Patient factors affecting successful linkage to treatment in a cervical cancer prevention program in Kenya: A prospective cohort study.

Charlotte M Page,Lawrence P Park,Megan J Huchko,Saduma Ibrahim,Violet Naanyu

doi:10.1371/journal.pone.0222750

Abstract

To identify patient factors associated with whether women who screened positive for high-risk human papillomavirus (hrHPV) successfully accessed treatment in a cervical cancer prevention program in Kenya. A prospective cohort study was conducted as part of a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya from January 2018 to February 2019. In this larger trial, women underwent hrHPV testing during community health campaigns (CHCs), and hrHPV+ women were referred to government facilities for cryotherapy. For this analysis, we looked at rates of and predictors of presenting for treatment and presenting within 30 days of receiving positive hrHPV results ("timely" presentation). Data came from questionnaires completed at the time of screening and treatment. Multivariable logistic regression was used to identify factors associated with each outcome. Of the 505 hrHPV+ women, 266 (53%) presented for treatment. Cryotherapy was performed in 236 (89%) of the women who presented, while 30 (11%) were not treated: 15 (6%) due to gas outage, six (2%) due to pregnancy, five (2%) due to concern for cervical cancer, and four (2%) due to an unknown or other reason. After adjusting for other factors in the multivariable analysis, higher education level and missing work to come to the CHC were associated with presenting for treatment. Variables that were associated with increased likelihood of timely presentation were missing work to come to the CHC, absence of depressive symptoms, told by someone important to come to the CHC, and shorter distance to the treatment site. The majority of hrHPV+ women who did not get treated were lost at the stage of decision-making or accessing treatment, with a small number encountering barriers at the treatment sites. Patient education and financial support are potential areas for intervention to increase rates of hrHPV+ women seeking treatment.

Highlights

Cervical cancer is the fourth most common cancer in women worldwide and the most common cancer among women in East Africa
Variables that were associated with increased likelihood of timely presentation were missing work to come to the community health campaigns (CHCs), absence of depressive symptoms, told by someone important to come to the CHC, and shorter distance to the treatment site
The majority of high-risk human papillomavirus (hrHPV)+ women who did not get treated were lost at the stage of decisionmaking or accessing treatment, with a small number encountering barriers at the treatment sites

Summary

Introduction

Cervical cancer is the fourth most common cancer in women worldwide and the most common cancer among women in East Africa. Most low-resource countries cannot provide the cytology-based screening that has dramatically reduced cervical cancer mortality in wealthy countries. Several alternative screening technologies are recommended for low-resource settings, and the most effective of these at reducing cervical cancer mortality is testing for high-risk human papillomavirus (hrHPV) [3, 4]. HrHPV testing must be part of a cervical cancer prevention cascade, including education, screening, communication of results, and linkage to treatment. The effectiveness of hrHPV testing is reduced if there are high rates of attrition between screening and treatment

Methods

Results

Conclusion