Women’s experiences in a community-based screen-and-treat cervical cancer prevention program in rural Malawi: a qualitative study

Abstract Background Malawi has the world’s highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country’s cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program. Methods We implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12. Results Between July – August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community. Conclusions Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.

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Barriers to cervical cancer screening among rural women in eastern China: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-026413 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026413 ◽

Cited By ~ 2

Author(s):

Huan Yang ◽

Shun-Ping Li ◽

Qing Chen ◽

Christopher Morgan

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Qualitative Study ◽

Cervical Cancer Screening ◽

Rural Women ◽

Eastern China ◽

Healthcare Providers ◽

Knowledge Gaps ◽

Policy And Practice ◽

Incidence And Mortality

ObjectivesTo explore barriers to free cervical cancer screening among rural women in China from the perspective of women, healthcare providers and women’s husbands to inform intervention planning.DesignA qualitative study framed around potential policy and practice options, drawing on the concepts of descriptive phenomenology and implementation research.SettingThis study was carried out at township level within two counties in Jining Prefecture of eastern China.Participants and data collectionSemi-structured in-depth interviews with 21 women and five healthcare providers, focus group discussions with nine healthcare providers and key informant interviews with four husbands of women eligible for screening.ResultsThematic analysis generated five major themes: (1) gaps in knowledge of cervical cancer and health awareness, (2) fear of cancer and screening outcomes, (3) cultural barriers including reticence for intimate examinations, (4) influence of close contacts on screening decisions and (5) inconvenience. These demonstrate key knowledge gaps challenging current community health education. Important barriers, including fear of treatment cost and the time needed for screening, were also raised.ConclusionOur study details important barriers to cervical cancer screening relating to knowledge gaps, attitudes of fear or embarrassment and the role of contacts and service models. These provide data for policy and planning to improve the screening that will decrease the incidence and mortality rates of cervical cancer in China.

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

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12204 ◽

2017 ◽

Vol 138 (2) ◽

pp. 194-200 ◽

Cited By ~ 4

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

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

10.21203/rs.2.23841/v2 ◽

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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Impact of human papillomavirus (HPV) self-collection on subsequent cervical cancer screening completion among under-screened US women: MyBodyMyTest-3 protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-019-3959-2 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Lisa P. Spees ◽

Andrea C. Des Marais ◽

Stephanie B. Wheeler ◽

Michael G. Hudgens ◽

Sarah Doughty ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cancer Incidence ◽

Perceived Risk ◽

Pap Test ◽

Hpv Testing ◽

Cervical Cancer Incidence ◽

Incidence And Mortality

Abstract Background Screening substantially reduces cervical cancer incidence and mortality. More than half of invasive cervical cancers are attributable to infrequent screening or not screening at all. The current study, My Body My Test (MBMT), evaluates the impact of mailed kits for self-collection of samples for human papillomavirus (HPV) testing on completion of cervical cancer screening in low-income, North Carolina women overdue for cervical cancer screening. Methods/design The study will enroll at least 510 US women aged 25–64 years who report no Pap test in the last 4 years and no HPV test in the last 6 years. We will randomize participants to an intervention or control arm. The intervention arm will receive kits to self-collect a sample at home and mail it for HPV testing. In both the intervention and control arms, participants will receive assistance in scheduling an appointment for screening in clinic. Study staff will deliver HPV self-collection results by phone and assist in scheduling participants for screening in clinic. The primary outcome is completion of cervical cancer screening. Specifically, completion of screening will be defined as screening in clinic or receipt of negative HPV self-collection results. Women with HPV-negative self-collection results will be considered screening-complete. All other participants will be considered screening-complete if they obtain co-testing or Pap test screening at a study-affiliated institution or other clinic. We will assess whether the self-collection intervention influences participants’ perceived risk of cervical cancer and whether perceived risk mediates the relationship between HPV self-collection results and subsequent screening in clinic. We also will estimate the incremental cost per woman screened of offering at-home HPV self-collection kits with scheduling assistance as compared to offering scheduling assistance alone. Discussion If mailed self-collection of samples for HPV testing is an effective strategy for increasing cervical cancer screening among women overdue for screening, this method has the potential to reduce cervical cancer incidence and mortality in medically underserved women at higher risk of developing cervical cancer. Trial registration ClinicalTrials.gov NCT02651883, Registered on 11 January 2016.

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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing

Viruses ◽

10.3390/v10120729 ◽

2018 ◽

Vol 10 (12) ◽

pp. 729 ◽

Cited By ~ 42

Author(s):

Andreas Chrysostomou ◽

Dora Stylianou ◽

Anastasia Constantinidou ◽

Leondios Kostrikis

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Hpv Vaccination ◽

Screening Method ◽

Population Based ◽

Screening Tests ◽

Screening Methods ◽

Hpv Testing ◽

Screening Programs

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.

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Facilitators and Barriers to Cervical Cancer Screening in Migori County, Kenya

Journal of Global Oncology ◽

10.1200/jgo.2016.003970 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 82s-82s

Author(s):

Holly Nishimura ◽

Nelly Yatich ◽

Megan Huchko

Keyword(s):

Cervical Cancer ◽

Focus Group ◽

Cancer Prevention ◽

Cervical Cancer Prevention ◽

Sub Saharan Africa ◽

Hpv Testing ◽

Community Members ◽

Screening Programs ◽

Barriers To Screening ◽

Incidence And Mortality

Abstract 77 Background: Cervical cancer, a disease that is largely preventable through organized screening programs, still impacts over 500,000 women every year. Sub-Saharan Africa has the highest global incidence and mortality, largely due to lack of screening coverage. Low-cost and simple-to-implement screening technologies can potentially impact the rates of cervical cancer, if they are acceptable and scalable. As part of a trial to evaluate implementation strategies for cervical cancer prevention in western Kenya, we sought to identify the barriers and facilitators of screening, as well as opinions on a strategy employing self-collection of specimens for human papillomavirus (HPV) testing. Methods: Providers and female community members were recruited for focus groups using purposive sampling. Two focus group discussions (FGDs) with community members (n=24) and one FGD with providers (n=12) and key stakeholders were held in Migori County, Kenya, using structured guides to assess and current cervical cancer knowledge, screening practices, barriers to screening and potential strategies to facilitate screening access and uptake, including self-collected HPV testing. Results: Participants in both groups assessed the education around HPV, cervical cancer, and screening as very low in the community, and identified this lack of education as the main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that lack of knowledge and discomfort among providers were significant barriers. Having undergone screening themselves or talking to someone with experience increased willingness to screen. Providers reported workload and lack of supplies and trained staff as significant barriers. Most participants in both FGDs felt that self-collection would help address barriers. Women expressed willingness to self-collect if given adequate instructions and if knowledgeable counselors were present to discuss results. Conclusion: Cervical cancer prevention strategies employing effective educational components and self-collected HPV testing could address many of the identified barriers to screening. Key findings from analysis of the focus group transcripts will be used to inform the implementation of community health campaigns. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

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

Cancer Medicine ◽

10.1002/cam4.3468 ◽

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

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Knowledge, Attitude, Practice and Barriers regarding cervical cancer and its screening using Pap smear, in rural women of Ba, Lautoka and Nadi, Fiji.

Pacific Journal of Reproductive Health ◽

10.18313/pjrh.2015.913 ◽

2015 ◽

Vol 1 (2) ◽

pp. 50 ◽

Cited By ~ 1

Author(s):

Swaran Naidu ◽

Gillian Heller ◽

George Qalomaiwasa ◽

Sheetal Naidu ◽

Rajat Gyaneshwar

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Rural Women ◽

Pap Smear ◽

Age Groups ◽

Pap Test ◽

High Rate ◽

Pap Smears ◽

Screening Programs ◽

Lack Of Knowledge

Background: Fiji has a high rate of cervical cancer, which is the second most common cause of cancer deaths in women in the country. Less than 10% of women are screened for cervical cancer in Fiji.In this paper we report the result of a study on Knowledge, Attitude, Practice and Barriers (KAPB) to cervical cancer and its screening with Pap smears, conducted on 1505 rural women in Fiji.Objectives: To assess the knowledge, attitudes, practice and barriers to cervical cancer and it’s screening with Pap smears in rural women of Ba, Lautoka and Nadi, in Fiji.Methods: Structured questionnaires were administered to women presenting to a rural outreach Reproductive Health education and clinics, by trained health educators to ascertain their Knowledge, Attitudes, Practice and Barriers to cervical cancer and its screening with Pap smears.Results: Seventy two percent of rural women had no knowledge of cervical cancer and 80% had no knowledge of the risk factors of cervical cancer. Lack of knowledge was significantly different for age groups (p=0.006), education levels and employment status(p<0.001) and ethnicity (p=0.022). Those groups with lowest knowledge were teenagers (18 to 19 years); those with less education; and iTaukei respondents. Of the respondents who had at least some knowledge of the Pap smear, 75% had had a Pap test. Of those who had no knowledge of the Pap smear, only 45% had had the test (p<0.001). Of those who did not have a Pap smear the commonest barrier was lack of knowledge at 46.3% and fear of procedure was 29.4%.Conclusion: More education is required to acquaint women in rural Fiji about cervical cancer, its associated risk factors as well as the benefits of cervical cancer screening programs and other prevention strategies.

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Identification of ideal strategy of cervical cancer screening in Japan based on Fukui cervical cancer screening study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17025 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17025-e17025

Author(s):

Tetsuji Kurokawa ◽

Akiko Shinagawa ◽

Yoko Chino ◽

Motohiro Kobayashi ◽

Yoshio Yoshida

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Positive Predictive Value ◽

Cervical Cancer Screening ◽

Predictive Value ◽

Screening Method ◽

Hpv Testing ◽

Abnormal Cytology ◽

Predictive Values ◽

Hpv Status

e17025 Background:The estimated age-standardized incidence rate for cervical cancer is higher in Japan than in North America and the UK. It is important to improve cancer screening. The introduction of HPV testing with cytology for triage of those that test positive for cervical cancer screening has been challenging. The Fukui Cervical Cancer Screening (FCCS) study was designed to determine the best cervical cancer screening method in the Japanese population. We performed a subanalysis using baseline data of FCCS study to determine the performance of cytology, the human papillomavirus (HPV) testing and cotesting with cytology and HPV testing, and to evaluate whether the stratification of HPV16, HPV18, and 12 other hrHPV types appropriately balances risks and harms in the Japanese cancer screening population. Methods:The study enrolled 7,584 women aged 25 years or older undergoing routine screening. All women underwent liquid-based cytology (LBC) and cobas HPV testing. Women with abnormal cytology regardless of the HPV status, women with positive hrHPV results regardless of cytology results, and women randomly selected from among those with normal cytology and negative hrHPV results were referred for colposcopy. Results:The prevalence of hrHPV, HPV16, and HPV18 was 6.8%, 1.2%, and 0.5%, respectively. The estimated sensitivities for cervical intraepithelial neoplasia (CIN) 2 or worse for cytology, HPV testing, and cotesting with cytology and HPV testing were 71%, 92%, and 100%, respectively. The estimated positive predictive values for cytology, HPV testing, and cotesting with cytology and HPV testing were 33%, 21% and 21%, respectively. Using a strategy whereby those with abnormal cytology or positive HPV16 genotype undergo colposcopy and biopsy results in a sensitivity of 85% and a positive predictive value of 33%. This strategy results in improved sensitivity while at the same time maintains the positive predictive value compared to screening with cytology alone. Conclusions:Baseline data from the FCCS study suggests that strategy of using colposcopy for women with abnormal cytology and/or HPV16 positivity appropriately balances risks and harms for Japanese women. Clinical trial information: UMIN000025977.

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Clinical Human Papillomavirus Detection Forecasts Cervical Cancer Risk in Women Over 18 Years of Follow-Up

Journal of Clinical Oncology ◽

10.1200/jco.2011.38.8389 ◽

2012 ◽

Vol 30 (25) ◽

pp. 3044-3050 ◽

Cited By ~ 61

Author(s):

Philip E. Castle ◽

Andrew G. Glass ◽

Brenda B. Rush ◽

David R. Scott ◽

Nicolas Wentzensen ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Risk ◽

Clinical Test ◽

Low Grade ◽

Hpv Testing ◽

Pap Testing ◽

Health Maintenance ◽

Hpv Test

Purpose To describe the long-term (≥ 10 years) benefits of clinical human papillomavirus (HPV) DNA testing for cervical precancer and cancer risk prediction. Methods Cervicovaginal lavages collected from 19,512 women attending a health maintenance program were retrospectively tested for HPV using a clinical test. HPV positives were tested for HPV16 and HPV18 individually using a research test. A Papanicolaou (Pap) result classified as atypical squamous cells of undetermined significance (ASC-US) or more severe was considered abnormal. Women underwent follow-up prospectively with routine annual Pap testing up to 18 years. Cumulative incidence rates (CIRs) of ≥ grade 3 cervical intraepithelial neoplasia (CIN3+) or cancer for enrollment test results were calculated. Results A baseline negative HPV test provided greater reassurance against CIN3+ over the 18-year follow-up than a normal Pap (CIR, 0.90% v 1.27%). Although both baseline Pap and HPV tests predicted who would develop CIN3+ within the first 2 years of follow-up, only HPV testing predicted who would develop CIN3+ 10 to 18 years later (P = .004). HPV16- and HPV18-positive women with normal Pap were at elevated risk of CIN3+ compared with other HPV-positive women with normal Pap and were at similar risk of CIN3+ compared with women with a low-grade squamous intraepithelial Pap. Conclusion HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening, especially in women age 30 years or older.

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