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

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 year...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2021-01, Vol.152 (1), p.60-67
Main Authors: Mungo, Chemtai, Ibrahim, Saduma, Bukusi, Elizabeth A., Truong, Hong‐Ha M., Cohen, Craig R., Huchko, Megan
Format: Article
Language:English
Subjects:
Adult
Aged
Cervical cancer prevention
Cervical cancer screening
Cervical Intraepithelial Neoplasia - diagnosis
Cervical Intraepithelial Neoplasia - prevention & control
Cohort Studies
Community Health Services - organization & administration
Female
Global women's health
HPV screening
Humans
Kenya
Low‐income countries
Mass Screening
Middle Aged
Papillomaviridae - isolation & purification
Papillomavirus Infections - diagnosis
Papillomavirus Infections - prevention & control
Papillomavirus Vaccines
Prospective Studies
Referral and Consultation
See‐and-treat
Surveys and Questionnaires
Uterine Cervical Neoplasms - diagnosis
Uterine Cervical Neoplasms - prevention & control
Vaccination
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Summary: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. Cryotherapy after a community‐based HPV self‐testing program was highly acceptable, but treatment access was low, highlighting the need for strategies to strengthen linkage to treatment.
ISSN:0020-7292
1879-3479
DOI:10.1002/ijgo.13171