Browsing by Author "Huchko, Megan J"

Background: Cervical cancer is a preventable disease with a disproportionate burden in Sub-Saharan Africa. In Kenya, cervical cancer is the leading cause of cancer-related death in women. In line with WHO recommendations, Kenya is offering screening to women between the ages of 30 and 65 years old; however, rates of screening uptake are far below desired levels due to economic, logistical, and social barriers. This study is phase 2 of a two-part trial exploring implementation strategies for HPV-testing using self-collected specimens. Drawing on lessons from phase 1, we offered HPV-testing through community health campaigns (CHCs) in rural communities followed by linking HPV-positive women to facility-based treatment. Methods: Target communities were enumerated before the CHCs to identify women in the age range of 30-65 years old and who were not pregnant. Women were educated about cervical cancer by community health volunteers and told of when and where the CHC would be happening. At the CHC, participants were consented, given a brief demographics survey, and instructed on how to self-collect cervical specimens for HPV-testing. Participants were later contacted via SMS messaging, phone calls, or home visits with their results. Women who were enumerated but did not attend the fair were visited at home and offered testing. Those who tested as HPV-positive were linked to their nearest health center for preventative treatment. Descriptive statistics and logistic regression were used to analyze the demographic characteristics of women who came to the CHC and women who sought treatment compared with those who didn’t. Results: A total of 3299 women were screened for HPV, an estimated target population reach of 77%. The average HPV positivity rate was 16.7% across both the CHCs and the mop up. Of the 551 women who were HPV positive, 278 of them (50.5%) sought treatment. Characteristics associated with screening at the CHC included being encouraged to come by someone the woman knows, having completed primary school, some secondary school or attending college and above, working in the labor, professional, academic professions, having heard of cervical cancer before, working outside the home, and having missed work to attend screening. Women who came to the CHC had 25% greater odds of seeking treatment compared to women screened in home visits. Characteristics associated with seeking treatment included having tested for cervical cancer before and having missed work to attend screening. Having heard of cervical cancer before was also associated with seeking treatment, but with less precise estimates. Conclusion: Social support for seeking care and knowledge of cervical cancer are associated with women attending community health campaigns that offer self-collected HPV-testing. Other demographics have weak or null associations with care-seeking behavior in this context, suggesting the CHC model with enhanced linkage to care methods could be a way to overcome some of the social and logistical barriers women face for accessing preventative treatment. However, at a treatment linkage rate of only 50%, more work needs to be done to further understand the barriers to care in this context.

Background: Despite increasing availability of preventative HPV vaccines and screening strategies, uptake of these effective measures in Kisumu, Kenya is limited by cultural and logistical barriers. Limited understanding and societal perceptions of HPV and cervical cancer are potential sources of stigma that could negatively impact screening behavior. By designing and implementing a stigma-responsive educational intervention, we sought to improve understanding and risk perception and increase the likelihood cervical cancer screening.

Methods: We carried out a study of a stigma responsive strategy to deliver HPV-based cervical cancer prevention services in Kisumu, Kenya. Focus group discussions (FGDs) explored experiences of HPV and cervical cancer screening, health messaging and potential stigma sources. Qualitative analysis of the FGDs informed the development of a stigma-responsive educational video. Four Kisumu County healthcare facilities were randomized to either watch the video or receive standard HPV and cervical cancer education, after which participants at both sites completed a survey to measure HPV- and cervical cancer stigma. Stigma scores were compared between control and intervention groups using linear regression.

Results: Thirty women participated in the focus group discussions. Drivers of stigma included concerns about confidentiality and disclosure of HPV results, fears of cancer or implications of a sexually transmitted infection diagnosis. Anticipated outcomes included illness or death, financial hardship or family abandonment. The FGDs findings informed development of the educational video. A total of 288 women, 109 in the intervention group, completed the stigma survey. Mean HPV and cervical cancer scores were found to be statistically lower in the intervention arm, with Dholuo language associated with higher stigma levels in both arms.

Conclusions: This multi-step study explored knowledge, attitudes and beliefs specific to HPV and cervical cancer health messaging in western Kenya in order to develop and test a stigma-responsive education strategy. The stigma-responsive video demonstrated a quantitative decrease in stigma survey response means for those who watched the video. The pre-pilot design will drive a larger pilot study to examine the effect of the educational video on HPV self-sampling.

Background: Cervical cancer is the fourth most common cancer worldwide, despite its highly preventable nature. Cervical cancer disproportionately affects individuals in low- and middle-income countries (LMICs), especially those in sub-Saharan Africa. Kenya experiences the highest cervical cancer incidence rate within the East African region (33.8 per 100,000 women) and is among the highest in the world. Huchko et al. demonstrated that cervical cancer screening via Human Papillomavirus (HPV)-based self-collection, led by community health volunteers (CHVs), is acceptable and well attended. While well received by communities in Western Kenya, researchers highlighted key barriers to the scale and potential effectiveness of this approach, including a need for electronic data collection and a lack of protocol and decision support tools for healthcare providers, who are often lay providers. Based on high reported mobile phone ownership within Kenya generally and past research documenting success with text message-based delivery of screening results within Western Kenya, the introduction of a mobile application-based intervention to address the identified challenges to cervical cancer screening and prevention appears feasible. This study sought to iteratively develop an mhealth intervention with key stakeholders, evaluate the usability of the intervention, and describe factors that limit and build cervical cancer screening self-efficacy among lay providers.

Methods: Between June 2019 and January 2020, we conducted a two-part study in Kisumu, Kenya to develop and pilot a mobile phone application, “mSaada.” In the first part of the study, between June and August 2019, a purposive sample of 18 participants completed in-depth interviews (IDIs) in two waves to provide a detailed review of the mSaada app and its features. Iterative revisions of the app were informed by participant feedback. During the second part, between October 2019 and January 2020, we conducted a small-scale pilot usability study within three healthcare facilities in Kisumu, Kenya. A convenience sample of 10 community health volunteers incorporated the mSaada mobile application into their daily interactions with clients during cervical cancer screening and education sessions. Participants completed usability and self-efficacy surveys throughout the study period as well as an in-depth interview to provide insight into their experience using mSaada.

Results: Iterative development of the mSaada mobile application resulted in major changes to the app’s user interface, aesthetics and organization, as well as the addition and clarification of educational content included within the platform. Overall, mSaada usability ratings increased significantly during the study period (4.54 to 4.84, p<0.001). During qualitative interviews, participants highlighted the app’s ease of use, impact on their workflow, and the comprehensiveness of the included information as strengths of mSaada. Participants did, however, cite concerns about the feasibility of broader implementation of the platform within Kenya. Overall, CHV self-efficacy increased significantly from the beginning to the end of the study period (4.53 to 4.74, p=0.008). When asked about factors limiting self-efficacy, participants discussed language barriers, time constraints, supply shortage, and privacy issues. Reference materials, personal knowledge, and experience and repetition were seen as factors that build self-efficacy.

Conclusions: While mSaada’s usability increased and the platform was observed to improve lay provider self-efficacy, much research is still needed in this area. Specifically, there is a need to engage women eligible for screening in future studies to help tailor mSaada such that it can best benefit the client population. Also, further development of the technological infrastructure within this setting is needed to promote long-term feasibility and sustainability of an mhealth solution like mSaada.