home-based cervical cancer screening project

Conditions: Cervical Cancer

Summary: cervical cancer is a public health problem in cameroon.in 2020, the country had a crude incidence of 20.2 per 100 000 women for an incidence to mortality ratio of 0.65. as for now, the country does not have a national screening program to combat the disease. only 6% of cameroonian women have once been screened for cervical cancer. in order to increase screening uptake so as to reach 70% recommended by the world health organization (who), a home-based cervical cancer screening approach is proposed. the objective of our study is to compare two recruitment strategies for cervical cancer screening in rural cameroon.

in 2018, a 5 years cervical cancer screening project called: "promoting comprehensive cervical cancer prevention and better women's health in low- and medium resource settings in the health district of dschang" was launched in the west region of cameroon. the study aimed at screening 2000 women per year following screen-triage-treatment as recommended by who in a 3t approach: test with hpv self-sampling test, triage by visual assessement of the cervix with acetic acid and lugol (via/vili), treatment with thermal ablation. despite sensitization using communication information channels, uptake of the screening was below the target. in order to increase uptake of the screening, this study proposes a home-based strategy using community health workers (chw). community health workers (chw) are lay members of the community who carry out health promotion activities after training. in a randomised controlled cluster trial, two recruitment strategies for cervical cancer screening will be compared: in one arm a team made up of a chw and a nurse will do door-to-door sensitization and propose home-based hpv self-sampling test to eligible women and in the other arm chw will do door-to-door sensitization and issue invitation cards to eligible women for hospital-based hpv self-sampling test. this study is nested in ongoing cervical cancer screening project. primary objective: to compare completeness of full screening between two different recruitment strategies in rural area: counselling and home-based hpv self-sampling test versus counselling and hospital-based hpv self-sampling test. secondary objectives: * to determine the proportion of women who will carry out an hpv self-sampling test in both strategies within 3 months of sensitization. * to determine the proportion of hpv positive women who will undergo via/vili in both arms within 3 months. * to assess the acceptability of home self-sampling hpv test and perception of single versus 2 visits approaches. * to determine predictors of non-adherence to care-seeking for hpv positive women. * to determine the number of pre-cancers and/or cancers diagnosed in both arms and their treatment. * to calculate the economic cost of both strategies. mixed method design, quantitative and qualitative informations will be collected.

Eligibility criteria:
inclusion criteria: * women aged 30-49 years * ability to understand study procedures and accepting voluntarily to participate by signing an informed consent form (icf). non-inclusion criteria: * pregnancy at the time of screening * history of cervical cancer screening by hpv test of less than 5 years (for hiv-negative women) or less than 3 years (for hiv positive women). * intra-vaginal treatment exclusion criteria: * symptoms of cervical cancer (e.g. metrorrhagia, known pelvic mass) * severe pre-existing medical conditions (e.g. advanced cancer, terminal renal failure) * women who are not able to comply with the study protocol. * previous hysterectomy * known cervical cancer

Keywords: cervical cancer human papillomavirus screening home-based