Dataset Information

Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

ABSTRACT: BACKGROUND:Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs. METHODS:We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to community health campaigns (CHCs), and six to screening at government clinics. All HPV-positive women were referred for cryotherapy at Migori County Hospital. We prospectively estimated direct costs from the health system perspective, using micro-costing methods. Cost data were extracted from expenditure records, staff interviews, and time and motion logs. Total costs per woman screening included three activities: outreach, HPV-based screening, and notification. Types of inputs include personnel, recurrent goods, capital goods, and services. We costed potential changes to implementation for scaling. RESULTS:From January to September 2016, 2899 women were screened in CHCs and 2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach, screening, and notification. The mean cost per woman screened was $25.00 for CHCs [median: $25.09; Range: $22.06-30.21] and $29.56 for clinics [$28.90; $25.27-37.08]. Clinics had higher costs than CHCs for personnel ($14.27 vs. $11.26) and capital ($5.55 vs. $2.80). Screening costs were higher for clinics at $21.84, compared to $17.48 for CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs. $0.17). After modeling a reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent to CHCs. CONCLUSIONS:HPV-based cervical cancer screening through community health campaigns achieved lower costs per woman screened, compared to screening at clinics. Periodic high-volume CHCs appear to be a viable low-cost strategy for implementing cervical cancer screening.

SUBMITTER: Shen J

PROVIDER: S-EPMC5970469 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

Shen Jennifer J Olwanda Easter E Kahn James G JG Huchko Megan J MJ

BMC health services research 20180525 1

<h4>Background</h4>Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs.<h4>Methods</h4>We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to communit ...[more]

PMID: 29801496

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Project description:BACKGROUND:Despite guidelines for cervical cancer prevention in low-resource countries, a very small proportion of women in these settings undergo screening, and even fewer women are successfully treated. Using pilot data from western Kenya and World Health Organization recommendations, we developed a protocol to implement evidence-based cervical cancer screening and linkage to treatment strategies to the rural communities. We describe the protocol for a cluster-randomized trial to compare two implementation strategies for human-papillomavirus (HPV)-based cervical cancer screening program using metrics described in the RE-AIM (reach, efficacy, adaption, implementation and maintenance) framework. METHODS:The study is a three-year, two-phase cluster-randomized trial in 18 communities in western Kenya. During Phase 1, six control communities were offered screening in health facilities; and six intervention communities were offered screening in community health campaigns. Screening was done with human-papillomavirus testing through self-collected specimens. Phase 1 ended and we are working in partnership with communities to further contextualize the implementation strategy for screening, and develop an enhanced linkage to treatment plan. This plan will be tested in an additional six communities in Phase 2 (enhanced intervention). We will compare the reach, efficacy, cost-effectiveness and adaptability of the implementation strategies. DISCUSSION:Effective low-cost cervical cancer prevention technologies are becoming more widely available in low- and middle-income countries. Despite increasing government support for cervical cancer prevention, there remains a sizeable gap in service availability. We will use implementation science to identify the most effective strategies to fill this gap through development of context-specific evidence-based solutions. This protocol design and results can help guide implementation of cervical cancer screening in similar settings, where women are most underserved and at highest risk for disease. TRIAL REGISTRATION:This trial is registered at ClinicalTrials.gov , NCT02124252 .

Project description: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.

Project description:BackgroundOver 43% of children living in low- and middle-income countries are at risk for developmental delays; however, access to protective interventions in these settings is limited. We evaluated the effect of maternal participation in Chamas for Change (Chamas)-a community-based women's health education program during pregnancy and postpartum-and risk of developmental delay among their children in rural Kenya.MethodsWe analyzed developmental screening questionnaire (DSQ) data from a cluster randomized controlled trial in Trans Nzoia County, Kenya (ClinicalTrials.gov, NCT03187873). Intervention clusters (Chamas) participated in community health volunteer-led, group-based health lessons twice a month during pregnancy and postpartum; controls had monthly home visits (standard of care). We screened all children born during the trial who were alive at 1-year follow-up. We labeled children with any positive item on the DSQ as "at-risk development." We analyzed data using descriptive statistics and multilevel regression models (α=.05); analyses were intention-to-treat using individual-level data.ResultsBetween November 2017 and March 2018, we enrolled 1,920 pregnant women to participate in the parent trial. At 1-year follow-up, we screened 1,273 (689 intervention, 584 control) children born during the trial with the DSQ. Intervention mothers had lower education levels and higher poverty likelihood scores than controls (P<.001 and P=.007, respectively). The overall rate of at-risk development was 3.5%. Children in Chamas clusters demonstrated significantly lower rates of at-risk development than controls (2.5% vs. 4.8%, P=.025). Adjusted analyses revealed lower odds for at-risk development in the intervention arm (OR=0.50; 95% confidence interval=0.27, 0.94).ConclusionsMaternal participation in a community-based women's health education program was associated with lower rates of at-risk development compared to the standard of care. Overall, rates of at-risk development were lower than expected for this population, warranting further investigation. Chamas may help protect children from developmental delay in rural Kenya and other resource-limited settings.

Project description:ObjectivesTo evaluate the cost-effectiveness of human papillomavirus (HPV) DNA testing (versus Papanicolaou (Pap)-based screening) for cervical cancer screening in Nicaragua.DesignA previously developed Monte Carlo simulation model of the natural history of HPV infection and cervical cancer was calibrated to epidemiological data from Nicaragua. Cost data inputs were derived using a micro-costing approach in Carazo, Chontales and Chinandega departments; test performance data were from a demonstration project in Masaya department.SettingNicaragua's public health sector facilities.ParticipantsWomen aged 30-59 years.InterventionsScreening strategies included (1) Pap testing every 3 years, with referral to colposcopy for women with an atypical squamous cells of undetermined significance or worse result ('Pap'); (2) HPV testing every 5 years, with referral to cryotherapy for HPV-positive eligible women (HPV cryotherapy or 'HPV-Cryo'); (3) HPV testing every 5 years, with referral to triage with visual inspection with acetic acid (VIA) for HPV-positive women ('HPV-VIA'); and (4) HPV testing every 5 years, with referral to Pap testing for HPV-positive women ('HPV-Pap').Outcome measuresReduction in lifetime risk of cancer and incremental cost-effectiveness ratios (ICER; 2015 US$ per year of life saved (YLS)).ResultsHPV-based screening strategies were more effective than Pap testing. HPV-Cryo was the least costly and most effective strategy, reducing lifetime cancer risk by 29.5% and outperforming HPV-VIA, HPV-Pap and Pap only, which reduced cancer risk by 19.4%, 12.2% and 10.8%, respectively. With an ICER of US$320/YLS, HPV-Cryo every 5 years would be very cost-effective using a threshold based on Nicaragua's per capita gross domestic product of US$2090. Findings were robust across sensitivity analyses on test performance, coverage, compliance and cost parameters.ConclusionsHPV testing is very cost-effective compared with Pap testing in Nicaragua, due to higher test sensitivity and the relatively lower number of visits required. Increasing compliance with recommended follow-up will further improve the health benefits and value for public health dollars.

Dataset Information

Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

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Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

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