Community-based self-collected human papillomavirus screening in rural Zimbabwe

Megan B Fitzpatrick,David Katzenstein,Ziad El-Khatib,Kathy Mccarty,Benjamin A Pinsky,Zvavahera Mike Chirenje

doi:10.1186/s12889-019-6810-5

Abstract

BackgroundIn low- and middle-income countries (LMIC), women have limited access to and uptake of cervical cancer screening. Delayed diagnosis leads to poorer outcomes and early mortality, and continues to impede cancer control disproportionately in LMIC. Integrating self-collected, community-based screening for High Risk-Human Papilloma Virus (HR-HPV) into existent HIV programs is a potential screening method to identify women at high risk for developing high-risk cervical lesions.MethodsWe implemented community-based cross-sectional study on self-collection HR-HPV screening in conjunction with existing community outreach models for the distribution of antiretroviral therapy (ART) and the World Health Organization Expanded Program on Immunization (EPI) outreach in villages in rural Zimbabwe from January 2017 through May 2017.ResultsOverall, there was an 82% response rate: 70% of respondents participated in self-collection and 12% were ineligible for the study (inclusion criteria: age 30–65, not pregnant, with an intact uterus). Women recruited in the first 2–3 months of the study had more opportunities to participate and therefore significantly higher participation: 81% participation (additional 11% ineligible), while those with fewer opportunities also had lower participation: 63% (additional 13% ineligible) (p < 0.001). Some village outreach centers (N = 5/12) had greater than 89% participation.ConclusionsIntegration of HR-HPV screening into existing community outreach models for HIV and immunizations could facilitate population-based screening to scale cancer control and prevention programs in sub-Saharan Africa. Community/village health workers (CHW/VHW) and village outreach programs offer a potential option for cervical cancer screening programs to move towards improving access of sexual and reproductive health resources for women at highest risk.

Highlights

In low- and middle-income countries (LMIC), women have limited access to and uptake of cervical cancer screening
We describe participation in a community-based self-collection HPV screening program which was combined with existing community outreach models for the distribution of antiretroviral therapy (ART) and immunizations in rural Zimbabwe (World Health Organization Expanded Program on Immunization (EPI))
Complete lists of eligible women were submitted from community health workers representing a total of 130 villages, and women were selected via random number generation using Microsoft Excel for participation in village-based self-collected High Risk-Human Papilloma Virus (HR-HPV) testing

Summary

Introduction

In low- and middle-income countries (LMIC), women have limited access to and uptake of cervical cancer screening. Fitzpatrick et al BMC Public Health 2019, 19(Suppl 1):603 the 2015 Zimbabwe Population-Based HIV Impact Assessment found that survey nationwide 86.8% of women knew their status, 87.3% of women living with HIV self-report current use of ART, and 87.9% are virally suppressed [6]. This headway made in HIV care in rural areas is at least in part attributable to successful community-based care combined with hospital care. CHWs may be critical in cervical cancer control and prevention in settings where limited transport, health centers, and human resources are barriers to care

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