Journal Article

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

Park, Lawrence P., Huchko, Megan J., Ibrahim, Saduma, Page, Charlotte M.

2020

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Assessments / Biology and life sciences / Bivariate analysis / Cancer / Cancer screening / Cervical cancer / Cervix / Community / Community Health Services - economics / Community Health Services - organization & administration / Community Health Services - statistics & numerical data / Complications and side effects / Cryotherapy / Cryotherapy - economics / Cryotherapy - statistics & numerical data / Disease prevention / Early Detection of Cancer - economics / Early Detection of Cancer - statistics & numerical data / Engineering and Technology / Female / Gynecology / Health care facilities / Health Care Rationing - economics / Health Care Rationing - organization & administration / Health Care Rationing - statistics & numerical data / Health facilities / Health Knowledge, Attitudes, Practice / Health Plan Implementation - economics / Health Plan Implementation - organization & administration / Health Plan Implementation - statistics & numerical data / Health promotion / Health Promotion - economics / Health Promotion - organization & administration / Health Promotion - statistics & numerical data / Health Services Accessibility - economics / Health Services Accessibility - organization & administration / Health Services Accessibility - statistics & numerical data / Health Workforce - organization & administration / Health Workforce - statistics & numerical data / Hospitals / Human papilloma viruses / Human papillomavirus / Humans / Kenya - epidemiology / Management / Mass Screening - economics / Mass Screening - organization & administration / Mass Screening - statistics & numerical data / Medical research / Medical screening / Medicine and Health Sciences / Mortality / Observational studies / Observational Studies as Topic / Obstetrics / Papillomaviridae - isolation & purification / Papillomavirus infections / Papillomavirus Infections - diagnosis / Papillomavirus Infections - epidemiology / Papillomavirus Infections - therapy / Papillomavirus Infections - virology / Patient Education as Topic / Polls & surveys / Prevention / Questionnaires / Referral and Consultation - statistics & numerical data / Resource availability / Rural Population - statistics & numerical data / Social Sciences / Studies / Surveys / Uterine Cervical Neoplasms - epidemiology / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - prevention & control / Uterine Cervical Neoplasms - virology / Women's health / Womens health