2023 ). A comprehensive understanding of the etiological factors underlying the development of UCC is crucial for devising improved prevention, early detection, and treatment strategies.…”