Prevention and Detection of Cervical Cancer through Self-Administered Screening in the Community
Cervical cancer impacts over half a million women globally each year, with almost 90% of cases occuring in resource-limited settings. This is mainly due to the lack of population-based screening programs, which reduce the burden of disease in resource-replete settings through treatment of precancerous lesions. In Sub-Saharan Africa, the cervical cancer disparity has worsened over the past twenty years due to the HIV epidemic, which increases the biologic risk for cervical cancer and has strained the already overburdened healthcare systems. In Uganda, the Ministry of Health has set an agenda for cervical cancer prevention over the next 5 years.
The Ministry of Health recognizes that in addition to employing evidence-based screening and treatment techniques, the overall population impact of cervical cancer screening depends on two main factors:
1. community-wide access to screening and
2. successful linkage to treatment or follow-up for women who screen positive.
Uganda's Strategic Plan for Cervical Cancer Control prioritizes the evaluation of implementation strategies for cervical cancer prevention as a key first step in addressing the burden of disease. In Project 2, we will evaluate a context-specific, community-based cervical cancer prevention program employing simple, low-cost screening and treatment techniques. Specifically, the program will provide cervical cancer screening with self-collected human papillomavirus (HPV) specimens offered through community health campaigns. The program will also provide cryotherapy through mobile treatment teams working in the local communities to reduce the risk of invasive cancer in women who test positive for HPV. Ongoing evaluation of the program will allow the research team to iteratively adapt the activities to address individual- and community-level factors as well as processes that impact the uptake of screening and treatment. Our specific aims are to:
1. Establish the acceptance and correlates of self-collected HPV-RNA testing among women in the rural Ugandan community as well as the incidence and determinants of successful completion of the cervical cancer screening cascade from self-collected HPV testing to receipt of results
2, Ascertain the frequency and determinants of successful acquisition of treatment among women who have HPV detected on self-collected swabs in rural Uganda.
3. Derive population-based estimates of the prevalence of high-risk HPV and cervical intraepithelial neoplasia (CIN) detected through community-based screening employing self-collected HPV RNA testing in rural Uganda.