Patient factors affecting successful linkage to treatment in a cervical cancer prevention program in Kenya: A prospective cohort study

Objective To understand the knowledge, preferences, and barriers for self‐collected cervical cancer screening (SC‐CCS) and follow‐up care at the individual and health system level to inform the implementation of community‐based SC‐CCS. Methods Surveys and focus group discussions (FGDs) with women and FGDs with healthcare providers were conducted in Uganda. Survey data were analyzed using frequencies and FGD data were analyzed using thematic content analysis. Data were triangulated between methods. Results Sixty‐four women were surveyed and 58 participated in FGDs. Facilitators to screening access included decentralization, convenience, privacy, confidentiality, knowledge, and education. Barriers to accessing screening included lack of transportation and knowledge, long wait times, difficulty accessing health care, and lack of trust in the health system. Additional implementation challenges included insufficiently trained human resources and lack of infrastructure. Conclusion Integrating SC‐CCS within rural health systems in low‐resource settings has been under‐evaluated. Community‐based SC‐CSS could prevent high cervical cancer‐related mortalities while working within the human and financial resource limitations of rural health systems. SC‐CCS is acceptable to women and healthcare providers. By addressing rural women's preferences and barriers to care, decision‐makers can build health systems that provide community‐centered care close to women's homes across the care continuum.

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“…At the clinic 16 (25) Didn't ask 1 (2) No response 4 (6) Preferred location for treatment if needed Clinic 46 (72)…”

Section: Discussionmentioning

confidence: 99%

Acceptability and preferences for self‐collected screening for cervical cancer within health systems in rural Uganda: A mixed‐methods approach

Rawat

Sanders

Mithani

et al. 2020

Intl J Gynecology & Obste

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“…The trial demonstrated significantly higher levels of population-based uptake and adherence for self-collection HPV testing. Huchko et al, 2017 [ 46 ]; Oketch et al, 2019 [ 80 ]; Page et al, 2019 [ 81 ] Kenya Women Age: 25–65 years CRCT 4944 Intervention: Cervical cancer screening was carried out using HPV testing of self-collected specimens through community health campaigns Device- careHPV Control: HPV testing at health facilities Uptake of HPV testing Screening uptake was greater in communities assigned to community health campaigns compared to those assigned to receive screening through health facilities (60.0% vs 37.0%, P <0.001). Modibbo et al, 2017 [ 48 ] Nigeria Women residing in an urban area Age: 30–65 years RCT 400 (Intervention group: 200; Control group: 200) Intervention: HPV self-sampling kit directly mailed to the home address with a prepaid return envelope (or could drop off the completed kit at designated collection points in the community or the hospital).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of randomized control trials of HPV self-collection studies among women in sub-Saharan Africa using the RE-AIM framework

Nwaozuru

Obiezu-Umeh

Obi‐Jeff³

et al. 2021

Implement Sci Commun

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Introduction Self-collection of samples for HPV testing may increase women’s access to cervical cancer screening in low- and middle-income settings. However, implementation remains poor in many regions. The purpose of this systematic review was to examine implementation data from randomized controlled trials evaluating human papillomavirus (HPV) self-collection testing among women in sub-Saharan Africa using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. Methods We searched four electronic databases (PubMed, CINAHL, Web of Science, and Global Health) for pragmatic randomized controlled trials that promote HPV self-collection among women in sub-Saharan Africa. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist. Two researchers independently extracted information from each article using a RE-AIM data extraction tool. The reporting of RE-AIM dimensions was summarized and synthesized across included interventions. Results We identified 2008 citations, and eight studies were included. These reported on five unique interventions. The five interventions were conducted in five countries: Cameroon, Ethiopia, Kenya, Nigeria, and Uganda. Intervention reach (80%) was the most commonly reported RE-AIM dimension, followed by adoption (56%), efficacy/effectiveness (52%), implementation (47%), and maintenance (0%). All the interventions described increased uptake of HPV testing among study participants (effectiveness). However, the majority of the studies focused on reporting internal validity indicators such as inclusion criteria (100%) and exclusion criteria (100%), and few reported on external validity indicators such as participation rate (40%), intervention cost (40%), staff selection (20%), and cost of maintenance (0%). Conclusions Our review highlights the under-reporting of external validity indicators such as participation rate, intervention, and maintenance costs in studies of self-collection for HPV testing among women in SSA. Future research should focus on including factors that highlight internal validity factors and external validity factors to develop a greater understanding of ways to increase not only reach but also implementation and long-term maintenance of these interventions. Such data may advance the translation of HPV interventions into practice and reduce health disparities in SSA. Findings highlight the need for innovative tools such as participatory learning approaches or open challenges to expand knowledge and assessment of external validity indicators to ultimately increase the uptake of HPV testing among women in SSA.

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“…The flow diagram for the patient component of this study has been published elsewhere [ 7 ] and is included here as a supporting file ( S1 Fig ). Demographic information on the participants can also be found in a supporting file ( S1 Table ).…”

Section: Resultsmentioning

confidence: 99%

“…stigma) as contributing factors [ 5 , 6 ]. We have previously reported on patient factors associated with whether women who screened hrHPV+ presented for treatment [ 7 ]. The aim of the current research was to identify health systems-level barriers to treatment, including both structural and clinic-based barriers.…”

Section: Introductionmentioning

confidence: 99%

Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies

et al. 2020

Self Cite

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Objective To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya. Methods In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018–2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively. Results Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women’s decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment. Conclusion Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.

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Patient factors affecting successful linkage to treatment in a cervical cancer prevention program in Kenya: A prospective cohort study

Cited by 9 publications

References 9 publications

Acceptability and preferences for self‐collected screening for cervical cancer within health systems in rural Uganda: A mixed‐methods approach

Acceptability and preferences for self‐collected screening for cervical cancer within health systems in rural Uganda: A mixed‐methods approach

A systematic review of randomized control trials of HPV self-collection studies among women in sub-Saharan Africa using the RE-AIM framework

Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies

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