Swanson Megan, Ibrahim Saduma, Blat Cinthia, Oketch Sandra, Olwanda Easter, Maloba May, Huchko Megan J
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, Mission Hall, 7th Floor, Room 7444, Box 0132, 550 16th St, San Francisco, CA, 94158, USA.
Research care and Training Programme/FACES NGO, Kenya Medical Research Institute, Nairobi, Kenya.
BMC Womens Health. 2018 Jul 3;18(1):116. doi: 10.1186/s12905-018-0586-0.
The incidence of cervical cancer in Kenya is among the highest in the world. Few Kenyan women are able to access screening, thus fueling the high cervical cancer burden. Self-collected human papilloma Virus (HPV) tests, administered during community-health campaigns in rural areas may be a way to expand access to screening.
In December 2015, we carried out a four-day community health campaign (CHC) to educate participants about cervical cancer prevention and offer self-administered HPV screening. Community enumeration, outreach and mobilization preceded the CHC. Samples were sent to Migori County Hospital for HPV DNA testing using careHPV Test Kits. Women were notified of results through their choice of short message service (SMS), phone call, home visit or clinic visit. HPV positive women were referred for cryotherapy following a screen-and-treat strategy.
Door-to-door enumeration identified approximately 870 eligible women in Ngodhe Community in Migori County. Among the 267 women attending the campaign, 255 women enrolled and collected samples: 243 tests were successfully resulted and 12 were indeterminate. Of the 243 resulted tests, 47 (19%) were positive for HPV, with young age being the only significant predictor of positivity. In multivariate analysis, each additional year of age conferred about a 4% decrease in the odds of testing positive (95% CI 0.1 to 7%, p = 0.046). Just over three-quarters of all women (195/255), were notified of their results. Those who were unable to be reached were more likely to prefer receiving results from clinic (54/60, 90%) and were less likely to have mobile phones (24/60, 73%). Although 76% of HPV positive women were notified of their results, just half (51%) of those testing positive presented for treatment. HPV positive women who successfully accessed the treatment facility did not differ from their non-presenting counterparts by demographics, health history, desired route of notification or access to a mobile phone.
Nearly a third of eligible women in Ngodhe Community attended the CHC and were screened for cervical cancer. Nearly all women who attended the CHC underwent cervical cancer screening by self-collected HPV tests. Three-quarters of all participants received results, but just half of HPV positive participants presented for treatment in a timely fashion, suggesting that linkage to treatment remains a major challenge.
NCT02124252 , Registered 25 April 2014.
肯尼亚宫颈癌发病率位居世界前列。很少有肯尼亚女性能够接受筛查，这加剧了宫颈癌的沉重负担。在农村地区开展社区健康活动期间进行的自我采集人乳头瘤病毒（HPV）检测，可能是扩大筛查覆盖面的一种方式。
2015年12月，我们开展了为期四天的社区健康活动（CHC），对参与者进行宫颈癌预防教育，并提供自我管理的HPV筛查。在社区健康活动之前进行了社区人口普查、宣传和动员。样本被送往米戈里县医院，使用careHPV检测试剂盒进行HPV DNA检测。通过女性选择的短信（SMS）、电话、家访或门诊就诊的方式通知她们检测结果。HPV检测呈阳性的女性按照筛查和治疗策略被转诊接受冷冻治疗。
挨家挨户的人口普查在米戈里县恩戈德社区确定了约870名符合条件的女性。在参加活动的267名女性中，255名女性登记并采集了样本：243份检测成功得出结果，12份结果不确定。在243份得出结果的检测中，47份（19%）HPV检测呈阳性，年轻是唯一显著的阳性预测因素。在多变量分析中，年龄每增加一岁，检测呈阳性的几率约降低4%（95%置信区间0.1%至7%，p = 0.046）。超过四分之三的女性（195/255）收到了检测结果通知。无法联系到的女性更倾向于在诊所获取结果（54/60，90%），且不太可能拥有手机（24/60，73%）。尽管76%的HPV检测呈阳性的女性收到了结果通知，但只有一半（51%）检测呈阳性的女性前来接受治疗。成功前往治疗机构的HPV检测呈阳性的女性与未前往的女性在人口统计学特征、健康史、期望的通知方式或是否拥有手机方面并无差异。
恩戈德社区近三分之一符合条件的女性参加了社区健康活动并接受了宫颈癌筛查。几乎所有参加社区健康活动的女性都通过自我采集HPV检测进行了宫颈癌筛查。四分之三的参与者收到了结果，但只有一半HPV检测呈阳性的参与者及时前来接受治疗，这表明与治疗的衔接仍然是一个重大挑战。
NCT02124252，2014年4月25日注册。
