HPV‐based cervical cancer screening in low‐resource settings: Maximizing the efficiency of community‐based strategies in rural Kenya

Abstract

Objective: To characterize the efficiency of screening through high-volume community health campaigns (CHCs) by comparing the costs and population reach and identify factors associated with gains in efficiency. Access to effective cervical cancer screening remains limited in low-resource settings, especially in rural areas. Periodic CHCs are a novel method of offering screening for HPV at lower costs and higher population coverage than health facilities. Methods:A micro-costing study was conducted within a cervical cancer screening trial to measure efficiency (cost per woman screened) and population uptake of HPVbased screening offered through CHCs in Migori County, Kenya between January and September 2016. Regression analysis assessed relationships between population size and efficiency. Structured observations and qualitative interviews identified implementation factors that affected efficiency in individual campaigns.Results: Communities screening through CHCs had costs per woman screened ranging from US $22.06 to $30.21. Efficiency was directly correlated to overall numbers of women screened, but not to proportion of population screened. Modifiable factors that acted as context-specific facilitators and barriers with a potential impact on efficiency were identified. Conclusion:There was substantial variation in efficiency among CHCs. Cultural factors, health beliefs, and poor coordination among implementation partners as potential key barriers to screening uptake were identified. K E Y W O R D S

Performance of HPV testing, Pap smear and VIA in women attending cervical cancer screening in Kilimanjaro region, Northern Tanzania: a cross-sectional study nested in a cohort

“…Consequently, they tend to present to the hospital with advanced disease with poor prognosis. 22 In this study, the sensitivity and specificity of HPVtesting for detection of CIN2+were 62.5% and 59.3%, respectively. The sensitivity is relatively lower compared with studies done in urban settings in Kenya, Burkina Faso and South Africa reporting sensitivity rates of 83.6% and 93.3%, respectively.…”

“…Importantly, inclusion of women attending screening at KCMC and the fact that the service is offered for free may have attracted women with a high risk of having CIN2+. Consequently, they tend to present to the hospital with advanced disease with poor prognosis 22…”

Cost‐effectiveness analysis of alternative screening strategies for the detection of cervical cancer among women in rural areas of Western Kenya

“…In multiple studies from LMICs, the cost-effectiveness of HPVbased screening, [20][21][22][23][24] the acceptance of HPV self-sampling and its potential for easier screening access and increased screening coverage [25][26][27][28] have been documented. A number of triage tests for LMICs are under investigation, including VIA, genotyping, digitally enhanced VIA, automated visual inspection, and biomarkers.…”

Cervical cancer knowledge, awareness and related health behaviours amongst women of reproductive age in Kiambu County, Kenya: a cross-sectional study

“…The high burden of cervical cancer in LMICs is linked to a lack of utilisation of screening, with the proportion screened ranging between 3% and 14% (Bruni et al, 2021 ; Huchko et al, 2020 ). The latter is true in Kenya, where despite the existence of preventive programmes, cervical cancer screening rates have remained relatively low with screening facilities underutilised (Ministry of Public Health and Sanitation & Ministry of Medical Services, 2012 ; Vermandere et al, 2016 ).…”