Predictors of Successful Treatment Acquisition Among HPV Positive Women in Western Kenya

Abstract

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