Characteristics of Women Who Attend Cervical Cancer Screening and Follow-Up in Community Health Campaigns Versus Home Visits in Rural Western Kenya

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.