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Implementing community-based human papillomavirus self-sampling with SMS text follow-up for cervical cancer screening
Naima T Joseph1,2, Alexcer Namuli3, Bernard Kakuhikire4
1Department of Obstetrics and Gynecology, Beth Isreal Deaconness Medical Center, Boston, MA, USA.
Background:
Self-collected HPV screening may improve cervical cancer screening coverage in low resource countries, yet data guiding implementation and follow-up of abnormal results are sparse.
Methods:
This is a prospective cohort implementation study of HPV self-testing program in Mbarara, Uganda with mobile phones to facilitate result notification and referral for treatment at a regional hospital. The effectiveness of the interventions was analyzed using Proctor's model of implementation. Women were interviewed following screening and at 6 months to assess acceptability and barriers to follow-up. Data were analyzed using descriptive statistics.
Results:
159 of 194 (82%) of eligible women underwent HPV self-sampling; of these, 27 (17%) returned positive for high-risk HPV subtypes. We sent SMS messages providing test results and follow-up instructions to all participants. Seventeen (63%) hrHPV-positive participants reported receiving SMS text instructions for follow-up, of whom 6 (35%) presented for follow-up. The most common reasons for not returning were: lack of transportation (n = 11), disbelief of results (n = 5), lack of childcare (n = 4), and lack of symptoms (n = 3). Confidence in test results was higher for self-screening compared to VIA (Likert score 4.8 vs 4.4, P = 0.001).
Conclusions:
Despite the use of SMS text-based referrals, only one-third of women presented for clinical follow-up after abnormal HPV testing.
