Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Asociación Benéfica PRISMA, Lima, Peru.
BMC Public Health. 2024 Aug 6;24(1):2121. doi: 10.1186/s12889-024-19436-3.
Cervical cancer is a preventable cancer; however, decreasing its prevalence requires early detection and treatment strategies that reduce rates of loss to follow-up. This study explores factors associated with loss to follow-up among HPV-positive women after implementation of a new HPV-based screen-and-treat approach for cervical cancer prevention in Iquitos, Peru.
We conducted semi-structured interviews with "obstetras" (i.e., midwives) (n = 15) working in cervical cancer prevention and women (n = 24) who were recorded as lost to follow-up after positive HPV results. We used the Health Care Access Barriers Model to guide analyses. We utilized manifest content analysis to describe barriers to follow-up according to the obstetras and thematic analysis to report themes from the women's perspectives. We also report the steps and time taken to contact women.
We found an incomplete and fragmented patient monitoring system. This incomplete system, in conjunction with challenges in contacting some of the women, led to structural barriers for the obstetras when attempting to deliver positive results. Women in this study expressed a desire to receive treatment, however, faced cognitive barriers including a lack of understanding about HPV results and treatment procedures, fear or anxiety about HPV or treatment, and confusion about the follow-up process. Women also reported having important work matters as a barrier and reported frequently using natural medicine. Reported financial barriers were minimal.
This study highlights the barriers to follow-up after implementation of a primary-level HPV-based screen-and-treat approach. While some barriers that have previously been associated with loss to follow-up were not as prominently observed in this study (e.g., financial), we emphasize the need for screen-and-treat programs to focus on strategies that can address incomplete registry systems, structural challenges in results delivery, cognitive barriers in understanding results and treatment, and work-related barriers.
宫颈癌是一种可预防的癌症；然而，要降低其发病率，需要采取早期检测和治疗策略，以降低失访率。本研究探讨了在秘鲁伊基托斯实施新的 HPV 为基础的宫颈癌筛查和治疗方法后，与 HPV 阳性女性失访相关的因素。
我们对半结构访谈进行了分析，这些访谈对象包括从事宫颈癌预防工作的“obstetras”（即助产士）（n=15）和 HPV 检测结果阳性后被记录为失访的女性（n=24）。我们使用卫生保健获取障碍模型来指导分析。我们采用显性内容分析法根据 obstetras 描述随访障碍，并采用主题分析法报告女性观点的主题。我们还报告了联系女性的步骤和时间。
我们发现患者监测系统不完整且分散。这个不完整的系统，加上联系部分女性的挑战，导致 obstetras 在传递阳性结果时面临结构性障碍。本研究中的女性表示希望接受治疗，但面临认知障碍，包括对 HPV 结果和治疗程序缺乏了解、对 HPV 或治疗的恐惧或焦虑、以及对随访过程的困惑。女性还报告说，重要的工作事务是一个障碍，并经常使用天然药物。报告的经济障碍很少。
本研究强调了在实施基层 HPV 为基础的筛查和治疗方法后，失访的障碍。虽然以前与失访相关的一些障碍在本研究中没有那么突出（例如，经济），但我们强调筛查和治疗计划需要关注可以解决不完整的登记系统、结果传递中的结构性挑战、理解结果和治疗的认知障碍以及与工作相关的障碍的策略。
