Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Gynecology Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
BMC Public Health. 2022 Mar 19;22(1):548. doi: 10.1186/s12889-022-12951-1.
The World Health Organization's (WHO) global strategy for cervical cancer elimination has set the target of 70% of women screened in all countries by 2030. Community sensitization through media is often used, but community health workers' (CHW) involvement may contribute to improving screening coverage. We aimed to assess effectiveness and costs of two cervical cancer screening recruitment strategies conducted in a low-resource setting.
The study was conducted in the West Region of Cameroon, in the Health District of Dschang, a community of 300,000 inhabitants. From September 2018 to February 2020, we recruited and screened women for cervical cancer in a single-visit prevention campaign at Dschang District Hospital. During the first 9 months, recruitment was only based on Community Information Channels (CIC) (e.g.. street banners). From the tenth month, participation of CHW was added in the community after training for cervical cancer prevention counselling. Population recruitment was compared between the two strategies by assessing the number of recruited women and direct costs (CHW costs included recruitment, teaching, certification, identification badge, flyers, transport, and incentives). The intervention's cost-effectiveness was expressed using an incremental cost-effectiveness ratio (ICER).
During the period under study, 1940 women were recruited, HPV positive rate was 18.6% (n = 361) and 39 cases of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were diagnosed. Among included participants, 69.9% (n = 1356) of women were recruited through CIC as compared to 30.1% (n = 584) by CHW. The cost per screened woman and CIN2+ diagnosed was higher in the CHW group. The ICER was 6.45 USD or 16.612021Int'l$ per screened woman recruited by CHW. Recruitment in rural areas increased from 12.1 to 61.4% of all women included between CIC-led and CHW-led interventions. These outcomes highlight the importance of training, preparing, and deploying CHW to screen hard-to-reach women, considering that up to 45% of Cameroon's population lives in rural areas.
CHW offer an important complement to CIC for expanding coverage in a sub-Saharan African region such as the West Region of Cameroon. CHW play a central role in building awareness and motivation for cervical cancer screening in rural settings.
世界卫生组织（WHO）的全球宫颈癌消除战略设定了到 2030 年所有国家 70%的妇女接受筛查的目标。通过媒体进行社区宣传通常是有用的，但社区卫生工作者（CHW）的参与可能有助于提高筛查覆盖率。我们旨在评估在资源匮乏环境中实施的两种宫颈癌筛查招聘策略的效果和成本。
该研究在喀麦隆西部地区的登格朗区进行，该社区有 30 万居民。从 2018 年 9 月至 2020 年 2 月，我们在登格朗区医院的单次预防活动中招募并筛查了宫颈癌妇女。在前 9 个月，仅通过社区信息渠道（例如街头横幅）进行招募。从第十个月开始，在对 CHW 进行宫颈癌预防咨询培训后，他们在社区中参与了招聘。通过评估招募的妇女人数和直接成本（包括 CHW 的招聘、教学、认证、识别徽章、传单、交通和激励费用）来比较两种策略的人群招募情况。干预措施的成本效益采用增量成本效益比（ICER）表示。
在研究期间，共招募了 1940 名妇女，HPV 阳性率为 18.6%（n=361），诊断出 39 例宫颈上皮内瘤变 2 级或更高级别（CIN2+）。在所纳入的参与者中，69.9%（n=1356）的妇女通过 CIC 招募，而 30.1%（n=584）的妇女通过 CHW 招募。每筛查一名妇女和每诊断出一名 CIN2+患者的成本在 CHW 组更高。通过 CHW 每筛查一名妇女的 ICER 为 6.45 美元或 16.612021 国际美元。在 CIC 主导和 CHW 主导的干预措施之间，农村地区的招募人数从所有纳入妇女的 12.1%增加到 61.4%。这些结果强调了培训、准备和部署 CHW 的重要性，以筛查难以接触的妇女，因为喀麦隆约有 45%的人口居住在农村地区。
CHW 为扩大撒哈拉以南非洲地区（如喀麦隆西部地区）的覆盖范围提供了对 CIC 的重要补充。CHW 在农村地区建立宫颈癌筛查意识和动机方面发挥着核心作用。
