Implementing community-based human papillomavirus self-sampling with SMS text follow-up for cervical cancer screening in rural, southwestern Uganda.
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ABSTRACT: Background
Self-collected HPV screening may improve cervical cancer screening coverage in low resource countries, yet data guiding implementation and follow-up of abnormal results are sparse.Methods
This is a prospective cohort implementation study of HPV self-testing program in Mbarara, Uganda with mobile phones to facilitate result notification and referral for treatment at a regional hospital. The effectiveness of the interventions was analyzed using Proctor's model of implementation. Women were interviewed following screening and at 6 months to assess acceptability and barriers to follow-up. Data were analyzed using descriptive statistics.Results
159 of 194 (82%) of eligible women underwent HPV self-sampling; of these, 27 (17%) returned positive for high-risk HPV subtypes. We sent SMS messages providing test results and follow-up instructions to all participants. Seventeen (63%) hrHPV-positive participants reported receiving SMS text instructions for follow-up, of whom 6 (35%) presented for follow-up. The most common reasons for not returning were: lack of transportation (n = 11), disbelief of results (n = 5), lack of childcare (n = 4), and lack of symptoms (n = 3). Confidence in test results was higher for self-screening compared to VIA (Likert score 4.8 vs 4.4, P = 0.001).Conclusions
Despite the use of SMS text-based referrals, only one-third of women presented for clinical follow-up after abnormal HPV testing.
SUBMITTER: Joseph NT
PROVIDER: S-EPMC8709902 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive. OBJECTIVE:This study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women. METHODS:This multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat. RESULTS:Between August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial-358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33). CONCLUSIONS:Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women. TRIAL REGISTRATION:ClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.2196/10.2196/15863.
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Project description:BACKGROUND:Self-sampling for human papillomavirus (HPV) offered to women who do not participate in cervical cancer screening is an increasingly popular method to increase screening coverage. The rationale behind self-sampling is that unscreened women harbour a high proportion of undetected precancer lesions. Here, we compare the cervical intraepithelial neoplasia grade 2 or worse (?CIN2) detection rate between non-attenders who participated in self-sampling and women attending routine screening. METHODS:A total of 23?632 women who were qualified as non-attenders in the Copenhagen Region were invited for HPV-based self-sampling. Of these, 4824 women returned a self-sample, and HPV-positive women were referred for cytology and HPV co-testing as follow-up. The entire cohort and a reference cohort (3347 routinely screened women) were followed for histopathology confirmed ?CIN2. Odds ratio (OR) and the relative positive predictive value of ?CIN2 detection between the two populations were estimated. RESULTS:Women participating in self-sampling had a higher ?CIN2 detection than women undergoing routine cytology-based screening (OR=1.83, 95% CI: 1.21-2.77) and a similar detection as routinely screened women tested with cytology and HPV testing (OR=1.03, 95% CI: 0.75-1.40). The positive predictive value for ?CIN2 was higher in screening non-attenders than in routinely HPV- and cytology-screened screened women (36.5% vs 25.6%, respectively). CONCLUSIONS:Self-sampling offered to non-attenders showed higher detection rates for ?CIN2 than routine cytology-based screening, and similar detection rates as HPV and cytology co-testing. This reinforces the importance of self-sampling for screening non-attenders in organised cervical cancer screening.
| S-EPMC5765223 | biostudies-literature
Project description:BackgroundRetention in HIV care contributes to antiretroviral therapy adherence, which is a key factor for improved treatment outcomes and prevention of drug resistance. However, HIV treatment among the youths is characterized by loss to follow up, poor adherence to ART, risk of treatment failure and high mortality rates compared to young children and adults. There is limited information about factors associated with retention of youths in HIV care in rural settings in Uganda. We aimed to determine retention in HIV care and associated factors among youths aged 15-24 years in rural southwestern Uganda.MethodsA cross-sectional study was conducted among youths aged 15-24 years who were receiving care at the HIV clinic at Kabuyanda HC IV who had been in care for at least 1 year before the study. We used an interviewer-administered questionnaire to collect socio-demographic information. Participant chart abstraction was used to collect information on HIV clinic attendance. We collected information on HIV related stigma using the 40-item Berger Stigma Scale. Chi-square test and multivariable logistic regression analysis were used to determine the factors associated with retention in HIV care with a significance level of < 0.05. Retention in HIV care was, defined as having sought care at least once per quarter in the 12 months prior to the study.ResultsWe enrolled 102 participants with a mean age of 20.95 (SD ± 3.07) years. Two thirds (65.7%) of the youths had been retained in HIV care in the previous 12 months. In adjusted analyses, being male, married and had perinatally acquired HIV were independently associated with retention in HIV care. The association between HIV related stigma and retention in HIV care was not statistically significant.ConclusionRetaining adolescents and young adults in HIV care in rural southwestern Uganda is still much lower than the WHO target of 90%. Being male, having perinatally acquired HIV and married or in a relationship are associated with retention in HIV care. Interventions targeting adolescents and young adults living with HIV are necessary to improve retention in HIV care to the WHO target of 90%.
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