Abstract
BackgroundNearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.ObjectiveWe aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation.MethodsA systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.ResultsIn the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions.ConclusionsCurrent evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.
Highlights
BackgroundAnnually, 311,000 women die from cervical cancer worldwide, with 90% of the deaths occurring in low- and middle-income countries (LMICs). [1]
In the 27 included studies, interventions for cervical cancer control focused on secondary prevention and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality
Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer, and test a greater diversity of digital strategies
Summary
BackgroundAnnually, 311,000 women die from cervical cancer worldwide, with 90% of the deaths occurring in low- and middle-income countries (LMICs). [1]. Systematic reviews of the effectiveness of such digital health strategies in LMIC settings are lacking, especially regarding how such strategies may improve the delivery, access, and utilization of cervical cancer control programs [4]. An initial cervical cancer screening is possible at primary health facilities, or even at the community level by frontline health workers, follow-up procedures, diagnosis, and treatment require access to trained medical providers (eg, expert colposcopists). Cervical cancer control programs must achieve high rates of screening coverage among eligible women and ensure that women who screen positive receive timely treatment and support for long-term management [12]. There is a lack of systematic reviews to understand how digital health strategies affect cervical cancer control in LMICs across the continuum spanning from prevention to palliative care.
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