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Community-Driven Cervical Cancer Prevention in Western Kenya

NCT02124252CompletedNAINTERVENTIONAL

Summary

There are many challenges to implementation of cervical cancer prevention in resource-limited countries, despite evidence based screening and treatment strategies. The investigators hypothesize that self-collected HPV specimens offered in a community health campaign setting will

Key Facts

Lead Sponsor

Duke University

Enrollment

7200

Start Date

2016-01-01

Completion Date

2016-10-01

Study Type

INTERVENTIONAL

Official Title

Evaluation of a Community-Driven Cervical Cancer Prevention Strategy in Western Kenya

Interventions

Community-based testing with standard linkage to careCommunity-based HPV testing with enhanced linkage to care

Conditions

Human Papilloma Virus InfectionCarcinoma in Situ of Uterine Cervix

Eligibility

Age Range

25 Years – 65 Years

Sex

FEMALE

Inclusion Criteria:

* Female, ages 25-65 Willing to sign informed consent Lives in community where randomization arm is

Exclusion Criteria:

* Prior hysterectomy

Outcome Measures

Primary Outcomes

Reach of cervical cancer screening using self-collected HPV specimens in community health campaigns compared to clinics

The investigators will compare the number of women who uptake HPV testing in the community health campaign arms compared to the number who uptake HPV testing in the clinic-based arms.

Time frame: 2 years

Secondary Outcomes

Determine the Efficacy of the cervical cancer prevention program

The investigators will compare the number of women accessing treatment for positive HPV results with standard linkage to care compared to the enhanced linkage to treatment strategy.

Time frame: 4 years

Locations

Kenya Medical Research Institute, Nairobi, Kenya

Linked Papers

2020-10-27

Comparison of the costs of HPV testing through community health campaigns versus home-based testing in rural Western Kenya: a microcosting study

Objectives To estimate the cost of human papillomavirus (HPV)-based screening through community health campaigns (CHCs) and home-based testing. Setting CHCs and home-based testing in six communities in rural Western Kenya. Participants CHCs and home-based screening reached 2297 and 1002 women aged 25–65 years, respectively. Outcome measures Outcome measures were overall cost per woman screened achieved through the CHCs and home-based testing and the cost per woman for each activity comprising the screening intervention. Results The mean cost per woman screened through CHCs and home-based testing were similar, at $37.7 (range $26.4–$52.0) and $37.1 (range $27.6–$54.0), respectively. For CHCs, personnel represented 49% of overall cost, supplies 25%, services 5% and capital goods 23%. For home-based testing, these were: personnel 73%, supplies 25%, services 1% and capital goods 2%. A greater number of participants was associated with a lower cost per participant. Conclusions The mean cost per woman screened is comparable for CHC and home-based testing, with differences in type of input. The CHCs generally reached more eligible women in the six communities, whereas home-based strategies more efficiently reached populations with low screening rates. Trial registration number NCT02124252 .

Linked Investigators

Easter Elizabeth Olwanda

Jessica Yasmine Islam

I am a tenure-track faculty member of Cancer Epidemiology at H. Lee Moffitt Cancer Center and Research Institute. I am a cancer epidemiologist and health services researcher dedicated to improving cancer care quality across the continuum, specifically at the intersection of infections and cancer. My research focus includes: the prevention of cancers caused by infection, and quality of cancer care delivery to people with HIV (PWH) both in the US and globally. My early work focused on identifying novel and effective methods for the detection and service delivery of cervical cancer screening to women living with and without HIV in low-resource settings globally. My research continues to focus more broadly on infection-associated cancers, including evaluating the use of home-based methods to test for high-risk HPV and optimal strategies for triage after a positive screen. To inform my research on improving cancer care delivery to PWH, I have received formal training in implementation science as a Fellow of the Cancer Prevention and Control Research Network (CPCRN) (2020-2021), HIV Implementation Science Program at the JHU CFAR (2021–2022), and the HIV, Infectious Disease, and Global Health Implementation Research Institute (HIGH IRI) at Washington University in St. Louis (2023-2025). I am dedicated to improving cancer care delivery and outcomes among people with HIV (PWH) by addressing the poor-quality care they may experience across the cancer continuum—from prevention through survivorship. My methodological expertise centers on leveraging large-scale “big data” resources, including cancer registries, electronic health records (EHRs), and novel data linkages, to construct robust epidemiologic cohorts that uncover inequities in cancer care delivery to PWH in the US. My recently funded R01 projects integrate advanced analytic approaches, including machine learning and multi-modal artificial intelligence methods, to extract, harmonize, and analyze complex clinical and contextual data. Through these efforts, my research identifies and addresses multilevel barriers to care, applying implementation science frameworks to guide the adaptation, implementation, and sustainability of interventions across healthcare systems to enhance cancer prevention and treatment for PWH. I have established a comprehensive research program aimed at understanding cancer care patterns and identifying actionable opportunities to improve the quality of cancer care for PWH within Florida’s healthcare system, a state with one of the highest HIV burdens in the country. My long-term goal is to translate large-scale epidemiologic findings into practical, evidence-based strategies that improve the adoption and delivery of cancer prevention and care interventions in real-world HIV care settings. Ultimately, my career goal is to be an independent, interdisciplinary investigator in cancer care disparities, advancing research at the intersection of infections and cancer both in the United States and globally.