Mungo Chemtai, Kachoria Aparna Ghosh, Adoyo Everlyn, Zulu Graham, Goraya Supreet Kaur, Omoto Jackton, Osongo Cirilus, Ferrari Renée M, Rahangdale Lisa
Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Ecancermedicalscience. 2025 May 13;19:1903. doi: 10.3332/ecancer.2025.1903. eCollection 2025.
Women in low- and middle-income countries (LMICs) bear a disproportionate burden of cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies such as 5-fluorouracil and imiquimod, for which efficacy evidence is available from high-income settings. We investigated African women's perceptions and perceived acceptability of these therapies for cervical precancer treatment.
Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25-65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored women's experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded and analysed using qualitative description using NVIVO software.
Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to women's perceptions of topical therapies. Participants were highly receptive to topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost and lack of privacy with pelvic examinations. Participants had a preference for topical therapies that are used less frequently compared to those used daily.
Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs.
Not applicable.
在低收入和中等收入国家（LMICs），尽管宫颈癌是一种可预防的疾病，但女性承担着不成比例的宫颈癌负担。由于卫生基础设施薄弱以及缺乏足够的人力资源来提供当前由医疗服务提供者实施的癌前病变治疗，LMICs的预防工作在一定程度上受到了获得宫颈癌前病变治疗机会的限制。迫切需要创新策略来缩小LMICs宫颈癌前病变治疗差距，包括使用自我给药的局部治疗方法，如5-氟尿嘧啶和咪喹莫特，高收入地区已有这些疗法的疗效证据。我们调查了非洲女性对这些用于宫颈癌前病变治疗的疗法的看法和可接受性。
2022年11月至2023年4月期间，我们在肯尼亚基苏木对年龄在25 - 65岁之间接受宫颈癌筛查或癌前病变治疗的女性进行了五次焦点小组讨论（FGDs）。FGDs探讨了女性的筛查和癌前病变治疗经历、她们对局部疗法用于癌前病变治疗的可接受性以及对采用这些疗法的感知障碍和促进因素。FGDs由当地定性研究助理主持，使用当地语言进行，转录后使用NVIVO软件通过定性描述进行编码和分析。
29名女性参与，平均年龄为35.4岁（标准差6.5）。所有人都接受过宫颈癌筛查，25人（83%）有过消融或切除癌前病变治疗史。确定了多个与女性对局部疗法的看法相关的主题。参与者对局部治疗高度接受，与由医疗服务提供者实施这些疗法相比，许多人更倾向于自我给药的选择。她们认为局部疗法的自我给药有助于应对当前治疗方法带来的挑战，包括难以获得治疗、治疗过程中的疼痛、费用以及盆腔检查缺乏隐私等问题。与每天使用的局部疗法相比，参与者更倾向于使用频率较低的局部疗法。
在有宫颈癌前病变治疗史的肯尼亚女性中，自我给药的癌前病变局部疗法是可接受的，并且有可能解决阻碍LMICs癌前病变治疗的障碍，包括获得治疗的机会、隐私和费用等问题。如果得到LMICs疗效研究的支持，自我给药的局部疗法为缩小LMICs癌前病变治疗差距提供了一种可扩展的方法。
不适用。
