Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy

Obol, James Henry; Harrison, Reema; Lin, Sophia; Obwolo, Mark James; Richmond, Robyn

doi:10.1186/s12889-020-09482-y

Cited by 5 publications

(2 citation statements)

References 57 publications

(68 reference statements)

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“…When discussing both cervical cancer diagnosis and HPV, stakeholders highlighted fear as a predominant emotion [ 14 , 25 , 26 , 41 ]. The fear of cervical cancer was so great that some women expressed reluctance to seek care, saying they would prefer “not to know” as they believed cervical cancer would inevitably lead to death [ 38 , 41 , 42 , 43 ] evident in a female participant in a focus group discussion in Uganda expressing: “ I fear going for a check-up since after getting the diagnosis of cervical cancer, I will then know that I am dying ” [ 38 ]. This was also supported in South Africa where women expressed that they would rather not “face” the possibility of a cervical cancer diagnosis [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

2021

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Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders’ understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke’s methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.

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Section: Resultsmentioning

confidence: 99%

Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

2021

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“…56.3% of patients visit a private hospital for histology, and costs would be out of pocket. 18 Both histology services and labs to monitor response were difficult to access throughout COVID. While UCI does cover the costs of cancer care, if there were shortages of PPE, these costs were transferred to the patient, as mentioned by KI.…”

Section: Discussionmentioning

confidence: 99%

The double burden of COVID-19 and cancer at the Uganda Cancer Institute

Anumolu,

Bojang,

Mulamira

et al. 2024

Journal of Global Health Reports

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Background Cancer is increasingly diagnosed in Africa, with more than one million new diagnoses annually. In Uganda, the Uganda Cancer Institute (UCI) is the primary cancer care facility, with patients travelling long distances to this facility to receive care. During the COVID-19 pandemic, cancer care was disrupted on several levels, including prevention, screening, diagnosis, treatment, and follow-up. National lockdowns impeded patient access to UCI and halted cancer screening. Methods This study used qualitative interviews to obtain primary data from professionals working at UCI. Interviews were conducted from April 2022 to January 2023. KI (key informants) ’s were purposively selected, identified by colleagues at UCI and recruited through email and WhatsApp messaging. Verbal consent was obtained. Thirty to 60-minute open-ended interviews conducted virtually and in person were audio recorded and transcribed verbatim. Transcripts were coded via MAXQDA software and analyzed to identify themes. Results Thematic analysis revealed three major challenges to cancer care during COVID-19. First, UCI experienced logistical barriers such as travel restrictions, staff shortages, and insufficient protective gear. Second, staff adapted to the inflexible national lockdown policy for chronic health care with modifications to treatment regimens. Third, KI reported a significant mental health burden and reflected on how care should be improved. Conclusions As colleagues got infected, UCI staff organized their training, discussed treatment plans with colleagues, and continued to care for patients at personal risk. Resilience characterized UCI’s response to COVID-19. They adapted treatment protocols to their setting, many of which remain the standard of care today. At the same time, there is a need for capacity building tailored to the Ugandan context to provide cancer care effectively in case of another pandemic.

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“By the time they run into the hospital, their life is already at stake”: a qualitative study of healthcare professional perceptions on priorities for cervical cancer policy in Uganda

Anumolu

Lechleitner

Patel

et al. 2022

Journal of Global Health Reports

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Background Cervical cancer (CxCa) incidence in Uganda is three times the global average and a leading cause of mortality for women. While there is funding and infrastructure to support HIV control in Uganda, these are not in place for CxCa prevention and control. This study was conducted to explore the knowledge and perceptions of HIV professionals in Uganda to identify perceived barriers and facilitators to CxCa screening and treatment among women living with HIV (WLHIV) as a basis to guide and inform policies and programs for CxCa prevention and control, including service integration. Methods This study used qualitative interviews to obtain primary data from professionals working in the HIV field in Uganda conducted from September 2020 to January 2022. Participants were identified through purposive and snowball sampling and consulted with colleagues at local service and academic agencies in Kampala. Both written and verbal informed consent was obtained. Hour-long interviews were conducted virtually and in person and recorded. Interviews consisted of open-ended questions exploring perspectives on, knowledge about, and practices surrounding HPV and CxCa among WLHIV in Uganda. Transcripts were analyzed and coded via MAXQDA software to identify facilitators and barriers to HPV vaccination, CxCa screening and treatment. Results Fifty key informant (KI) interviews were conducted. Analysis revealed two themes regarding priorities for cervical cancer policy in Uganda after KIs reflected on improving barriers to CxCa care. These were: (1) decentralization of care through integration of services and (2) leadership on a national level by increasing funding and organizing advocacy initiatives. Practical recommendations identified by KI that derived from these themes included leveraging community institutions and mass media campaigns to target misconceptions surrounding screening, making CxCa screening opt-out and integrated with HIV care, strengthening a centralized database, organizing mass roll-out of self-testing, and organizing training of healthcare workers. Conclusions Key informants call for solutions that address individual, community, and national barriers of cervical cancer care and emphasize the need for a strong national cervical cancer policy to coordinate currently fragmented services and the political will to adequately fund these.

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Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy

Cited by 5 publications

References 57 publications

Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

The double burden of COVID-19 and cancer at the Uganda Cancer Institute

“By the time they run into the hospital, their life is already at stake”: a qualitative study of healthcare professional perceptions on priorities for cervical cancer policy in Uganda

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