Implementation Of Cervical Cancer Screening Research Articles

Common predictors of cervical cancer related mortality in Ethiopia. A systematic review and meta-analysis

BackgroundCervical cancer accounts for 7.5% of all female cancer related deaths worldwide; peaking between the ages of 35 and 65, and not only kills young women but also destroys families with young children.ObjectiveThis review was intended to measure national level magnitude and the most common predictors of cervical cancer related mortality in Ethiopia.MethodsCommon Public databases like Science Direct, Embase, the Cochrane Library, and PubMed were thoroughly searched. The STATA 14 and Rev-Manager 5.3 statistical software packages were used for analysis, as well as a standardized data abstraction tool created in Microsoft Excel. The Cochrane Q-test statistics and the I2 test were used to assess non-uniformity. The pooled magnitude and predictors of cervical cancer related mortality were estimated using fixed-effect and random-effect models, respectively.ResultThe pooled mortality among cervical cancer patients was estimated that 16.39% at 95% confidence level fall in 13.89–18.88% in Ethiopia. The most common predictors of cervical cancer related mortality were late diagnosed, radiation therapy alone, and Being anemic were identified by this review. Among cervical cancer treatment modalities effectiveness of surgery with adjuvant therapy was also approved in this meta-analysis.Conclusion and recommendationIn this study high cervical cancer-related mortality was reported as compared to national strategies to alleviate cervical cancer related mortality. Advanced implementation of cervical cancer screening at the national level for early diagnosis, anaemia detection, and combination anticancer therapy during initiation, as well as combination therapy, is critical to improve cervical cancer patient survival and decreasing mortality rates.

Implementation strategies of cervical cancer screening in South Asia: A systematic review.

Cervical cancer is a preventable cancer by screening, vaccination and timely management of preinvasive cervical lesions. However, about 90% of the global burden of cervical cancer is reported from developing countries. This systematic review aimed to analyze the strategies implemented for cervical cancer screening in South Asia. An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles published in English, evaluating the implementation of cervical cancer screening between December 2000 and June 2023 in South Asia using appropriate search terms. Cross-sectional studies, randomized control trials (RCTs) or non-randomized controlled trials evaluating different cervical screening strategies were included. A three-stage selection process was performed using a validated proforma including the title, author, year of publication, objective, country, study design, screening methods, strategies and outcomes, and results. The systematic review was designed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Out of the initial 1135 articles reviewed systematically, 23 studies met the inclusion criteria and were included in the qualitative synthesis of results. The implementation outcomes measured were acceptability (n = 23 100%), feasibility (n = 22, 95.7%), fidelity (n = 14, 60.9%), sustainability (n = 7, 30.4%), coverage (n = 4, 17.4%) and cost (n = 1, 4.3%). Cervical cancer screening can be effectively implemented by restructuring the ongoing programs.

Abstract 28: Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru

Abstract Purpose: In many countries, implementation planning for delivery of cancer screening services functions as a ‘top-down’ process, often resulting in fragmentation and bottlenecks at points of service delivery. Participatory engagement of health system planners and actors from across cancer screening and treatment continuum involved with implementation, planning, and adaptation is hypothesized to lead to plans that have a higher likelihood of adoption and sustainability. We tested the feasibility of conducting a 4-day series of participatory ‘design workshops’ for implementation of the recently initiated HPV screening program in the DIRIS Lima Norte (DLN) region of Peru. Methods: The workshop agendas were co-designed by the Peruvian Ministry of Health (MINSA) and the National Cancer Institute (NCI) using principles of participatory action research, implementation science, and systems thinking. The workshop objectives were to clarify the goals and processes of the HPV cervical screening program and reflect on the initial implementation experience. Workshop design was attentive to a) building trust among the health system planners and actors, b) surfacing misconceptions and process bottlenecks, c) equitable representation of perspectives on the process from all levels of the screening system, and d) shared decision-making in actions to improve the system. Results: Through real-time participatory reflection and process mapping of the screening program, context-specific challenges were rapidly identified. The process maps helped participants gain a shared understanding of the complexity of the screening system and quickly identified how one part of the system can create barriers for proximal and distal parts of the system. Participants mentioned feeling detached from the distal barriers before the workshops but now understood their role in the decision-making and problem-solving processes and demonstrated a willingness to work with the regional director to implement process improvements in the system, specifically to ensure women testing positive received the appropriate follow-up care. Conclusion: Rapid embedded implementation research using facilitated workshops with broad health system representation to reflect on the processes and procedures was an acceptable quality improvement activity. MINSA plans to replicate this experience in other regions and to continue to create a culture of trust and establishment of learning health systems. Citation Format: Fatou Jallow, Andrea Matos Orbegozo, Maria Del Carmen Caruhapoma, Víctor A. Palacios, Milagros Montes, Carlos Santos, Margarita Correa-Mendez, Aubrey Villalobos, Alejandro Salicrup, Jose Jeronimo, Laura Nervi, Patti Gravitt, Julia Gage. Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 28.

Abstract A118: Uptake of cervical cancer screening services in urban Zimbabwe: Healthcare provider perspectives

Abstract Background: In sub-Saharan Africa, Zimbabwe is among the top 6 countries with the highest cervical cancer incidence and mortality rates. Despite the disproportionate and growing burden, uptake of cervical cancer screening remains low. Little is known about the perceptions of healthcare providers who play a vital role in the provision and implementation of cervical cancer screening. This study explores healthcare provider perceptions of the factors that influence the uptake of cervical cancer screening in Zimbabwe. Methods: One-on-one in-depth interviews were conducted with healthcare providers currently or previously involved in cervical cancer prevention programs at select hospitals and clinics in Harare and Chinhoyi – two urban cities in Zimbabwe. A deductive thematic approach was used to analyze qualitative data to understand factors influencing the provision and uptake of cervical cancer screening. Results: We conducted 21 interviews with healthcare providers working in cervical cancer prevention for an average of 4 years. Three main themes related to the provision of cervical cancer screening were funding availability through donor support, demand of screening services, and availability of technical and human resources. Experiencing symptoms and no-cost screening services were perceived as facilitators for uptake of cervical cancer screening, while lack of adequate health education about cervical cancer and misconceptions about the screening procedure and outcomes were perceived as barriers to uptake of screening. Majority of the providers recommended increased sensitization and health education through various platforms; outreach initiatives; and training of more healthcare providers to conduct cervical cancer screening. Conclusion: This study contributes to a holistic understanding and identification of intervention points to effectively increase uptake of cervical cancer screening. Multi-level strategies promoting awareness of cervical cancer screening and strengthening healthcare systems may contribute significantly to increasing cervical cancer screening rates which in turn will lead to reducing the burden of cervical cancer in Zimbabwe. Citation Format: Thembekile Shato, Ucheoma Nwaozuru, Eric Adjei Boakye, Qiang John Fu, Juliet Iwelunmor, Anne Sebert Kuhlmann. Uptake of cervical cancer screening services in urban Zimbabwe: Healthcare provider perspectives [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A118.

Thousands of Women's Lives Depend on the Improvement of Poland's Cervical Cancer Screening and Prevention Education as Well as Better Networking Strategies Amongst Cervical Cancer Facilities.

Proper targeted cancer prophylaxis reduces the incidence of cancer in all forms; this includes cancers with significant progression potential and poor prognosis. Based on the assumption that one of the risk factors of cervical cancer is the avoidance of screening tests, we analyzed the current scenario of cervical cancer (CC) screening and recommendations in Poland (country with a well-off socioeconomic status). Based on the comprehensive literature review concerning documents of guidelines and recommendations of various bodies, including national ones, data on the implementation of CC screening in Poland, and different models for medium-to-high-income countries, we proposed how the CC screening strategy could be improved. Finally, the new strategy was further developed for those who are prone to not being screened. The proposal on how to improve the Polish CC screening program is the following: refinement of the public education on CC risk factors, popularization of CC screening incentives amongst the public, and improvement of networking strategies between CC screening facilities (“cervical screening clinical”), allowing screenings to be more efficient and rapid. We believe that, to enhance the future quality of life of those with rapid CC progression by catching the disease preemptively and limiting the sequelae of the disease, we have to improve education and access to medical services.

Survival With Cemiplimab in Recurrent Cervical Cancer

(Abstracted from N Engl J Med 2022;386(6):544–555) Despite widespread implementation of cervical cancer screening and prevention programs including cytologic assessment and high-risk human papillomavirus DNA detection as well as effective vaccines, the incidence of cervical cancer remains high. Treatment varies based on stage and grade and involves a combination of surgery, platinum-based chemotherapy, bevacizumab, chemoradiation, and intracavitary brachytherapy.

Cervical Cancer Screening Uptake and Predictors Among Women in Jeddah, Saudi Arabia.

Introduction: Cervical cancer is one of the most common cancers among females, contributing to significant mortality and morbidity worldwide. These numbers have significantly decreased since the implementation of cervical cancer screening. Despite that, screening in many countries, including Saudi Arabia, remains suboptimal.Methods: A cross-sectional study was conducted between May to November 2021 among 385 women aged 21-65 years who live in Jeddah, Saudi Arabia. The data were collected using a four-part online survey: demographic characteristics, cervical cancer screening status, predictors of undergoing cervical cancer screening, and barriers to screening.Results: Among the 385 women who completed the survey, only around one-third (33.4%) had a Pap smear at some point in their lives. The factors that were found to be significantly associated with the screening status (having a Pap test) in the univariate analysis are increasing age, education level, monthly income, perceived risk of getting cervical cancer, source of information about Pap test, having a family doctor, recommendation by the family doctor to have a Pap test, undergoing a gynecological examination, visiting a gynecologist in the past, history of previous gynecological complaint, and history of abortion. In the multivariable analysis, only four factors were found to be significantly associated with the screening status: age, monthly income, undergoing a gynecological examination in the past, and the recommendation by the family doctor, which by far had the largest effect.Conclusion: Cervical cancer screening rate is relatively low in the city of Jeddah. The recommendation of a Pap test by the family doctor had the largest impact on screening status. These results support the important role of family physicians in promoting screening tests for preventive healthcare. The results also suggest the need for education programs to promote cervical cancer screening among women in Saudi Arabia.

Cervical cancer burden, status of implementation and challenges of cervical cancer screening in Association of Southeast Asian Nations (ASEAN) countries.

Multiple barriers impede the transformation of evidence-based research into implementation of cervical cancer screening in ASEAN countries. This review is the first of its kind to show the disease burden of cervical cancer, progress till date to implement screening and corresponding challenges, and propose tailored solutions to promote cervical cancer prevention in ASEAN. In 2020, approximately 69000 cervical cancer cases and 38000 deaths happened in ASEAN, and more than 44% and 63% increases on new cases and deaths are expected in 2040. Only four countries have initiated population-based cervical cancer screening programs, but the participation rate is less than 50% in some countries and even lower than 10% in Myanmar and Indonesia. Inequity and unavailability in service delivery, lack of knowledge and awareness, limited follow-up and treatment capacity, and funding sustainability affect successful scale-up of cervical cancer screening most in ASEAN. Implementing HPV detection-based primary screening, appropriate management of screen-positives, enhancing health education, integrating health services can accelerate reduction of cervical cancer burden in ASEAN. Achieving high screening coverage and high treatment compliance will help ASEAN countries remain aligned to cervical cancer elimination strategies.

Characteristics and Related Factors of High-Risk Human Papillomavirus Infection in Pregnant Women.

BackgroundCervical cancer is a risk for women worldwide. The aim of this study was to examine the occurrence of high-risk human papillomavirus (HR-HPV) infection and its related factors in pregnant women and provide a scientific basis for the targeted prevention and treatment of cervical cancer in pregnant women.Material/MethodsA total of 1774 pregnant women were included, and 1774 non-pregnant women were selected as controls. Cervical exfoliated cells were collected from all women for HR-HPV (AptimaE6, E7mRNA) and ThinPrep cytologic testing, and the vaginal discharge of all pregnant women was tested for pH level and routine pathogenic microorganisms.ResultsThe HPV-16-positive and HPV-16/18/45-positive rates in pregnant women were higher than those of non-pregnant women (P<0.05). There was a statistically significant difference in HR-HPV-positive rate, HPV-16-positive rate, and non-HPV-16/18/45-positive rate among pregnant women of different ages (P<0.05). There was a statistically significant difference in HR-HPV-positive rate and non-HPV-16/18/45-positive rate in the first, second, and third trimester (P<0.05). The HR-HPV-positive rate, HPV-16-positive rate, HPV-18/45-positive rate, and non-HPV-16/18/45-positive rate of pregnant women with concurrent infection were higher than those in women without concurrent infection (P<0.05). The HR-HPV-positive and HPV-16/18/45-positive rates in pregnant women were associated with cytologic examination results (P<0.05).ConclusionsThe overall infection rates of HR-HPV-16 and HR-HPV-18/45 in pregnant women were higher than those in non-pregnant women. The gestation period was found to be a susceptible period for infection with HR-HPV, and we recommend the implementation of cervical cancer screening based on HR-HPV testing in pregnant women.

Histological outcomes in HPV-screened elderly women in Denmark.

Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948. Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region. 4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases. HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.

HPV and Its high-risk Genotypes in Middle Eastern Countries: A meta-analysis

Background: HPV is the main cause of cervical cancer. Determining the geographic distribution of HPV genotypes is a major step in the implementation of cervical cancer screening. This study aimed to evaluate the prevalence of HPV and its high-risk genotypes in Middle Eastern countries. Materials &amp; methods: MEDLINE, ISI Web of Science, PubMed, EMBASE, Scopus and ProQuest were searched from 2005 to 2018. The quality of the studies was determined by Strengthening the Reporting of Observational Studies in Epidemiology checklist. Fixed/random effects models were conducted to estimate the pooled prevalence. Results: The pooled prevalence of HPV was 12.3 and 5.2%. The prevalence of HPV in Africa (22%) was higher than that in Eurasia (8.3%) and Asia (12.6%). The prevalence of HPV was 14.4, 8.3, 22 and 10.2% in Iran, Turkey, Egypt and Arab countries, respectively. The prevalence of high-risk-HPV in the above-mentioned countries was 6.5, 6.2, 6.5 and 3.7%. Conclusion: Prevalence of HPV was increased in the Middle East. This highlights the need for public education, screening and vaccination programs.

Assessing the implementation of population based cervical cancer screening in Amadora, Portugal

Abstract Background Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora. Methods Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies). Results As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6). Conclusions Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue. Key messages Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.

Protocol for systematic literature review on implementation of cervical cancer screening and associated factors in Nepal from 2000 to 2018

Background Cervical cancer is a major cause of cancer death among women in Nepal. The high burden of this disease necessitates identifying relevant evidence to inform policy development and guidelines. This protocol describes a planned systematic review that will collate and report the experiences of implementation of cervical cancer screening and associated factors in Nepal over the last two decades to identify knowledge gaps to inform future implementation strategies. Methods and analysis This protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA_P) statement and will apply eligibility criteria to screening and select peer-reviewed research articles and grey literature. A computer-based search will be conducted for each type of publication in the PubMed/MEDLINE, CINAHL, Scopus and EMBASE databases using various search terms. Search terms will be modified according to each database and the reference lists of the included studies will be screened to identify additional relevant materials. Data synthesis will use narrative synthesis and meta-analysis where appropriate. Ethics and dissemination This study does not require ethical approval as only secondary data from published and grey literature will be assessed. The review will be published in a peer-reviewed scientific journal. PROSPERO registration number: CRD42019144645.

Implementation of the Program for Early Detection of Cervical Cancer in the Federal Republic of Germany.

Introduction:There are many cervical cancer screening programs in the world. Germany, as well as a number of other countries in the world, carry out its national cervical cancer screening program.Aim:In order to improve screening results, new guidelines for cervical cancer screening are in force in Germany.Methods:Auhors used descriptive-analytical method to described advantages and disadvantages of new adopted Guidelines for screnning program according eperiences of used previous program in Germany.Discussion:These guidelines have been adopted and approved by the competent Federal Committee for the implementation of cervical cancer screening in Germany. The committee is under the independent management of doctors and health insurance companies. The Committee is also under the legal control of the German Federal Ministry of Health.Conclusion:New Guidelines for Cervical Cancer Screening in Germany has an unchanged part relating to cervical cytodiagnostics. In addition, HPV typizatiion has been integrated in the new screening guidelines to further improve the quality of cervical cancer screening in Germany.

Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study

BackgroundDespite cervical cancer being preventable with effective screening programs, it is the most common cancer and the leading cause of cancer-related death among women in many countries in Africa. Screening involving pelvic examination may not be feasible or acceptable in limited-resource settings. We sought to evaluate women’s perspectives on human papillomavirus (HPV) self-sampling as part of a larger trial on cervical cancer prevention implementation strategies in rural western Kenya.MethodsWe invited 120 women participating in a cluster randomized trial of cervical cancer screening implementation strategies in Migori County, Kenya for in-depth interviews. We explored reasons for testing, experience with and ability to complete HPV self-sampling, importance of clinician involvement during screening, factors and people contributing to screening decision-making, and ways to encourage other women to come for screening. We used validated theoretical frameworks to analyze the qualitative data.ResultsWomen reported having positive experiences with the HPV self-sampling strategy. The factors facilitating uptake included knowledge and beliefs such as prior awareness of HPV, personal perception of cervical cancer risk, desire for improved health outcomes, and peer and partner encouragement. Logistical and screening facilitators included confidence in the ability to complete HPV self-sampling strategy, proximity to screening sites and feelings of privacy and comfort conducting the HPV self- sampling. The barriers to screening included fear of need for a pelvic exam, fear of disease and death associated with cervical cancer. We classified these findings as capabilities, opportunities and motivations for health behavior using the COM-B framework.ConclusionsOverall, HPV self-sampling was an acceptable cervical cancer screening strategy that seemed to meet the needs of the women in this community. These findings will further inform aspects of implementation, including outreach messaging, health education, screening sites and emphasis on availability and effectiveness of preventative treatment for women who screen positive.

Prevalence of cervical cancer and pre-cancerous lesions among unscreened Women in Kumasi, Ghana.

Ghana does not have a universal population-based cervical cancer screening program and there is very limited information about the distribution of cervical epithelial cell lesions. This study provides evidence that a moderately high prevalence of cervical cancer and precancerous lesions exists among unscreened women in Kumasi.The prevalence of cervical epithelial cell abnormalities among a cross-section of women attending cervical cancer screening for the first time in a suburb of Ghana from 2011 to 2014 was studied. Cervical smears were prepared and examined independently by 2 cytotechnologists and confirmed by a pathologist. Cervical lesions were classified according to the Bethesda System for cervical cytology 2001.Out of the 592 women for whom a Pap smear was available for evaluation, 555 (93.8%) were negative for intraepithelial lesion or malignancy. Eight women (1.4%) showed atypical squamous cells of undetermined significance (ASCUS), 9 (1.4%) low-grade squamous intraepithelial lesions, and 2 (0.3%) high-grade squamous intraepithelial lesions. A total of 15 (2.5%) smears were unsatisfactory for cervical cytology. Additionally, 3 women (0.5%) had squamous cell carcinoma, giving an overall rate of 3.7% for epithelial cell abnormalities.Cervical cancer and precursor epithelial cell abnormalities are common among women in Kumasi for a disease that can be prevented by early detection through routine screening and management. This study provides adequate background data to recommend the implementation of cervical cancer screening in all eligible women in Ghana.

Progress in immunocytochemical staining for cervical cancer screening.

Cervical cancer is one of the most common gynecological malignancies. In recent years, the implementation of cervical cancer screening has resulted in the effective control of cervical cancer incidence. However, many deficiencies still exist in the current screening techniques and strategies. With advancements in cervical cancer screening research, immunochemical staining to determine cervical cytology has shown a broader application prospect in the early screening for cervical cancer, especially for triage in cervical cancer screening.

A Qualitative Exploration of Women's Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya.

Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low- and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impacts screening uptake and acceptability. We evaluated women's experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of self-collected HPV testing, and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV- and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.

Health impact of delayed implementation of cervical cancer screening programs in India: A modeling analysis.

India has the highest burden of cervical cancer in the world. To estimate the consequences of delaying implementation of organized cervical cancer screening, we projected the avertable burden of disease under different implementation scenarios of a screening program. We used an individual‐based microsimulation model of human papillomavirus (HPV) infection and cervical cancer calibrated to epidemiologic data from India to project age‐specific cancer incidence and mortality reductions associated with screening (once‐in‐a‐lifetime among women aged 30–34 years) with one‐visit visual inspection with acetic acid (VIA) and one‐ and two‐visit HPV DNA testing. We then applied these reductions to a population model to project the lifetime cervical cancer cases and deaths averted under different implementation scenarios taking place from 2017 to 2026: (1) immediate implementation of screening with currently available screening tests (one‐visit VIA, two‐visit HPV testing); (2) immediate implementation of screening with currently available screening tests, with a switch to point‐of‐care one‐visit HPV testing in 5 years; and (3) 5‐year delayed implementation of screening with current screening tests or point‐of‐care HPV testing. Immediate implementation of two‐visit HPV testing with a switch to one‐visit HPV testing averted 574,100 cases and 382,500 deaths over the lifetimes of 81.4 million 30‐ to 34‐year‐old women screened once between 2017 and 2026. Delayed implementation with a one‐visit HPV test averted 209,300 cases and 139,100 deaths. Delaying implementation of screening programs in high‐burden settings will result in substantial morbidity and mortality among women beyond the age for adolescent HPV vaccination.

Abstract C74: Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile

Abstract Introduction: Cervical cancer is a serious public health problem. An estimated 270,000 women die every year from cervical cancer and more than 85% of these deaths take place in developing countries. Chile´s national cervical cancer program was created in 1987. Since then, and with the systematic implementation of cervical cancer screening through Papanicolau (Pap) smears, cervical cancer mortality rates have dropped significantly. Cancer screening rates, however, have stabilized in the last 10 years at approximately 59%. Additionally, most late-stage cervical cancers are diagnosed in low-socioeconomic-status (SES) Latinas. Mobile technologies may have use in improving health disparities due to their widespread availability. In Chile, more than 80% of low-SES people own a cell phone. Nevertheless, developing an effective mHealth intervention may require tailoring and adjusting of available technology in developing countries. The aim of this study was to describe key aspects of an mHealth intervention to be used in Latinas from an underserved area of Santiago, Chile. Methods: We held 9 focus groups at three health care centers with Latinas between 25-64 years old and midwives. Focus groups were recorded, and transcribed verbatim. We analyzed and coded the data grouping findings into relevant themes. With these findings, we developed a customized mHealth intervention that is now being tested using a randomized controlled trial (RCT) in a vulnerable area of Santiago, Chile. Results: Development: The results of our study revealed key aspects to consider for the final intervention: We asked about mode of delivery, content, frequency, and duration of the ideal intervention. Mode of delivery: Although younger women preferred texting and other “indirect” modes of communication, older women were not as savvy with reading texts--their preferred method of contact was a phone call. Content: Women agreed that messages needed to be clear and written in simple language. They would like the messages to have information about cervical cancer, as well as Pap smear availability at their health care centers. Frequency and duration of the intervention: Women mentioned the messages should be sent every week and no more than two times a week. They would like the messages to alternate being sent during weekends and weekday evenings to allow for sufficient time to read them. Previous studies had shown that a duration of 6 months would be effective to promote change in screening behavior. The final intervention was designed with the following characteristics: 1. Four months of text messages and two months of automated phone calls; 2. Twice a week on Wednesday and Sunday evenings; 3. Two types of messages: Information about cervical cancer and clinic hours, scheduling procedures, etc. Implementation: We planned to deliver the text and phone messages using a custom web platform connected to a generic SMS gateway provider. Lack of close relations between two such providers and Chilean mobile carriers generated profound disruptions in the reliability with which messages were sent during testing. After an iterative trial-and-error we settled for our current provider, which is delivering messages for our clinical trial without major issues. Conclusions: Developing and implementing an effective mHealth intervention requires tailoring according to cultural, socioeconomic, and educational characteristics of the population as well as knowledge of the technology available in every country. Transferring technologies proven easy to implement in developed countries is not as straightforward as it may seem. Our intervention is currently being tested through a RCT in a vulnerable population of Santiago, Chile. We hope to learn more about the implementation of such technologies in vulnerable populations, thus improving cancer screening rates across the country. Citation Format: Javiera Martinez Gutierrez, Daniel Capurro, Francis Ciampi, Mauricio Soto, Mackenzie C. Momany, Emilia Cea, Tania Mergudich, Klaus Puschel. Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C74.