Effect of service integration on cervical cancer screening and family planning uptake: A uncontrolled before and after facility study in Mukono District, Uganda.

Abstract

Background Cervical cancer (CACX) is the third most common cancer among women globally yet it is largely preventable. Uganda has one of the highest age standardized CACX incidence rates in the world yet it has a low screening rate ranging from 4.8 to 19% compared to the national target of 80%. Women using hormonal contraceptives over a long time are among the most at risk of CACX yet there is limited information about their screening status. In 2014, an integrated FP-CACX screening service model was implemented in Mukono district in Uganda to reduce this unmet need for both services. This study assessed whether an integrated model resulted into increased utilization of both services at health facilities in Mukono district.Methods Integration was defined as the uptake of both FP and CACX screening services during the same visit. Monthly quantitative data on service utilization was collected retrospectively from records at 7 health facilities, 36 months before and 27 months after the integration intervention. The period 2011 to 2013 defined years before while 2014 to 2016 were years after integration. Descriptive analyses and tests of significance were carried out and results were expressed in percentages, means and mean differences.Results Among 48595 women desiring FP or CACX screening in the 7 facilities for the period 2011 to 2016, 41374 (85%) opted to solely receive an FP service. CACX screening services were received solely by 937 (2%) women while 6284 (13%) received integrated services. There were significant increases in the services received solely and as a combination. Integrated services increased by 15 mean clients per month (p<0.001) from a mean number of 5 (SD±14.5) to 20 (SD±26.9) clients per month in 2016 after integration.Conclusion Integrating CACX screening with FP service provision led to significant increases in the services received solely and as a combination after integration. More research on approaches including how and when to roll out integration in different settings is needed to inform future expansion efforts for better uptake of integrated services.