Impact of a sustainable breast and cervical cancer screening program in spite of COVID-19 pandemic: The AMPATH experience in Kenya.
Authors: Kiptoo Stephen , Busakhala Naftali Wisindi , Itsura Peter , Tonui Philip , Vik Terry , Loehrer Patrick J. , Orang'o Omenge Elkanah 
Published: June 2021

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Background: Cancer is the third leading cause of death with about 48,000 new yearly diagnoses in Kenya. Breast and cervical cancers are the major leading cancers in females, both of which are curable with access to timely and effective care. To meet population health goals, early abnormalities of the cervix and breast must be treated promptly to maximize the chance for cure. The AMPATH Breast and Cervical Cancer Control Program (ABCCCP) was initiated to improve access to screening and diagnostic services for breast and cervical cancer in Kenya by addressing the barriers of cancer care through a population health approach, working with communities and the Ministry of Health in Kenya with a potential for scaling these efforts to other parts of the region. Methods: We performed an interim analysis 3 years into a 5-year program, to assess the impact of COVID-19 on our screening program. Statistical descriptive summaries were used to show the trend of screening using visual inspection with acetic acid and breast clinical examination. The screening was conducted facility-based along with community screening upon requests across nine counties. Also, we conducted capacity building through mentoring of health care providers and initiating a telemedicine program to improve patient care and management plans. Results: From 2018-2021, we conducted training, connected 12 centers with telemedicine capacity and screened a total of 100,973 persons were for breast and cervical cancer. The yearly trends demonstrate that the facility routine screenings were maintained: 23,421 (2018); 27,997 (2019); and 28,045 (2020). The total women seen through organized mass screenings however declined (10,304 (2018); 10,107 (2019); and 1,099 (2020), respectively) as this type of screening was stopped after the onset of COVID-19 pandemic. Of all women screened, 3,019 (2.98%) had clinical abnormalities requiring follow-up per standard of care including 1,781(1.8%) who were eventually histologically confirmed to have cancer. During our first and second year of the program, 83 physicians were trained on cancer management and treatment, 341 nurses were trained on breast and cervical cancer screening procedures, and 247 community health workers (CHW) were trained on the importance of screening to enlighten the community on awareness. However, this training was suspended in our year three due to COVID-19. Conclusions: An integrated training program utilizing CHW, nurses and physicians are an effective means for breast and cervical cancer screening in LMC, such as Kenya. This capacity building allows flexibility and sustainability even in the midst of the global COVID-19 pandemic. We also demonstrated successful integration with the county government for program sustainability. The use of telemedicine has greatly enhanced our screening and patient care across several facilities in western Kenya.