Predictors of Successful Treatment Acquisition Among HPV Positive Women in Western Kenya
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Background: While highly preventable cervical cancer remains a leading cause of
cancer in women globally. Sub-Saharan Africa is disproportionately affected, and in
Kenya specifically, over 4,800 new cervical cancer cases are diagnosed and over 2,000
deaths occur each year. While screening for human papillomavirus (HPV) is a more
cost-effective screening strategy with the potential to increase screening uptake, there is
substantial lost to follow-up (LTFU) for treatment following a positive HPV screen. This
study aimed to identify the predictors of successful treatment acquisition and explore
the barriers and facilitators to seeking treatment among HPV positive women.
Methods: This mixed-methods study was integrated into an ongoing clusterrandomized
trial of implementation strategies in rural western Kenya. This study
randomly selected 100 HPV positive women from the original study database and
conducted a treatment acquisition behavior survey. The study sought a 50/50 ratio of
women who were treated and LTFU, but obtained data from 61 treated women and 39
LTFU women. A subset of 10 women in each group were then selected for in-depth
interviews. Analysis included descriptive statistics to compare treated and LTFU
women’s responses to the survey questionnaire. Interview transcripts were coded and
analyzed through code-by-code comparisons of women who were treated and women
who were LTFU.
Results: Cost of transportation and distance to the health facility were the most
common challenges in seeking treatment among both treated and LTFU women. Among
women who sought treatment, 67% (n=41) reported that their peers knew their HPV test
result, whereas among LTFU women only 38% (n=15) reported that their peers knew
their HPV test result (p=0.007). There was a significant difference in knowing their peers’
HPV result between treated and LTFU women (p=0.03). Partner support was described
by treated and LTFU women similarly, in that most women reported that they relied on
their partners for transportation money, and that men not understanding the disease
may prevent them from supporting their wives in seeking treatment. Additional barriers
included fear of the treatment process, stigma within their community, logistical
barriers, and lack of information on the disease and treatment. Facilitators to treatment
seeking included peer encouragement, support and encouragement of their children,
involving men in educational sessions, bringing facilities closer and providing
transportation to the health facility.
Conclusions: Cost of transportation, distance to the treatment facility, support of
partners and children, feelings of fear and stress, stigma within the community and
logistical barriers were reported similarly across treated and LTFU groups. The greatest
disparity between the two groups was a lack of social support among LTFU women.
Given the potential impact of involving men and women in the community in
educational sessions, and promoting treatment seeking in groups, interventions that use
these treatment facilitators are needed.
Lost to follow-up
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Rights for Collection: Masters Theses