Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies

Abstract

Objective To 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. Methods In 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. Results Seventeen 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. Conclusion Patient 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.

Cervical cancer prevention: Human papillomavirus testing as primary screening

“…Offering self‐sampling options for HPV testing can be advantageous, because it allows task shifting to the women themselves, especially in light of frequent provider shortages in low‐resource settings 27 . The quality of self‐collected samples is comparable to clinician‐collected samples, 28‐33 and women also consider self‐collection to be acceptable, adequately private, and preferable over clinician‐collected sampling 20,30,34,35 .…”

“…The quality of self‐collected samples is comparable to clinician‐collected samples, 28‐33 and women also consider self‐collection to be acceptable, adequately private, and preferable over clinician‐collected sampling 20,30,34,35 . However, despite the general acceptance of self‐collection among women, lack of confidence in and awareness of HPV testing and self‐collection have also been reported in some contexts as barriers to screening uptake 16,27,36‐38 . Strategies such as having a health care worker present to facilitate and explain the procedure may provide assurance to women during self‐collection 34 .…”

The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States

“…Inadequate housing and neighbourhood air pollution are associated with emergency room visits for asthma [32][33][34][35][36]. Transportation barriers are associated with missed preventive screenings, delayed cancer diagnoses, and inadequate management of chronic diseases [37][38][39][40][41]. Food insecurity and inadequate access to healthy foods are associated with higher rates of obesity and other cardiometabolic conditions [42][43][44] and possibly lung function [45].…”

Piloting a systems level intervention to improve cervical cancer screening, treatment and follow up in Kenya

“…However, in a survey of 12 hospitals across 7 counties, only 25% of facilities had a functional cryotherapy machine ( 9 ), allowing them to offer services compliant with these guidelines. Even amongst those who offer same day services, supply stock outs, C02 shortages for the cryotherapy machine, and lack of trained providers available to perform the procedure can delay treatment and cause increased burden on patients ( 15 , 16 ). Of those who do not receive same day services, only 20–53% of those diagnosed returned for cryotherapy ( 15 , 16 ).…”

“…Even amongst those who offer same day services, supply stock outs, C02 shortages for the cryotherapy machine, and lack of trained providers available to perform the procedure can delay treatment and cause increased burden on patients ( 15 , 16 ). Of those who do not receive same day services, only 20–53% of those diagnosed returned for cryotherapy ( 15 , 16 ). Indeed, in a multinational study in sub-Saharan African capitals, only 15.8% of CC patients received care with curative potential ( 17 ).…”