Enhancing client-centered approaches to improve cervical cancer prevention in Western Kenya. A targeted training for Community Health Volunteers (CHVs)

Abstract

Cervical cancer continues to exert a disproportionate burden on women in low and middle-income countries (LMICs), particularly in Sub-Saharan Africa where over 90% of global cervical cancer fatalities occur. In Kenya, cervical cancer is the number one cause of cancer-related mortality in women. Low availability of screening facilities, inadequate awareness of the benefits of screening, stigma, and fear are among the major contributors to this disparity. Community Health Volunteers (CHVs), with the appropriate training and support can play a pivotal role in addressing this disparity through community education and awareness creation, distribution of HPV self-testing kits and follow-up and linkage to screening and treatment services. We conducted a cluster-randomized study of 125 CHVs (66 in intervention and 59 in control) in Western Kenya to evaluate the impact of a tailored training program on their knowledge of HPV and cervical cancer prevention key concepts and practices, and their confidence to provide these services. Pre-training, CHVs exhibited low knowledge of key concepts and practices in cervical cancer prevention in intervention and control groups, with a mean score of 53% and 56%, respectively. After training, the overall knowledge of key concepts and practices in HPV and cervical cancer prevention, and knowledge of HPV and cervical cancer screening guidelines improved significantly in both groups (p<0.001, p= 0.008, p<0.000, p<0.000). However, significant improvement in knowledge of ethical and professionalism was observed only in the intervention group (p=0.003 vs p=0.946). In this study, stigma related to cervical cancer, HPV, and HIV was low, and the increase in knowledge had a weak correlation with stigma reduction in all three disease domains in both groups. This study showed significant improvement in CHV’s knowledge of key concepts and practices in HPV and cervical cancer prevention in intervention and control groups. Additionally, there was significant improvement of knowledge about ethical and professional practices only in the intervention group. Therefore, to promote the cervical cancer prevention services rendered by CHVs, and to build the trust and credibility of CHVs, regular tailored CHV training is imperative.