Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

Background: Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality.Objectives: Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control.Methods: We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed.Results: Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15–65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities.Discussion: The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.

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Community Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review Protocol

10.21203/rs.3.rs-37012/v1 ◽

2020 ◽

Author(s):

Magdiel A Habila ◽

Namoonga Mantina ◽

Linda Jepkoech Kimaru ◽

Jonah Musa ◽

Maia Ingram ◽

...

Keyword(s):

Cervical Cancer ◽

Community Engagement ◽

Cancer Prevention ◽

Cause Of Death ◽

Scoping Review ◽

Prevention And Control ◽

Cervical Cancer Prevention ◽

Sub Saharan Africa ◽

Sub Saharan ◽

And Control

Abstract Introduction Cervical cancer is the fourth leading cause of death in women globally and remains the foremost cause of death in African women in spite of campaigns to increase education and prevention of the disease. The goal of participatory action research or community based participatory research is to engage communities in the research process in order to increase disease awareness and decrease disease mortality as a result of health disparities. The primary objective of this study is to summarize methods of community engagement in research on the prevention and control of cervical cancer in sub-Saharan Africa (SSA). MethodsWe will search through the following electronic databases for potential studies: PubMed, Embase, African Journals Online (AJOL), and African Index Medicus-WHO from inception until the date the last search will be conducted. Articles included will be restricted to those published in English and pertaining to research conducted in SSA. Articles generated from the search will be managed in our database. A narrative synthesis will be performed on the final list of included articles. DiscussionThis scoping review will provide evidence and perspectives on how research studies have engaged community members to bolster the cervical cancer prevention and control efforts. Findings of this review will contribute to the literature by identifying the benefits of community engagement in cervical cancer prevention in SSA and advance the science of cervical cancer prevention in the region and globally.

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Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

Vaccines ◽

10.3390/vaccines9050496 ◽

2021 ◽

Vol 9 (5) ◽

pp. 496

Author(s):

Caroline Deignan ◽

Alison Swartz ◽

Sara Cooper ◽

Christopher J. Colvin

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Sub Saharan Africa ◽

African Countries ◽

Qualitative Systematic Review ◽

Sub Saharan ◽

And Gender

Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders’ understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke’s methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.

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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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