Implementation and Evaluation of Evidence-based Strategies to Increase Screening and Prevention of Cervical Cancer in Kilimanjaro, Tanzania
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Authors
Chelva, Melinda
Date
2024-09-30
Type
thesis
Language
eng
Keyword
cervical cancer , human papillomavirus , Tanzania , patient navigation , implementation science , risk communication , shared decision-making
Alternative Title
Abstract
Background: Cervical cancer (CC) is the leading cause of cancer-related female death in Tanzania. National Expansion of Human Papillomavirus (HPV)-based Cervical Cancer Screening in Tanzania (NECST) is a pilot multicomponent research program. It evaluates evidence-based strategies that can be implemented to improve the CC ‘screen-triage-treat’ approach, including HPV DNA self-sampling.
Objectives: 1) Review the literature on existing mHealth interventions used to address women’s cancers in low- and middle-income countries (LMICs). 2) Evaluate the effectiveness of evidence-based recruitment strategies in increasing attendance to visual inspection of the cervix with/through acetic acid (VIA). 3) Understand CC risk and willingness to attend screening at the participant level. 4) Assess the effectiveness of mHealth-supported patient navigation (PN) strategies to increase adherence to VIA triage and treatment of precancerous lesions.
Methods: 1) Conduct a scoping review through a search strategy of five electronic databases and compare outcomes against the mHealth evidence reporting and assessment (WHO-mERA) checklist. 2) Eligible women were recruited from 30 communities (wards) in Tanzania to perform HPV DNA self-sampling to compare evidence-based recruitment strategies. 3) Participants completed exit surveys after undergoing HPV DNA self-sampling. 4) HPV-positive participants are being randomized to one of four PN conditions in an ongoing randomized controlled trial.
Results: 1) 30 studies met the inclusion criteria. More than 50% of the studies provided enough information to assess a minimum of 10 items on the WHO-mERA checklist. 2) The preliminary analysis revealed no significant difference in attendance to VIA (if HPV-positive) between the recruitment arms. 3) Despite high awareness of CC among participants, significant knowledge gaps and misconceptions remain regarding CC and HPV risk. However, when provided with CC counselling and screening, most participants felt well-informed and trusted and relied on their partners’ input in making health-related decisions. 4) Delivering evidence-based strategies to improve linkage to preventive care for CC is ongoing as a culmination of the completed work to date in the research program.
Conclusions: Implementing the selected innovative, evidence-based strategies in Tanzania’s cervical cancer prevention ‘screen-triage-treat’ pathway will inform health system change in the national CC screening program and other countries with a similar cancer-health disparity.
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.