P-B20 Evaluation of the feasibility of incorporating HPV DNA- based cervical cancer screening into routine antenatal care in Nigeria

Abstract

Introduction: Persistent high-risk HPV infection is a necessary cause of cervical cancer. HPV DNA testing is now the primary WHO recommended approach to cervical cancer screening. Cervical cancer screening uptake remains abysmally low in Nigeria and in other low and middle income countries (LMIC). Antenatal care-based HPV DNA testing is a largely unexplored strategy to increase uptake of cervical cancer screening in LMIC. Up to 70% of women in Africa attend ANC at least once during their pregnancy and many attend at least twice. We evaluated the acceptability of HPV DNA testing as part of routine antenatal care among pregnant women and healthcare workers in Nigeria. Methodology: We conducted focus group discussions (FGD) among pregnant women and Key Informant Interviews among healthcare providers at a hospital facility in Abuja, Nigeria. A total of 24 muslim and christian pregnant women were invited for the focus groups and each group comprised of 6–10 participants. Obstetric/Gynaecologists (O&G) and ANC nurses were interviewed. We used content analysis method for data analysis. Coding sheets were developed to summarize findings. Results: Our study showed fair level of knowledge and awareness of cervical cancer and cervical cancer screening among the pregnant women, however, practice was poor, as none of the women had ever been screened for cervical cancer. Lack of awareness about cervical cancer screening, costs, and fear of screening outcome were commonly cited as barriers to uptake. The nurses interviewed expressed reservations about the willingness of pregnant women to participate in screening but there was a high level of willingness among the pregnant women to be screened during the ANC period. Their religion and parity played no role in determining the acceptance of HPV DNA testing in ANC. The O&G specialists expressed full support for integrating HPV DNA testing into routine ANC services. Conclusions: Our results show the need to explore more innovative public health interventions to reduce cervical cancer burden in LMIC.