Abstract
BackgroundRapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive.ObjectiveThis study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women.MethodsThis multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat.ResultsBetween August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial—358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33).ConclusionsAttendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women.Trial RegistrationClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702.International Registered Report Identifier (IRRID)RR2-10.2196/10.2196/15863
Highlights
BackgroundDespite the fact that cervical cancer can be prevented, the global age-standardized incidence and mortality rates of cervical cancer were 13.1 and 6.9, respectively, per 100,000 women in 2018 [1]
Implementation of rapid human papillomavirus (HPV) testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women
Connected2Care is an unblinded, multicenter, parallel-group randomized controlled trial conducted at 3 hospitals in Tanzania: Ocean Road Cancer Institute (ORCI) in Dar es Salaam and Kilimanjaro Christian Medical Centre (KCMC) and Mawenzi Regional Hospital in Moshi
Summary
BackgroundDespite the fact that cervical cancer can be prevented, the global age-standardized incidence and mortality rates of cervical cancer were 13.1 and 6.9, respectively, per 100,000 women in 2018 [1]. Primary prevention of cervical cancer includes vaccination against high-risk human papillomavirus (HPV) types, and secondary prevention involves early and accurate detection through screening and subsequent treatment of precancerous lesions [4]. Rapid HPV DNA testing is an emerging screening strategy in resource-limited countries, as it has proven to be an objective and more sensitive alternative to VIA [7,8]. Subsequent screening of these women is needed to identify those who have precancerous lesions. This leads to a risk of loss to follow-up compared with screening by the use of VIA. Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive
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