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Dzobo M, Dzinamarira T, Maluleke K, Jaya ZN, Kgarosi K, Mashamba-Thompson TP. Mapping evidence on the acceptability of human papillomavirus self-sampling for cervical cancer screening among women in sub-Saharan Africa: a scoping review. BMJ Open 2023; 13:e062090. [PMID: 37085299 PMCID: PMC10124230 DOI: 10.1136/bmjopen-2022-062090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES The objective of this scoping review was to map evidence on the acceptability of self-sampling for human papillomavirus testing (HPVSS) for cervical cancer screening among women in the sub-Saharan Africa region. DESIGN Scoping review. METHODS Using Arksey and O'Malley's framework, we searched Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the acceptability of HPVSS among women aged 25 years and older published between January 2011 and July 2021. We included studies that reported evidence on the acceptability of HPVSS for cervical cancer screening. Review articles and protocols were excluded. We also searched for evidence from grey literature sources such as dissertations/theses, conference proceedings, websites of international organisations such as WHO and relevant government reports. Two reviewers independently performed the extraction using a pre-designed Excel spreadsheet and emerging themes were narratively summarised. RESULTS The initial search retrieved 1018 articles. Of these, 19 articles were eligible and included in the review. The following themes emerged from the included articles: acceptability of HPVSS; lack of self-efficacy to perform HPVSS, complications when performing HPVSS, preferences for provider sampling or assistance; setting of HPVSS; HPVSS by vulnerable populations. CONCLUSION Evidence shows that HPVSS is highly acceptable for cervical cancer screening in sub-Saharan Africa. Further research exploring the acceptability of HPVSS among women residing in rural areas is required, as well as studies to determine women's preferences for HPVSS intervention including the preferred type of sampling devices. Knowledge on the acceptability and preferences for HPVSS is important in designing women-centred interventions that have the potential to increase screening coverage and participation in cervical cancer screening programmes.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Kuhlula Maluleke
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Ziningi Nobuhle Jaya
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Habila MA, Kimaru LJ, Mantina N, Valencia DY, McClelland DJ, Musa J, Madhivanan P, Sagay A, Jacobs ET. Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review. Front Glob Womens Health 2021; 2:697607. [PMID: 34816234 PMCID: PMC8594022 DOI: 10.3389/fgwh.2021.697607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality. Objectives: Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control. Methods: We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed. Results: Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15-65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities. Discussion: The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.
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Affiliation(s)
- Magdiel A. Habila
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- Department of Health and Pharmaceutical Outcomes, University of Arizona, Tucson, AZ, United States
| | - Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Namoonga Mantina
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Dora Yesenia Valencia
- Clinical Translational Sciences, College of Medicine, University of Arizona Health Sciences, Tucson, AZ, United States
| | - D. Jean McClelland
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
- Health Sciences Library, University of Arizona, Tucson, AZ, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, Chicago, IL, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Atiene Sagay
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
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Mahande MJ, Oneko O, Amour C, Pollie M, Smith C, Mboya IB, Finkel M. Feasibility and acceptability of human papillomavirus self-sampling in a semi-urban area in northern Tanzania. Int J Gynaecol Obstet 2021; 154:113-118. [PMID: 33404089 DOI: 10.1002/ijgo.13579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of HPV self-sampling in Arusha region, northern Tanzania, because the ability for women to self-collect HPV samples can help reduce the number of health facility visits and improve cervical cancer screening coverage rates. METHODS We conducted a facility- and community-based cross-sectional study among 350 women aged 25-55 years in Arumeru district, Arusha region, northern Tanzania. Women were trained to self-collect an HPV sample, and follow-up visits were used to provide results after laboratory testing. Data were analyzed using Stata version 15.1 and summarized using mean and standard deviation for numeric variables and frequencies and percentages for categorical variables. RESULTS Among 350 women, 65 (18.6%) ever screened for cervical cancer, all provided self-collected samples, and 349 (99.4%) would advise their female friends to undergo the same procedure. The prevalence of positive HPV results was 31 (8.9%), of which 26 (83.9%) were further examined. Two women found with lesions were treated following the national guidelines. CONCLUSION This study has demonstrated that the HPV self-sampling intervention for cervical cancer screening is a feasible and acceptable intervention, especially in resource-limited countries like Tanzania. Scaling-up policies should consider addressing the potential barriers to the uptake of this intervention.
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Affiliation(s)
- Michael J Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Olola Oneko
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Caroline Amour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Meridith Pollie
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Cheyenne Smith
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Innocent B Mboya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,School of Mathematics, Statistics and Computer Science, University of KwaZulu Natal, Pietermaritzburg, Scottsville, South Africa
| | - Madelon Finkel
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Kamath Mulki A, Withers M. Human Papilloma Virus self-sampling performance in low- and middle-income countries. BMC WOMENS HEALTH 2021; 21:12. [PMID: 33407355 PMCID: PMC7789658 DOI: 10.1186/s12905-020-01158-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
Background Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. Methods This study’s objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs.
Results Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86–97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants’ homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75–97%, 18 studies), painless (60–90%, nine studies), and preferred over provider-collected sampling (57–100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. Conclusion Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.
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Affiliation(s)
- Ashwini Kamath Mulki
- Department of Family Medicine, Lehigh Valley Health Network, 1730 Chew St, Allentown, PA, 18104, USA. .,Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA.
| | - Mellissa Withers
- Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA
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Self-Collected Specimens Revealed a Higher Vaccine- and Non-Vaccine-Type Human Papillomavirus Prevalences in a Cross-Sectional Study in Akuse. Adv Prev Med 2020; 2020:8343169. [PMID: 32411484 PMCID: PMC7204098 DOI: 10.1155/2020/8343169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background Population-specific epidemiologic data on human Papillomavirus infection, which are limited in most of the SubSaharan African countries, are necessary for effective cervical cancer prevention. This study aimed to generate population-specific data on human Papillomavirus infections, and determine which of these, self-collected and provider-collected specimens, gives a higher estimate of the prevalence of human Papillomaviruses, including vaccine and non-vaccine-type human Papillomavirus. Methods In this cross-sectional study, following a questionnaire-based collection of epidemiological data, self-, and provider-collected specimens, obtained from women 15−65 years of age, were analysed for human Papillomavirus types by a nested-multiplex polymerase chain reaction, and for cervical lesions by Pap testing. HPV data were categorised according to risk type and vaccine types for further analysis. Results The difference between the overall human Papillomavirus infection prevalences obtained with the self-collected specimens, 43.1% (95% CI of 38.0–51.0%) and that with the provider-collected samples, 23.3% (95% CI of 19.0–31.0%) were significant (p ≤ 0.001). The prevalence of quadrivalent vaccine-type human Papillomaviruses was 12.3% with self-collected specimens, but 6.0% with provider-collected specimens. For the nonavalent vaccine-types, the prevalences were 26.6% and 16.7% respectively. There were multiple infections involving both vaccine-preventable and nonvaccine preventable high-risk human Papillomavirus genotypes. Conclusion The Akuse subdistrict can, therefore, be said to have a high burden of human Papillomavirus infections, which included nonvaccine types, as detected with both self-collected and provider-collected specimens. These imply that self-collection is to be given a higher consideration as a means for a population-based high-risk human Papillomavirus infections burdens assessment/screening. Additionally, even with a successful implementation of the HPV vaccination, if introduced in Ghana, there is still the need to continue with the screening of women.
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Johnson LG, Armstrong A, Joyce CM, Teitelman AM, Buttenheim AM. Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review. Implement Sci 2018; 13:28. [PMID: 29426344 PMCID: PMC5807829 DOI: 10.1186/s13012-018-0718-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/29/2018] [Indexed: 12/23/2022] Open
Abstract
Background Developed countries, such as the USA, have achieved significant decreases in cervical cancer burden since the introduction of Pap smear-based programs in the 1960s. Due to implementation barriers and limited resources, many countries in sub-Saharan Africa (SSA) have been unable to attain such reductions. The purpose of this review is to evaluate implementation strategies used to improve the uptake and sustainability of cervical cancer prevention programs in SSA. Methods A reviewer (LJ) independently searched PubMed, Ovid/MEDLINE, Scopus, and Web of Science databases for relevant articles with the following search limits: English language, peer reviewed, and published between 1996 and 2017. The 4575 search results were screened for eligibility (CJ, LJ) to identify original research that empirically evaluated or tested implementation strategies to improve cervical cancer prevention in SSA. Fifty-three articles met criteria for inclusion in the final review. AA, CJ, and LJ abstracted the included articles for implementation-related content and evaluated them for risk of bias according to study design with the National Heart, Lung, and Blood Institute’s (NHLBI) Quality Assessment Tools. Results were reported according to PRISMA guidelines. Results The 53 included studies are well represented among all sub-Saharan regions: South (n = 16, 30.2%), West (n = 16, 30.2%), East (n = 14, 26.4%), and Middle (n = 7, 13.2%). There are 34 cross-sectional studies (64.2%), 10 pre-posttests (18.9%), 8 randomized control trials (15.1%), and one nonrandomized control trial (1.9%). Most studies are “fair” quality (n = 22, 41.5%). Visual inspection with acetic acid (VIA) (n = 19, 35.8%) was used as the main prevention method more frequently than HPV DNA/mRNA testing (n = 15, 28.3%), Pap smear (n = 13, 24.5%), and HPV vaccine (n = 9, 17.0%). Effectiveness of strategies to improve program implementation was measured using implementation outcomes of penetration (n = 33, 62.3%), acceptability (n = 15, 28.3%), fidelity (n = 14, 26.4%), feasibility (n = 8, 15.1%), adoption (n = 6, 11.3%), sustainability (n = 2, 3.8%), and cost (n = 1, 1.9%). Education strategies (n = 38, 71.7%) were used most often but have shown limited effectiveness. Conclusion This systematic review highlights the need to diversify strategies that are used to improve implementation for cervical cancer prevention programs. While education is important, implementation science literature reveals that education is not as effective in generating change. There is a need for additional organizational support to further incentivize and sustain improvements in implementation. Electronic supplementary material The online version of this article (10.1186/s13012-018-0718-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren G Johnson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | - Allison Armstrong
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline M Joyce
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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