Journal Article

A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya

Isaacson, Sinéad, Oketch, Sandra, Adewumi, Konyin, Novak, Carissa, Smith, Jennifer S, Huchko, Megan J

2023

Overview

Abstract Background Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact. Materials and Methods This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers. Results Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support. Conclusions Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings. This article reports the results of a study that explored the perspectives of women who underwent self-collected HPV testing, received a positive result with the request to attend follow-up, and did not present within 60 days. In-depth interviews were used to develop an analytical framework to examine the barriers, beliefs, social norms, and logistical factors that contributed to women’s access to and decision-making about treatment.

• Publisher: Oxford University Press
• Subject: Care and treatment / Cervical cancer / Diagnosis / Early Detection of Cancer - methods / Female / Health aspects / Human papillomavirus / Humans / Kenya - epidemiology / Mass Screening / Medical screening / Papillomaviridae / Papillomavirus infections / Papillomavirus Infections - diagnosis / Qualitative Research / Transportation costs / Uterine Cervical Neoplasms - diagnosis / Uterine Cervical Neoplasms - epidemiology / Uterine Cervical Neoplasms - therapy / Women / Womens health