Huchko Megan J, Saduma Ibrahim, Blat Cinthia, Oketch Sandra, Bukusi Elizabeth A
Duke University, Durham, NC.
Kenya Medical Research Institute, Nairobi, Kenya.
J Glob Oncol. 2019 Jun;5:1-8. doi: 10.1200/JGO.18.00264.
Human papillomavirus (HPV) testing is being more widely used in simplified cervical cancer screening protocols in low-resource settings. One challenge to successful implementation is the multiple visits necessary to provide results and follow-up. mHealth strategies may reduce visit burden by providing information through text message.
As part of a cluster-randomized trial to compare HPV testing in clinics and community health campaigns in western Kenya, we carried out a mixed-methods study to assess women's preferences and experiences with different strategies to receive their results. Women could opt to receive their HPV results via text message, cell phone call, home visit, or return clinic visit. We examined overall receipt of results, follow-up rates, and acceptability by notification method.
Among the 4,947 women who underwent HPV-based cervical cancer screening, 1,596 (32%) received results via text message, 1,181 (24%) via cell phone call, 1,563 (32%) via clinic visit, and 605 (12%) via home visit. Women opting for texts or calls were younger and had higher rates of prior cervical cancer screening, HIV testing, and modern contraceptive use ( < .001 for all). Home visits were associated with a significantly higher rate of treatment acquisition (45%) than texts (38%), cell phone calls (38%), and clinic visits (23%; < .001). In a model controlling for age, prior screening, HIV testing, and contraceptive use, clinic visits remained significantly associated with decreased odds of treatment (adjusted odds ratio, 0.45; 95% CI, 0.29 to 0.69) compared with texts. Among treated women, there was no difference in time to treatment by notification method.
Cell phone-based results notification strategies were preferred by women with greater health-seeking behavior; however, HPV-positive women who received results via home visit were more likely to pursue for treatment.
在资源匮乏地区，人乳头瘤病毒（HPV）检测在简化宫颈癌筛查方案中得到了更广泛的应用。成功实施该检测面临的一个挑战是需要多次就诊才能提供检测结果并进行后续跟进。移动健康策略可能通过短信提供信息来减轻就诊负担。
作为一项在肯尼亚西部比较诊所HPV检测和社区健康活动的整群随机试验的一部分，我们开展了一项混合方法研究，以评估女性对不同结果接收策略的偏好和体验。女性可以选择通过短信、手机通话、上门家访或回诊所就诊来接收HPV检测结果。我们通过通知方式检查了结果的总体接收情况、后续跟进率和可接受性。
在4947名接受基于HPV的宫颈癌筛查的女性中，1596名（32%）通过短信接收结果，1181名（24%）通过手机通话接收结果，1563名（32%）通过诊所就诊接收结果，605名（12%）通过上门家访接收结果。选择短信或电话的女性更年轻，先前宫颈癌筛查、HIV检测和现代避孕措施的使用率更高（所有P均<0.001）。上门家访与接受治疗的比例（45%）显著高于短信（38%）、手机通话（38%）和诊所就诊（23%；P<0.001）相关。在控制年龄、先前筛查、HIV检测和避孕措施使用的模型中，与短信相比，诊所就诊与接受治疗几率降低仍显著相关（调整后的优势比为0.45；95%置信区间为0.29至0.69）。在接受治疗的女性中，通过不同通知方式接受治疗的时间没有差异。
有更多健康寻求行为的女性更喜欢基于手机的结果通知策略；然而，通过上门家访接收结果的HPV阳性女性更有可能寻求治疗。
