Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review (original) (raw)
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International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2017
The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks. In addition, some common elements such as political will and government investment have facilitated action in these diverse settings. There are several challenges for continued scale-up in these countries, including maintaining trained personnel, overcoming limited follow-up and treatment capacity, and implementing quality assurance measures. Countries considering scale-up should asse...
BMC Women's Health
Objectives Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. Design This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. Setting We included studies conducted in LMICs published in English between 2010 and 2020. Participants We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. Results Seventy-nine articles ...
Journal of Global Health Reports
Background Background Poor cervical cancer screening coverage and utilization by women in low-and middle-income countries (LMICs) are linked to health system factors such as lack of access and availability of quality health care, inadequate workforce capacity, and socio-cultural and behavioral barriers. To improve women's participation in cervical screening, strategies such as involvement of community resources have been recommended. The aim of this review is to understand the current roles of community-based resources (CBRs) such as community health workers (CHWs) and community-based civil society organizations (CBOs) including key stakeholders-for example health champions, traditional leaders, chief's wives, etc. in the community in cervical screening in LMICs settings. Methods and analysis Methods and analysis We will conduct a scoping review of MEDLINE, CINAHL and Global Health databases from January 2016 to June 2020 for published peer-reviewed literature from LMICs including reference list tracking and handsearching of studies with community focus published in English describing interventions provided by CBRs in cervical screening uptake. Ethics and dissemination Ethics and dissemination Ethical approval is not required. Findings from this review will be summarised for conferences and published in peer-reviewed journals for widespread dissemination. Study will identify possible gaps in the evidence and differences in the role of CBRs between sub-Saharan Africa (SSA) and other LMIC regions and inform recommendations and implementation of future cervical screening research, policy, and practice.
Jurnal Ners, 2020
Introduction: This review aims to explore the factors influencing cervical screening uptake among women in low and middle-income countries. Methods: The studies were systematically identified by searching electronic databases with the keywords “cervical cancer AND screening AND low of income countries AND middle of income countries.” The results consisted of 94 articles from Scopus, 100 articles from Science Direct, 74 articles from EBSCO, and 32 articles from PubMed. Following this, 16 studies were included in this systematic review with the inclusion criteria being quantitative or qualitative studies exploring the factors influencing woman’s cervical cancer screening uptake covering women in low- and middle- income countries, a clear study outcome and details on the associated factors, barriers to, and facilitators of screening uptake. Results: Knowledge about the disease and its prevention, knowing someone with cervical cancer and someone who has ever been screened, attitude an...
Effective screening programmes for cervical cancer in low- and middle-income developing countries
Bulletin of the World Health Organisation
Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Ma...
Pan African Medical Journal, 2015
This review aims at identifying barriers to utilization of cervical cancer prevention services in low-and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low-and middle-income countries.
Global Health Action, 2019
Background: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low-and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges. Objective: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque's Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership's approach to shaping Senegal's regional cervical cancer screening policy. Methods: The systematic review search strategy comprised two complementary subsearches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance. Results: Our findings identified specific demand-side (clients and community) and supplyside (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand-and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature. Conclusions: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.
Cureus
Screening guidelines and practices differ according to resource availability and continually update as scientific developments take place. In this article, we have reviewed screening guidelines and programs for cervical cancer prevention in selected countries belonging to different economic groups viz high income, middle income, and low income. We have selected six countries-the United States of America (USA), the United Kingdom (UK), India, South Africa, Bangladesh, and Malawi. Considerable differences are observed across the health systems. Countries with established screening guidelines complemented by organised nationwide programs or insurance practices have much better screening rates. Human Papilloma Virus (HPV) DNA testing is currently the test of choice in the majority of settings for cervical cancer screening due to its higher sensitivity (up to 90-100%) and longer screening intervals (three to five years). It is also costeffective, less dependent on operator expertise, and suitable for all settings as compared to a Pap smear test or visual inspection with acetic acid (VIA). Self-sampling of HPV can further help to improve screening coverage by increasing opportunities of reaching to women who would otherwise not participate in screening programs. Resource-constrained countries recommend VIA-based screening in their national programs due to its low cost. The share of cervical cancer is higher in middle and low-income countries as they have lower screening coverage, compared to high-income countries. The main barriers faced in the implementation of the program in low-income countries (LICs) are pertaining to the health system, patientspecific challenges, and healthcare provider-specific challenges.
International Journal of Cancer, 2017
The incidence of cervical cancer in low-and middle-income countries (LMICs) is five times higher than that observed in highincome countries (HICs). This discrepancy is largely attributed to the implementation of cytology-based screening programmes in HICs. However, due to reduced health system infrastructure requirements, HPV testing (self-and provider-collected) and visual inspection with acetic acid (VIA) have been proposed as alternatives that may be better suited to LMICs. Knowing the relative value of different screening options can inform policy and the development of sustainable prevention programs. We searched MEDLINE and EMBASE for English language publications detailing model-based cost-effectiveness analyses of cervical cancer screening methods in LMICs from 2000 to 2016. The main outcome of interest was the incremental costeffectiveness ratio (ICER). Quantitative data were extracted to compare commonly evaluated screening methods and a descriptive review was conducted for each included study. Of the initial 152 articles reviewed, 19 met inclusion criteria. Generally, cytology-based screening was shown to be the least effective and most costly screening method. Whether provider-collected HPV testing or VIA was the more efficient alternative depended on the cost of the HPV test, loss to follow-up and VIA test performance. Self-collected HPV testing was cost-effective when it yielded population coverage gains over other screening methods. We conclude that HPV testing and VIA are more cost-effective screening methods than cytology in LMICs. Policy makers should consider HPV testing with self-collection of samples if it yields gains in population coverage.
Archives of Gynecology and Obstetrics, 2012
Introduction Thousands of women living in many middle and low-income countries are unnecessarily dying from cervical cancer, partly due to limited screening coverage. Objectives To identify social determinants of health (SDH) associated with cervical screening for women living in middle and low-income countries, to inform responses to improve SDH and screening coverage, and to identify research gaps. Methods A scoping literature review. We located original research articles on SDH associated with cervical cancer screening through bibliographic databases, supplemented by hand searching (n = 166 ? 4). Included were those conducted in middle and low-income countries and published in English, Portuguese and Spanish academic journals between January 2000 and June 2011 (n = 37). Excluded were those from high-income countries or focusing on screeningdiagnostic techniques or HPV vaccine. Narrative synthesis examined the results in relation to a SDH framework. Results A number of factors influence access along the pathway to cervical cancer screening. Structural (cultural and societal values, socioeconomic position, ethnicity), intermediary (geographic location, health seeking behaviours, psychosocial factors, nature of the health system), and cross-cutting (social cohesion) SDH were all important. No single factor could entirely explain the observed cervical screening patterns. Conclusion Cervical cancer screening among women living in middle and low-income countries are influenced by the interaction among several different SDH. The majority of researchers studying cervical cancer screening focused on exploring single socio-demographic variables, which is typical of positivist, biomedical and epidemiological research. An inter-sectionality approach may provide a richer understanding of the complexities that influence women's pathways to cervical cancer screening and assist design of international programmes and policies from a social justice perspective.