Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study.

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Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings.Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV).We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic.Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services.There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.





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Olwanda, Easter, Jennifer Shen, James G Kahn, Katelyn Bryant-Comstock and Megan J Huchko (2018). Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study. Global health action, 11(1). 10.1080/16549716.2018.1451455 Retrieved from

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Megan Justine Huchko

Hollier Family Associate Professor of Global Health

Megan Huchko, MD, MPH, holds a dual appointment as an Associate Professor in the Department of Obstetrics & Gynecology and the Duke Global Health Institute.  Dr. Huchko was an undergraduate at Duke before moving to New York City to complete medical school at the Albert Einstein College of Medicine, and residency training at Columbia Presbyterian Medical Center.  She completed her fellowship in Reproductive Infectious Disease the University of California, San Francisco, and was a faculty member there. 

Dr. Huchko practices as an ob/gyn generalist and specializes in cervical cancer prevention through her clinical work and global women’s health research.  Her research focuses on optimizing the diagnosis and treatment of cervical cancer among vulnerable women in settings where health disparities occur. She has been working with the Family AIDS Care and Education Services (FACES) program in the Nyanza Province of western Kenya since 2006.  

She designed and implemented a cervical cancer screening and prevention (CCSP) program for HIV-infected women enrolled in care at FACES.  The CCSP program has provided a clinical resource, as well as a cohort to evaluate the epidemiology of cervical cancer among HIV-infected women, the feasibility of integrating cervical cancer prevention programs into HIV and general outpatient clinics, the safety of various diagnostic and treatment modalities, the efficacy of low-cost/low-resource screening modalities in HIV-infected women and provider and patient-level barriers and facilitators to uptake of cervical cancer prevention activities.  

Currently, she is carrying out several large studies in central Uganda and western Kenya to evaluate the optimal implementation strategy for HPV-based cervical cancer screening in rural settings.  At Duke, she leads the Center of Excellence in Global Women’s Health through the Global Health Institute and serves as Director for the Ob/Gyn Clinical Research Unit (CRU).

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