A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision

Abstract

The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub-Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low-resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community-based self-administered HPV testing and mobile treatment provision. In two rural districts of western-central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self-collection of vaginal samples for high-risk human papillomavirus (hrHPV) testing. High-risk human papillomavirus-positive women were re-contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self-collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low-resource settings.