Assessing Barriers Encountered by Women in Cervical Cancer Screening and Follow-Up Care in Urban Bolivia, Cochabamba

Abstract

Background: Timely detection of cervical cells infected with high-risk human papillomavirus (HPV) improves cervical cancer prevention. In Bolivia, actual screening coverage only reaches 33.3% of the target population aged between 25 and 64 years despite free cytology screening. Furthermore, 50% to 80% screened women are lost during follow-up. This study aimed at identifying factors explaining this lack of follow-up care. Method: During the first phase, face-to-face semi-structured interviews were conducted with HPV-positive women. Secondly, we explored the reasons for the non-adherence to the follow-up care: knowledge, perceptions and beliefs about HPV, as well as barriers to healthcare access, using a structured survey on Cochabamba women and healthcare professionals. Results: Barriers to effective follow-up of the targeted populations were associated with health system shortcomings, including poor service delivery at the front- and second-line, health providers shortage, inadequate training, waiting time, high direct and indirect costs of care seeking and care, complex procedures to obtain HPV screening results and poor patient–provider communication. The follow-up was perceived as extremely stressful by the participants. Conclusion: Improved communication on HPV and HPV-related cancers in terms of representation in the general population and among the health professional’s population is vital to improve access for HPV infection follow-up care.

The impact of loss to follow‐up in the Dutch organised HPV‐based cervical cancer screening programme

“…LTFU is particularly interesting, because women who are LTFU were initially willing to undergo screening, as opposed to non‐attenders, who do not participate in the programme at all. From an international perspective, main reasons for dropping out are among others finances, physical access to hospitals or communication of positive test results 3–5 . However, in the Netherlands these factors play less of a role as the cervical cancer screening programme is reimbursed by the government, distances to hospitals are small and the communication of test results is centralised.…”

“…From an international perspective, main reasons for dropping out are among others finances, physical access to hospitals or communication of positive test results. [3][4][5] However, in the Netherlands these factors play less of a role as the cervical cancer screening programme is reimbursed by the government, distances to hospitals are small and the communication of test results is centralised. Therefore, especially in such a setting where factors related to the healthcare system play less of a role, it is possible to investigate other factors that play a role in the LTFU of patients, such as patient characteristics.…”