Barriers and Facilitators to Cervical Cancer Screening, Diagnosis, Follow‐Up Care and Treatment: Perspectives of Human Immunodeficiency Virus‐Positive Women and Health Care Practitioners in Tanzania

Background: Increasingly, evidence is emerging from developing countries like Kenya on the burden of loss to follow-up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the western region of Kenya. This study is designed to determine the proportion of and predictors and reasons for defaulting from follow-up care after positive cervical cancer screen. Aim: To determine the rates and factors associated with loss to follow-up in a multivisit cervical cancer screening and treatment program in western Kenya. Methods: We conducted a prospective study of women, who presented for cervical cancer screening at Chulaimbo and Webuye subcounty hospitals, and screened positive by VIA. A 2-3 weeks appointment was then set for review by a gynae-oncologist. A total of 100 women, scheduled for review, were recruited in the study and followed between August 2016 and May 2017. LTFU was defined as failure to keep a second rescheduled appointment or being unreachable for 3 consecutive months and failure to confirm that a woman sought for care in another health facility. Descriptive statistics was used for summary and the Cox regression model was used to estimate the risk of LTFU for different covariates. Results: The age range was 21-77 years, with a mean of 44.45 years. 39% of the women defaulted from scheduled follow-up appointment of which 25 (64%) were LTFU. Univariate Cox regression was conducted for HIV cases (HR=2.7, P value=0.021), clinic revisits (HR=2.6, P value=0.026), married (HR=0.63, P value=0.237) and previously screened women (HR=1.67, P value=0.198). Increased risk of LTFU was observed for HIV cases (HR=2.4, P value=0.04) and revisits (HR=7.5, P value=0.014) in an adjusted model. Conclusion: LTFU affects cervical cancer management due to several factors some of which are beyond the control of the women. We recommend a larger study be replicated for ease of generalizability of results; awareness and strategies are required to retain them to obey the treatment appointment since they are the highly vulnerable.

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The Lived Experience of Cervical Cancer Screening as Perceived by Indigenous Maya Women in Guatemala

International Journal for Human Caring ◽

10.20467/1091-5710.23.4.320 ◽

2019 ◽

Vol 23 (4) ◽

pp. 320-328 ◽

Cited By ~ 1

Author(s):

Rhonda Lynn Goodman

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Lived Experience ◽

Cervical Cancer Screening ◽

Opportunity To Learn ◽

Medical Doctor ◽

Culturally Appropriate ◽

Follow Up Care ◽

Before And After

Indigenous Maya women in Guatemala have little or no access to cervical cancer screening or follow-up care. Healthcare groups initiated a program to address this situation. This study collected the women's stories before and after screening. Screening was conducted by a licensed Guatemalan medical doctor. The participants had never experienced cervical cancer screening. They were given an opportunity to tell how they felt about the screening. The stories provide an opportunity to learn of the experience of cervical cancer screening as perceived by the indigenous Maya women and could assist to develop culturally appropriate approaches to this population.

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Barriers to Cervical Cancer Screening and Follow‐up Care among Black Women in Massachusetts

Journal of Obstetric Gynecologic & Neonatal Nursing ◽

10.1111/1552-6909.12488 ◽

2014 ◽

Vol 43 (5) ◽

pp. 580-588 ◽

Cited By ~ 17

Author(s):

Jacqueline Nolan ◽

Tajan Braithwaite Renderos ◽

Jane Hynson ◽

Xue Dai ◽

Wendy Chow ◽

...

Keyword(s):

Cervical Cancer ◽

Black Women ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Follow Up Care

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The Capulana study: a prospective evaluation of cervical cancer screening using human papillomavirus testing in Mozambique

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001643 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1292-1297 ◽

Cited By ~ 1

Author(s):

Mila P Salcedo ◽

Cristina Oliveira ◽

Viviane Andrade ◽

Arlete A N Mariano ◽

Dércia Changule ◽

...

Keyword(s):

Cervical Cancer ◽

Human Immunodeficiency Virus ◽

Human Papillomavirus ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Hpv Testing ◽

Immunodeficiency Virus ◽

Loop Electrosurgical Excision ◽

Loop Electrosurgical Excision Procedure ◽

Abnormal Results

BackgroundCervical cancer is the leading cause of cancer and related deaths among women in Mozambique. There is limited access to screening and few trained personnel to manage women with abnormal results. Our objective was to implement cervical cancer screening with human papillomavirus (HPV) testing, with navigation of women with abnormal results to appropriate diagnostic and treatment services.MethodsWe prospectively enrolled women aged 30–49 years living in Maputo, Mozambique, from April 2018 to September 2019. All participants underwent a pelvic examination by a nurse, and a cervical sample was collected and tested for HPV using the careHPV test (Qiagen, Gaithersburg, Maryland, USA). HPV positive women were referred for cryotherapy or, if ineligible for cryotherapy, a loop electrosurgical excision procedure. Women with findings concerning for cancer were referred to the gynecologic oncology service.ResultsParticipants (n=898) had a median age of 38 years and 20.3% were women living with the human immunodeficiency virus. HPV positivity was 23.7% (95% confidence interval 21.0% to 26.6%); women living with human immunodeficiency virus were twice as likely to test positive for HPV as human immunodeficiency virus negative women (39.2% vs 19.9%, p<0.001). Most HPV positive women (194 of 213, 91.1%) completed all steps of their diagnostic work-up and treatment. Treatment included cryotherapy (n=158, 77.5%), loop electrosurgical excision procedure (n=30, 14.7%), or referral to a gynecologist or gynecologic oncologist (n=5, 2.5%). Of eight invasive cervical cancers, 5 (2.8%) were diagnosed in women living with human immunodeficiency virus and 3 (0.4%) in human immunodeficiency virus negative women (p=0.01).ConclusionCervical cancer screening with HPV testing, including appropriate follow-up and treatment, was feasible in our study cohort in Mozambique. Women living with human immunodeficiency virus appear to be at a significantly higher risk for HPV infection and the development of invasive cervical cancer than human immunodeficiency virus negative women.

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Cervical Cancer Screening: Exploring Appalachian Patients’ Barriers to Follow-Up Care

Social Work in Health Care ◽

10.1080/00981389.2013.827149 ◽

2014 ◽

Vol 53 (2) ◽

pp. 83-95 ◽

Cited By ~ 8

Author(s):

Gretchen E. Ely ◽

Carol White ◽

Kate Jones ◽

Frances Feltner ◽

Maria Gomez ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Follow Up Care

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Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000463641.59285.09 ◽

2015 ◽

Vol 125 ◽

pp. 105S ◽

Cited By ~ 1

Author(s):

Geneva DeGregorio ◽

Edith Welty ◽

Thomas Welty ◽

Simon Manga ◽

Javier G. Ogembo ◽

...

Keyword(s):

Cervical Cancer ◽

Human Immunodeficiency Virus ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Immunodeficiency Virus

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Enablers and Barriers of Follow-Up Care: An Experience From an HPV DNA Detection–Based Cervical Cancer Screening Program in Rural India

Journal of Global Oncology ◽

10.1200/jgo.18.24200 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 144s-144s

Author(s):

S. Mittal ◽

P. Basu ◽

R. Mandal ◽

I. Ghosh ◽

D. Banerjee ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Screening Program ◽

Treatment Services ◽

Primary Health ◽

Cancer Screening Program ◽

Follow Up Care ◽

Cervical Cancer Screening Program

Background: Success of a cervical cancer screening program is intrinsically linked with appropriate management of women detected positive on screening tests. While routine screening can be done in any setting, the follow-up care of screen positive women is linked with settings that are equipped with diagnostic and treatment facilities, and trained medical providers. In low resource settings, the major obstacles to deliver follow-up care are lack of adequate healthcare infrastructure and trained service providers at district or subdistrict levels. Aim: To assess feasibility of implementing community based interventions to increase uptake of follow-up care of screen positive women in a HPV detection based screening program conducted by Chittaranjan National Cancer Institute (CNCI), Kolkata. Strategy: A network of key stakeholders including government authorities and civil society organizations was developed to deliver continuum of care at the doorsteps of screen positive women. The infrastructure of government's primary health care delivery system was used to set up temporary clinics at district and subdistrict levels. The clinics were organized on prescheduled dates and times that were convenient to the women. Community health workers (CHWs) were trained in community mobilization strategies to increase uptake of follow-up services. All instruments, equipment and consumables required for providing follow-up services were carried to the clinics in a vehicle. Program: The CHWs played a key role in counseling and recalling the screen positive women. The temporary clinics were arranged in the government primary health centers. A team of trained doctors and paramedics provided the diagnostic and treatment services. Colposcopy was performed on all screen positive women using portable colposcopes and guided biopsies were taken as indicated. Women who were eligible for ablative treatment were counseled and treated in the same sitting. All women were advised yearly follow-up. Outcomes: A total of 43,325 women were screened by HC2 test during July 2010 to March 2015, and 2045 (4.7%) women were detected to be high-risk HPV positive. Compliance to first recall was good with 78.6% (1608/2045) of women undergoing diagnostic evaluation at field clinics. But overall compliance to at least one follow-up visit after 1 year was poor (23.2%). Follow-up compliance rate was higher in women who were diagnosed with CIN1 as compared with those with normal diagnosis ( P < 0.001). What was learned: Diagnostic and treatment services could be effectively organized in the community in convergence with existing healthcare delivery system. High compliance to initial diagnostic evaluation and treatment was achieved by making the services available close to the doorsteps of the women. The reasons for low compliance to yearly follow-up were lack of understanding of future cancer risk, unwilling to undergo speculum examination again, and lack of cooperation of spouse/family.

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