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

Abstract

Objective To evaluate access to treatment after community‐based HPV testing as testing within screen‐and‐treat programs has the potential to lower mortality from cervical cancer in low‐resource settings. Methods A prospective cohort study was conducted in western Kenya in 2018. Women aged 25–65 years underwent HPV self‐testing. HPV‐positive women were referred for cryotherapy. Participant data were obtained from questionnaires during screening and treatment. The proportion successfully accessing treatment and variables associated with successful treatment was determined. Results Of the 750 women included, 140 (18.6%) tested positive for HPV. Of them, 135 were notified of their results, of whom 77 (59.2%) sought treatment and 73 (52.1%) received cryotherapy. Women who received treatment had a shorter time from screening to result notification (median 92 days, interquartile range [IQR] 84–104) compared to those who did not (97 days, IQR 89–106; P=0.061). In adjusted analyses, women with a history of cervical cancer screening (odds ratio [OR] 11, 95% confidence interval [CI] 1.42–85.20) and those electing result notification through a home visit (OR 4, 95% CI 1.23–14.17) were significantly more likely to acquire treatment at follow‐up. Conclusion Linkage to treatment after community‐based HPV screening in this population was low, highlighting the need for strategies aimed at strengthening treatment linkage in similar settings.

Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening Among HIV-Positive Women in Western Kenya

“… 9 In the 2018 global call for cervical cancer elimination, the WHO recommends HPV testing as a primary screening method, 10 listing it as a Best Buy for noncommunicable disease prevention. 11 HPV screening, although increasingly feasible through self-sampling, 12 is limited by poor specificity, as it cannot separate transient from persistent infections, leading to overtreatment in a screen-and-treat approach. 9 , 13 This lack of specificity highlights a need for adjunct screening or triage methods that increase specificity within the screen-and-treat approach without a substantial decrease in sensitivity or increase in cost or infrastructure requirements.…”

Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya

“…All women who tested positive for HPV, regardless of HIV status, were referred to one of three sub-county hospitals within a ten-kilometer radius for cryotherapy treatment, which was provided at no cost. Results of this follow-up strategy and treatment uptake have been previously published elsewhere [ 28 ].…”

“…All analyses were performed using Stata/MP version 17 (StataCorp). As previously mentioned, the analysis for linkage-to-treatment for women who tested positive for HPV is reported elsewhere [ 28 ].…”

Cervical cancer prevention: Human papillomavirus testing as primary screening

“…Strategies to implement HPV testing as primary screening include community‐based interventions to increase coverage of screening, especially in rural areas where access to health facilities may be limited. Community health campaigns and home visits by community health workers in particular have been shown to increase screening uptake, especially when women are given the option to self‐collect samples for HPV testing 18‐24 . A study in Uganda found over 99% compliance among women who were offered HPV tests by self‐collection, whereas VIA at a health clinic reached only approximately 48% compliance, given that self‐collection allowed women to provide samples immediately upon recruitment by health workers at home or work visits 23 .…”

“…Among common HPV DNA test types (eg, careHPV, Hybrid Capture 2, Aptima, and Xpert DNA), processing usually occurs in batches and can take several hours after being transferred from the community screening site to the laboratory 39 . Treatment acquisition among HPV‐positive women thus remains inadequate; the proportion of screen‐positive women accessing care ranges from 32% to 60% among several community‐based cervical cancer screening interventions 18‐23 . In 1 study, implementing mobile treatment sites resulted in treatment rates as high as 86% among women notified, which involved stationing convenient treatment units within the community and moving from community to community to provide treatment for intervals of several days 20 .…”