“There is nothing that can prevent me from supporting her:” Men’s perspectives on their involvement and support of women’s use of topical therapy for cervical precancer treatment in Kenya

Abstract

PurposeCervical cancer disproportionately impacts women in low- and middle-income countries (LMICs). The World Health Organization’s (WHO) 90/70/90 strategy aims to eliminate cervical cancer by 2030 by increasing HPV vaccination coverage to 90%, screening 70% of eligible women, and effectively treating 90% of those with abnormal results by 2030, potentially preventing 62 million deaths in LMICs. LMICs, however, struggle with limited access to cervical precancer treatment, in part due to a lack of trained professionals and weak health systems. Effective non-surgical, self-administered, which have demonstrated efficacy in high-income countries, could bridge the treatment gap in LMICs and may be more scalable and cost-effective than provider-administered therapies. To inform feasibility studies in LMICs, data are needed on the role of male partners in influencing the acceptability and uptake of self-administered topical therapies, including their support of recommended abstinence and contraception guidelines associated with these therapies.MethodsBetween November 2022 and April 2023, we conducted five focus group discussions (FGDs) with men aged 25 to 65 years in Kenya to explore their perspective and perceived support regarding their female partners using topical self-administered therapies for cervical precancer treatment. The FGDs were moderated by local qualitative research assistants and conducted in local languages, transcribed, coded, and analyzed using qualitative description.ResultsMale participants in the FGDs strongly expressed acceptance and willingness to support their wives or partners in using topical therapies for cervical precancer treatment, if available. Reported supportive behavior included permitting the use of the therapies and support of maintaining abstinence during the recommended times. Additionally, participants desired male involvement in clinic and community-based education about topical therapies to facilitate widespread support.ConclusionThe use of self-administered topical therapies for cervical precancer treatment, if supported by efficacy studies in LMICs, may support achieving the WHO’s 2030 goal of 90% treatment access. We find that with adequate education, men express overwhelming support of their female partner’s use of topical therapies, including adherence to abstinence and contraception guidelines.

Men’s perceptions and perceived acceptability of their female partner’s use of self-administered intravaginal therapies for treatment of cervical precancer in Kenya

“…In the cervical precancer treatment literature, studies have found that while guidelines recommend abstinence for 4-6 weeks after ablation or excisional procedures, 32 some women in Malawi, 39 Kenya, 40 and Peru 41 reported inability to maintain abstinence for the recommended period due to lack of male partner support. 38 Further studies, including pilot trials of self-administered topical therapies in LMICs, can investigate men's actual support of adherence recommendation, in contrast to the perceived support reported in our study. The shorter abstinence duration associated with topical therapies compared to conventional surgical precancer treatments may be an advantage for their use in these settings.…”

Perceived acceptability of self-administered topical therapy for cervical precancer treatment among women undergoing cervical cancer screening in Kenya

“…41 Kisumu County is among the highest HIV burden regions in Kenya, with a 17.5% prevalence rate, compared to a national average prevalence of 4.9% in 2018. 42 Cervical cancer is the leading cause of cancer death for women in Kenya, with an estimated 3,200 deaths in 2020. 11…”

“ARVs is for HIV and cream is for HPV or precancer:” Women’s Perceptions and Perceived Acceptability of Self-Administered Topical Therapies for Cervical Precancer Treatment: A Qualitative Study from Kenya

“…This study is part of a larger project exploring the acceptability of topical therapies for the treatment of HPV and cervical precancer, which included in-depth interviews and focus groups with women undergoing cervical cancer screening and male partners in Kenya, in eastern Africa. Results of a qualitative analysis of men's perspectives have been reported elsewhere [23]. This current analysis encompasses focus group discussions with female participants.…”

“…We used purposive sampling and a stepped recruitment process to recruit FGD participants, as described previously [23] [29]. Women age 25 to 65 years undergoing cervical cancer screening or precancer treatment in public clinics in western Kenya between November 2022 and April 2023 were included in the study.…”

“…While no topical therapies are currently approved for the treatment of cervical precancer, the use of self-or provider-administered topical therapies for cervical precancer treatment is an area of active investigation [16], [17], [18], [19], [20], [21], [22], [23]. The feasibility, acceptability, and efficacy of topical therapies for cervical precancer treatment has been demonstrated by several studies in highincome countries, including randomized trials [16], [17], [20], [24].…”