Abstract

ObjectiveTo identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya.MethodsIn a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018–2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively.ResultsSeventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women’s decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment.ConclusionPatient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.

Highlights

  • In East Africa, cervical cancer is the most common cancer among women

  • Seventeen site assessments were performed across three treatment sites

  • Patient education and financial support to reach treatment are potential areas for intervention to increase rates of highrisk human papillomavirus (hrHPV)+ women presenting for treatment

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Summary

Introduction

In East Africa, cervical cancer is the most common cancer among women. HrHPV testing must be part of a cervical cancer prevention cascade that includes education, screening, communication of results, and linkage to treatment. As hrHPV testing is relatively new in low- and middle-income countries such as Kenya, there is limited data on barriers to women’s completion of a cervical cancer prevention cascade after screening. Research by Geng et al on loss-to-follow-up among HIV patients in East Africa has identified structural barriers (e.g. transportation), clinic-based barriers (e.g. wait time), and psychosocial barriers (e.g. stigma) as contributing factors [5, 6]. The aim of the current research was to identify health systems-level barriers to treatment, including both structural and clinic-based barriers

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