Loss to Follow-Up in a Cervical Cancer Screening and Treatment Program in Western Kenya

Abstract

Background: Increasingly, evidence is emerging from developing countries like Kenya on the burden of loss to follow-up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the western region of Kenya. This study is designed to determine the proportion of and predictors and reasons for defaulting from follow-up care after positive cervical cancer screen. Aim: To determine the rates and factors associated with loss to follow-up in a multivisit cervical cancer screening and treatment program in western Kenya. Methods: We conducted a prospective study of women, who presented for cervical cancer screening at Chulaimbo and Webuye subcounty hospitals, and screened positive by VIA. A 2-3 weeks appointment was then set for review by a gynae-oncologist. A total of 100 women, scheduled for review, were recruited in the study and followed between August 2016 and May 2017. LTFU was defined as failure to keep a second rescheduled appointment or being unreachable for 3 consecutive months and failure to confirm that a woman sought for care in another health facility. Descriptive statistics was used for summary and the Cox regression model was used to estimate the risk of LTFU for different covariates. Results: The age range was 21-77 years, with a mean of 44.45 years. 39% of the women defaulted from scheduled follow-up appointment of which 25 (64%) were LTFU. Univariate Cox regression was conducted for HIV cases (HR=2.7, P value=0.021), clinic revisits (HR=2.6, P value=0.026), married (HR=0.63, P value=0.237) and previously screened women (HR=1.67, P value=0.198). Increased risk of LTFU was observed for HIV cases (HR=2.4, P value=0.04) and revisits (HR=7.5, P value=0.014) in an adjusted model. Conclusion: LTFU affects cervical cancer management due to several factors some of which are beyond the control of the women. We recommend a larger study be replicated for ease of generalizability of results; awareness and strategies are required to retain them to obey the treatment appointment since they are the highly vulnerable.

Scaling up cervical cancer prevention in Western Kenya: Treatment access following a community‐based HPV testing approach

“…Our treatment uptake rate of 52%, while lower than reported rates in the two studies using the Xpert HPV assay, is comparable to rates of follow‐up reported in VIA‐based programs in similar settings 14,20. However, studies show that HPV‐based screening, recommended as first‐line in LMICs where available, is more effective than VIA‐based screening,21 and has greater reduction in mortality from cervical cancer when coupled with treatment compared to VIA 5.…”

A public health approach to cervical cancer screening in Africa through community‐based self‐administered HPV testing and mobile treatment provision

“…12 However, there still remain challenges in getting treatment to those with positive tests. 13,14 Women often need to travel great distances to facilities for treatment, resulting in substantial defaulting and failure to receive therapy. 11 To address the public health problem of cervical cancer in sub-Saharan Africa, we sought to take advantage of the technologic advancements in HPV testing and couple them with practical insights (eg, mobile treatment provision) to develop a community-based "public health approach" to screening.…”

“…Regarding treatment, the World Health Organization recommends ablative therapy for a positive HPV result without further diagnostic confirmation 12 . However, there still remain challenges in getting treatment to those with positive tests 13,14 . Women often need to travel great distances to facilities for treatment, resulting in substantial defaulting and failure to receive therapy 11 …”

Chemoradiation in Stage IIIB Cancer of the Uterine Cervix: A Review of the Zimbabwean Experience

“… 4 LTFU in cancer care remains a challenge, as is the case in most lower- and middle-income countries. 7 One third of our participants could not be accounted for after the first visit. Contributing factors to high LTFU could not be established in this study, but unreported deaths, low socioeconomic status, low education levels, lack of adequate patient education, and higher levels of alternative medicine use are among the reasons cited in other sources.…”