The Promise of Self-Testing to Prevent Cervical Cancer

When Megan Huchko, M.D., began working in Kenya nearly two decades ago, she realized that one of the biggest barriers for women to be screened for cervical cancer was not necessarily the test itself, but where it took place.

In Kenya, many women live in rural areas, sometimes hours away from the nearest health clinic. Even as more women have careers, they are still the primary caregivers in their households, needing to be present whenever a child or family member falls ill.

“With all of these responsibilities, it’s hard to prioritize screenings,” says Huchko, the Hollier Family Associate Professor of Global Health at the Duke Global Health Institute and director of DGHI’s Center for Global Reproductive Health.

Huchko and her team have been working to change that with a mobile health app called mSaada, which allows community health volunteers (CHVs)to facilitate cervical cancers screenings at women’s homes. Launched in 2019, the app has been tested in Kisumu County, home to more than 1 million people. Since the launch of the app, around 25,000 women have been screened for human papillomavirus (HPV), which if untreated can cause cervical cancer, including more than 8,000 in the past six months.

That work has appealed to the Kenyan government, which has allowed mSaada to be integrated into CommCare, a mobile health platform used by CHVs when they go door-to-door in communities to conduct regular health checks.

“Allowing women to screen via self-collection so they avoid a pelvic exam and have more time for a personalized, accurate screening is women-centered,” says Huchko, who is also an associate professor in the department of obstetrics & gynecology at Duke. “It’s really great to see this technology in this county.”

Bringing HPV Testing into the Home

During a home visit, CHVs can use mSaada to show women how to collect a sample to test for HPV. Women can do this privately, giving samples to the CHVs for testing at a lab. Up to 90 samples are tested at once, and results are given to patients between one to two weeks later. Women can choose to receive their results via phone call or a return visit from a volunteer.  

In Kisumu County, CHVs screen between two and three women each day when making home visits. They have also offered screenings at community events such as health fairs, setting up tents to provide private spaces for self-testing.

In Kenya, cervical cancer is the second most common cancer in women, claiming around 5,200 lives annually, reports Gavi. Typically, women in Kenya are screened for HPV every three to five years. But more routine screenings are needed for women living with pre-existing conditions, such as HIV, that increase the risk of acquiring HPV.

Although there is a vaccine to prevent HPV, it’s still only offered to adolescent girls in Kenya, making routine screening essential for adult women. If a woman tests positive for HPV, she can receive treatment at local clinics, which also get supplies and assistance from Huchko and her team.

“CHVs ensure women get into clinics for treatment if they test positive for HPV,” Huchko says. “This eliminates the burden for women to come into clinic for screening. Self-testing is increasingly being promoted as a primary [tool] for HPV screening around the world.”

‘Meet Women Where They Are’

The development of mSaada, which is Swahili for “support,” grew out of need. But it is also the product of a partnership with Gregory Ganda, an obstetrician and gynecologist in Kenya. A long-time collaborator with Huchko on cervical cancer prevention strategies, Ganda is now the minister of health for Kisumu County, and he helped push for mSaada’s integration into CommCare in 2023.

“He advised me on the best way to reach women – to meet them where they are,” says Huchko, noting Ganda always favored screenings to be in homes rather than health facilities. “We feel incredibly lucky that he is so dedicated to the challenge of cervical cancer in Kenya.”

In 2019, Huchko enlisted help from students in a Duke computer science Capstone course. They developed the first iteration of mSaada, which allowed a patient’s record to be linked electronically to her individual sample. Results from that study were published in the Journal of Medical Internet Research in 2022.

Duke undergraduate and graduate students have continued to refine and test the app, adding automatic text messages to patients and training materials for CHVs. Multiple student teams have spent time in Kisumu County as part of DGHI’s Student Research Training program, and recently two students helped launch a childcare center at a hospital in the county to make it easier for women to keep appointments to receive HPV treatment.

“We’ve heard women say they’re afraid to have the diagnosis or don’t understand treatment,” Huchko says. “We want them to understand the importance of screening. And, to support them.”

Prospects Beyond Kenya

With the support of grants from the National Institutes of Health and other sources, the use of mSaada has grown from an initial group of fewer than 20 community health volunteers to more than 120 today. But sustainable expansion will require more partners, including investment from the Kenyan government, Huchko says. She met with representatives of Kenya’s National Cancer Institute to discuss that possibility during DGHI’s partnership meeting in Eldoret in June 2024.

“It’s challenging when there’s a limited pile of resources and a dependency on donor funding for these programs,” she says. “We’re trying to create something that the [Kenya] ministry can have total guidance over.”

With the World Health Organization calling to end cervical cancer globally by 2030, Huchko hopes mSaada can serve as an intervention beyond Kisumu County. Health leaders in Uganda and in Liberia have expressed interest in using the mobile app in their communities. It’s those conversations that give mSaada promise as a part of the toolbox to put an end to the preventable disease in Kenya and beyond.