scholarly journals A public health approach to cervical cancer screening in Africa through community‐based self‐administered HPV testing and mobile treatment provision

2020 ◽  
Vol 9 (22) ◽  
pp. 8701-8712
Author(s):  
Miriam Nakalembe ◽  
Philippa Makanga ◽  
Andrew Kambugu ◽  
Miriam Laker‐Oketta ◽  
Megan J. Huchko ◽  
...  
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Public Health Approach ◽  
Hpv Testing ◽  
Community Based ◽  
Treatment Provision

scholarly journals A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision

2019 ◽  
Author(s):  
Miriam Nakalembe ◽  
Philippa Makanga ◽  
Andrew Kambugu ◽  
Miriam Laker-Oketta ◽  
Megan Huchko ◽  
...  
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cancer Control ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Public Health Approach ◽  
Community Based ◽  
Treatment Unit

Background: Sub-Saharan Africa bears the world's highest incidence of cervical cancer. To address the lack of widespread screening and treatment that contributes to this burden, the World Health Organization (WHO) recommends that low-resource countries adopt simplified protocols for screening directly coupled with treatment. The WHO recommendations present an opportunity -- akin to what has been done for HIV care in Africa -- for a true public health approach to cervical cancer control in resource-poor settings. We evaluated the feasibility of such a public health approach to cervical cancer that features community-based self-administered HPV screening and mobile treatment provision. Methods: In two rural districts of western Uganda, we first trained Village Health Team members (VHTs, also known as Community Health Workers) in a one-day session in the fundamental aspects of cervical cancer and its prevention. We then provided guidance to the VHTs to mobilize adult women from different communities within the district to attend a one-day HPV screening fair at a central location in their respective community. On the day of the fair, the study team and VHTs provided educational talks and instructions for self-collection of a vaginal sample. The samples were subsequently tested for high risk HPV (hrHPV) E6/E7 mRNA using the APTIMA® platform. Women who tested positive for hrHPV were re-contacted and referred for treatment with cryotherapy at a mobile treatment unit in their community. Visual assessment with acetic acid was used to guide suitability for cryotherapy in the mobile treatment unit versus further referral to a larger facility for a loop electrosurgical excision procedure (LEEP). Results: Between March and November 2016, 2,142 women attended a health fair in one of 24 communities in rural Western Uganda and expressed interest in being screened for cervical cancer; 1902 were eligible for cervical cancer screening of which 1,892 (99.5%) provided a self-collected vaginal sample. The median age of those screened was 34 years (IQR: 28-40), HIV prevalence was 11%, and most (95%) had not been previously screened. Almost all women stated that they would perform the self-collection again and recommend it to a friend. Prevalence of any hrHPV mRNA was 21% (HPV-16, 6%; HPV-18/45, 1.9%). Among the 393 women with detectable hrHPV mRNA, 89% had their results transmitted to them, of whom 86% returned to the mobile treatment unit. At the mobile treatment, 85% of women underwent ablative therapy, with the remainder deferred either because of pregnancy (9.0%), need for LEEP (2.6%) or other reasons (3.3%). Conclusion: A public health approach to cervical cancer screening, featuring community-based self-administered HPV testing and mobile treatment, was feasible and readily accepted by community women. The process is termed a "public health approach" because -- as is the case for HIV care in the region -- it explicitly concedes perfection at the individual level in deference to reaching a larger fraction of the population. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low resource settings. If resources for cancer control remain limited in sub-Saharan Africa, this public approach may offer one of the most efficient solutions for stemming the incessant tide of cervical cancer in the region.

A pilot study of community-based self-sampling for HPV testing among non-attenders of cervical cancer screening programs in El Salvador

2017 ◽  
Vol 138 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Bari Laskow ◽  
Ruben Figueroa ◽  
Karla M. Alfaro ◽  
Isabel C. Scarinci ◽  
Elizabeth Conlisk ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Pilot Study ◽  
El Salvador ◽  
Cervical Cancer Screening ◽  
Hpv Testing ◽  
Community Based ◽  
Screening Programs

scholarly journals Prevention of cervical cancer through two HPV-based screen-and-treat implementation models in Malawi: protocol for a cluster randomized feasibility trial

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jennifer H. Tang ◽  
Jennifer S. Smith ◽  
Shannon McGue ◽  
Luis Gadama ◽  
Victor Mwapasa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Family Planning ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
Budget Impact ◽  
Feasibility Trial ◽  
Hpv Testing ◽  
Community Based ◽  
Cluster Randomized

Abstract Background Cervical cancer is the leading cause of cancer incidence and mortality among Malawian women, despite being a largely preventable disease. Implementing a cervical cancer screening and preventive treatment (CCSPT) program that utilizes rapid human papillomavirus (HPV) testing on self-collected cervicovaginal samples for screening and thermal ablation for treatment may achieve greater coverage than current programs that use visual inspection with acetic acid (VIA) for screening and cryotherapy for treatment. Furthermore, self-sampling creates the opportunity for community-based screening to increase uptake in populations with low screening rates. Malawi’s public health system utilizes regularly scheduled outreach and village-based clinics to provide routine health services like family planning. Cancer screening is not yet included in these community services. Incorporating self-sampled HPV testing into national policy could address cervical cancer screening barriers in Malawi, though at present the effectiveness, acceptability, appropriateness, feasibility, and cost-effectiveness still need to be demonstrated. Methods We designed a cluster randomized feasibility trial to determine the effectiveness, acceptability, appropriateness, feasibility, and budget impact of two models for integrating a HPV-based CCSPT program into family planning (FP) services in Malawi: model 1 involves only clinic-based self-sampled HPV testing, whereas model 2 includes both clinic-based and community-based self-sampled HPV testing. Our algorithm involves self-collection of samples for HPV GeneXpert® testing, visual inspection with acetic acid for HPV-positive women to determine ablative treatment eligibility, and same-day thermal ablation for treatment-eligible women. Interventions will be implemented at 14 selected facilities. Our primary outcome will be the uptake of cervical cancer screening and family planning services during the 18 months of implementation, which will be measured through an Endline Household Survey. We will also conduct mixed methods assessments to understand the acceptability, appropriateness, and feasibility of the interventions, and a cost analysis to assess budget impact. Discussion Our trial will provide in-depth information on the implementation of clinic-only and clinic-and-community models for integrating self-sampled HPV testing CCSPT with FP services in Malawi. Findings will provide valuable insight for policymakers and implementers in Malawi and other resource-limited settings with high cervical cancer burden. Trial registration ClinicalTrials.gov identifier: NCT04286243. Registered on February 26, 2020.

scholarly journals Effectiveness of a two-stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low-income setting

2014 ◽  
Vol 136 (6) ◽  
pp. E743-E750 ◽  
Author(s):  
Pierre-Marie Tebeu ◽  
Joël Fokom-Domgue ◽  
Victoria Crofts ◽  
Emmanuel Flahaut ◽  
Rosa Catarino ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Acetic Acid ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Low Income ◽  
Visual Inspection ◽  
Hpv Testing ◽  
Two Stage ◽  
Low Income Setting

scholarly journals “They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

2018 ◽  
Vol 5 ◽  
pp. 233339361878363 ◽  
Author(s):  
Brianne Wood ◽  
Virginia L. Russell ◽  
Ziad El-Khatib ◽  
Susan McFaul ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Cervical Cancer Screening ◽  
Cervical Screening ◽  
Hpv Testing ◽  
Shared Decision ◽  
Care Providers

In this study, we examine from multiple perspectives, women’s shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a “decision,” which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.

scholarly journals Vietnamese American women’s beliefs and perceptions on cervical cancer, cervical cancer screening, and cancer prevention vaccines: A community-based participatory study

2017 ◽  
Vol 2 (4) ◽  
pp. 133-142 ◽  
Author(s):  
Connie Kim Yen Nguyen-Truong ◽  
Kim Quy Vo Nguyen ◽  
Thai Hien Nguyen ◽  
Tuong Vy Le ◽  
Anthony My Truong ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cancer Prevention ◽  
Cervical Cancer Screening ◽  
Community Based ◽  
Vietnamese American

scholarly journals Uptake and acceptability of human papillomavirus self-sampling in rural and remote Aboriginal communities: Evaluation of a nurse-led community engagement model

2020 ◽  
Author(s):  
Tegan Dutton ◽  
Jo Marjoram ◽  
Shellie Burgess ◽  
Laurinne Campbell ◽  
Anne Vail ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Clinical Outcomes ◽  
Cervical Cancer Screening ◽  
Rural And Remote ◽  
Service Model ◽  
Community Based ◽  
Aboriginal Women ◽  
Never Screened

Abstract Background: Aboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants.Methods: Aboriginal women aged 25-69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model.Results: In total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n=46) were never-screened and one-third (n=69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women tested positive for a high risk type other than HPV 16/18 (HPV other), of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (>92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them.Conclusions: A community-based service model that respects Aboriginal Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services.

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