Background

Cervical cancer is a major disease burden globally, and is ranked the fourth common cancer with over 660,000 new cases and 350,000 deaths annually. The highest burden however is seen in Low-and-middle income countries especially in sub-Saharan Africa, Central America and South-East Asia. In Sub-Saharan Africa, cervical cancer is the cause of high mortality among women yet it is preventable through screening and vaccination. In Kenya it is the second most common cancer among women, accounting for 5,845 new cases (20.6% of all female cancers) annually with an age standardized rate of 32.8 per 100,000. Equitable access to quality screening and treatment services, robust and interoperable monitoring systems and tools, and clear patient referral pathways and management are critical for countries to deliver and measure progress towards achieving the WHO 90-70-90 strategy.
 
Objectives

This study aimed to evaluate canSCREEN model designed to improve linkage to treatment of pre-invasive cervical lesions among women who test positive during screening, conduct follow-up of women and linkage of canSCREEN data to Nairobi cancer registry database, to understand disease progression, diagnosis and treatment.
 
Methodology

canSCREEN® platform was implemented two years ago as a pilot study in Nairobi County in selected healthcare facilities composed of a national referral facility (level 6), County hospital (level 5), sub-County hospital (level 4), a faith-based hospital and a community clinic. This prospective study utilized a mixed method approach to evaluate indices of adoption, implementation, utility, feasibility, and sustainability of canSCREEN® as a tool to improve cervical cancer referral pathway and management in Nairobi. The study population was made up of women screened in the selected facilities and enrolled in the canSCREEN platform. The study further conducted an intervention to improve follow-up of women and appropriate linkage to care and conduct linkage of the canSCREEN data and cancer registry data to better understand disease progression and linkage to diagnosis and treatment.

Results

A total of 9,087 women were enrolled in the canSCREEN® platform. 4,700 were screened using VIA and 518 with HPV with a with positivity rate of 5.8% (273/4700) and 41.7% (216/518) respectively. Of HPV screening episode, 477 (92%) were based on self-collection and 41 (8%) by healthcare practitioner. In the quantitative arm, 236 participants were enrolled. 61% (143/236) were on routine screening, 91% (216/236) have heard of cervical cancer, and 49% (116/236) have heard of HPV vaccine. 65% (99/236) believe the available information sufficiently address their needs on cervical cancer. The user experience, and stakeholders feedback were documented qualitatively to evaluate the usability, adaptability, sustainability and cost effectiveness of implementing the canSCREEN® data platform.

Conclusions / Implications for policy

We expect more women to access screening services and complete the care, gain knowledge on the implementation of a cervical cancer screening registry, an improved cervical cancer referral pathway, and greater proportion of women who receive appropriate follow-up and care, following abnormal cervical cancer screening, ultimately reducing the incidence rate and mortality due to cervical cancer.