Skip to main content
Top
Published in: BMC Women's Health 1/2024

Open Access 01-12-2024 | Cervical Cancer | Research

Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders’ perspectives

Authors: Fitriana Murriya Ekawati, Putri Listiani, Sri Idaiani, Jarir At Thobari, Firdaus Hafidz

Published in: BMC Women's Health | Issue 1/2024

Login to get access

Abstract

Objectives

Cervical cancer is a significant public health concern in Indonesia, and effective screening methods are necessary to improve the detection and reduce mortality. This study aimed to explore the perspectives of high-level stakeholders involved in cervical cancer screening in Indonesia and whether the use of human papillomavirus-deoxyribonucleic acid (HPV-DNA) methods for cervical cancer screening is acceptable in Indonesian settings.

Methods

A qualitative research approach guided by realist evaluation was applied using focus group discussions (FGDs) between December 2021 and February 2022, conducted with stakeholders involved in cervical cancer screening in Indonesia. They were representatives of practitioners and policymakers involved in the screening, and were recruited through purposive recruitment. The data were analysed using inductive approach of thematic analysis.

Results

The analysis of two FGDs with 29 participants identified four main themes: (i) Visual inspection with acetic acid (VIA) method as the most common modality used for cervical cancer screening, (ii) the applied screening programs in the community, (iii) the perceived challenges on the screening program, such as limitations of the National Health Insurance benefits package and a lack of regulations regarding screening procedures, and (iv) the possibilities of HPV-DNA testing as another modality for cervical cancer screening. Incorporating HPV-DNA testing also needs to ensure the capacity of the workers and the readiness of healthcare facilities.

Conclusion

Although HPV-DNA testing is a promising modality, challenges on the cervical cancer screening in Indonesia remain on the coverage, accessibility of the tools in practice and the women’s awareness towards the screening. Ultimately, the findings of this study would help inform policies to improve cervical cancer screening programs in Indonesia.
Appendix
Available only for authorised users
Literature
1.
go back to reference Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRefPubMed Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRefPubMed
2.
go back to reference Wahidin M, Febrianti R, Susanty F, Hasanah SR. Twelve years implementation of cervical and breast Cancer screening program in Indonesia. Asian Pac J Cancer Prevention: APJCP. 2022;23(3):829.CrossRef Wahidin M, Febrianti R, Susanty F, Hasanah SR. Twelve years implementation of cervical and breast Cancer screening program in Indonesia. Asian Pac J Cancer Prevention: APJCP. 2022;23(3):829.CrossRef
3.
go back to reference Domingo EJ, Noviani R, Noor MRM, Ngelangel CA, Limpaphayom KK, Van Thuan T, et al. Epidemiology and prevention of cervical cancer in Indonesia, Malaysia, the Philippines, Thailand and Vietnam. Vaccine. 2008;26:M71–M9.CrossRefPubMed Domingo EJ, Noviani R, Noor MRM, Ngelangel CA, Limpaphayom KK, Van Thuan T, et al. Epidemiology and prevention of cervical cancer in Indonesia, Malaysia, the Philippines, Thailand and Vietnam. Vaccine. 2008;26:M71–M9.CrossRefPubMed
4.
go back to reference Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):191–203.CrossRef Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):191–203.CrossRef
5.
go back to reference Organization WH. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. World Health Organization; 2021. Organization WH. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. World Health Organization; 2021.
6.
go back to reference Spagnoletti BRM, Atikasari H, Bennett LR, Putri HM, Rachellina M, Ramania A. Hitting the pause button: the impact of COVID-19 on cervical cancer prevention, screening and treatment access in Indonesia. Asian Pac J Cancer Care. 2020;5(S1):255–7.CrossRef Spagnoletti BRM, Atikasari H, Bennett LR, Putri HM, Rachellina M, Ramania A. Hitting the pause button: the impact of COVID-19 on cervical cancer prevention, screening and treatment access in Indonesia. Asian Pac J Cancer Care. 2020;5(S1):255–7.CrossRef
7.
go back to reference Utami TW, Nuranna L, Mahathir M, Peters AA, Fleuren GJ, Osse M et al. Visual inspection of Acetic Acid (VIA) as a Promising Standard for Cervical Cancer Screening. Indonesian J Obstet Gynecol. 2014:216–9. Utami TW, Nuranna L, Mahathir M, Peters AA, Fleuren GJ, Osse M et al. Visual inspection of Acetic Acid (VIA) as a Promising Standard for Cervical Cancer Screening. Indonesian J Obstet Gynecol. 2014:216–9.
8.
go back to reference Vet J, Kooijman J, Henderson F, Aziz F, Purwoto G, Susanto H, et al. Single-visit approach of cervical cancer screening: see and treat in Indonesia. Br J Cancer. 2012;107(5):772–7.CrossRefPubMedPubMedCentral Vet J, Kooijman J, Henderson F, Aziz F, Purwoto G, Susanto H, et al. Single-visit approach of cervical cancer screening: see and treat in Indonesia. Br J Cancer. 2012;107(5):772–7.CrossRefPubMedPubMedCentral
9.
go back to reference Nuranna L, Purwoto G, Hadisty A. EP372 DoVIA and TeleDoVIA as a documentation and consultation media in VIA methods of cervical cancer screening in Indonesia. BMJ Specialist Journals; 2019. Nuranna L, Purwoto G, Hadisty A. EP372 DoVIA and TeleDoVIA as a documentation and consultation media in VIA methods of cervical cancer screening in Indonesia. BMJ Specialist Journals; 2019.
10.
go back to reference Indarti J, Pratama YS. The accuration of liquid based cytology and HPV DNA test combination as precervical cancer lesion screening. Indonesian J Obstet Gynecol. 2017:241–5. Indarti J, Pratama YS. The accuration of liquid based cytology and HPV DNA test combination as precervical cancer lesion screening. Indonesian J Obstet Gynecol. 2017:241–5.
11.
go back to reference Robbers GML, Bennett LR, Spagnoletti BRM, Wilopo SA. Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review. Glob Health Action. 2021;14(1):1979280.CrossRefPubMedPubMedCentral Robbers GML, Bennett LR, Spagnoletti BRM, Wilopo SA. Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review. Glob Health Action. 2021;14(1):1979280.CrossRefPubMedPubMedCentral
12.
go back to reference Kementerian Kesehatan RI. Profil Kesehatan Indonesia Tahun 2019. Jakarta: Kementerian Kesehatan Republik Indonesia; 2020. Kementerian Kesehatan RI. Profil Kesehatan Indonesia Tahun 2019. Jakarta: Kementerian Kesehatan Republik Indonesia; 2020.
13.
go back to reference Ogilvie GS, Krajden M, van Niekerk DJ, Martin RE, Ehlen TG, Ceballos K, et al. Primary cervical cancer screening with HPV testing compared with liquid-based cytology: results of round 1 of a randomised controlled trial -- the HPV FOCAL study. Br J Cancer. 2012;107(12):1917–24.CrossRefPubMedPubMedCentral Ogilvie GS, Krajden M, van Niekerk DJ, Martin RE, Ehlen TG, Ceballos K, et al. Primary cervical cancer screening with HPV testing compared with liquid-based cytology: results of round 1 of a randomised controlled trial -- the HPV FOCAL study. Br J Cancer. 2012;107(12):1917–24.CrossRefPubMedPubMedCentral
14.
go back to reference Schiffman M, Herrero R, Hildesheim A, Sherman ME, Bratti M, Wacholder S, et al. HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica. JAMA. 2000;283(1):87–93.CrossRefPubMed Schiffman M, Herrero R, Hildesheim A, Sherman ME, Bratti M, Wacholder S, et al. HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica. JAMA. 2000;283(1):87–93.CrossRefPubMed
15.
go back to reference Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin-Hirsch PP, Mustafa RA et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Reviews. 2017(8). Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin-Hirsch PP, Mustafa RA et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Reviews. 2017(8).
16.
go back to reference Jeronimo J, Bansil P, Lim J, Peck R. A multicountry evaluation of careHPV Testing, VisualInspection with Acetic Acid, and Papanicolaou Testing forthe detection of cervical cancerand the START-UP. Study Group International Journal of Gynecological Cancer; 2014. Jeronimo J, Bansil P, Lim J, Peck R. A multicountry evaluation of careHPV Testing, VisualInspection with Acetic Acid, and Papanicolaou Testing forthe detection of cervical cancerand the START-UP. Study Group International Journal of Gynecological Cancer; 2014.
18.
go back to reference Indonesia KKR. Perubahan Atas Peraturan Menteri Kesehatan Nomor 34 Tahun 2015 Tentang Penanggulangan Kanker Payudara Dan Kanker Leher Rahim. 2017. Indonesia KKR. Perubahan Atas Peraturan Menteri Kesehatan Nomor 34 Tahun 2015 Tentang Penanggulangan Kanker Payudara Dan Kanker Leher Rahim. 2017.
20.
go back to reference Pawson R. Realist Evaluation. Adapted from Pawson R & Tilley N. Realist evaluation London SAGE. Available online at British Cabinet Office: London; 1997. Pawson R. Realist Evaluation. Adapted from Pawson R & Tilley N. Realist evaluation London SAGE. Available online at British Cabinet Office: London; 1997.
21.
go back to reference Pawson R, Tilley N. Realist evaluation. 2004. Google Scholar. 2015:36. Pawson R, Tilley N. Realist evaluation. 2004. Google Scholar. 2015:36.
22.
go back to reference Ekawati FM, Emilia O, Gunn J, Licqurish S, Lau P. The elephant in the room: an exploratory study of hypertensive disorders of pregnancy (HDP) management in Indonesian primary care settings. BMC Fam Pract. 2020;21(1):242.CrossRefPubMedPubMedCentral Ekawati FM, Emilia O, Gunn J, Licqurish S, Lau P. The elephant in the room: an exploratory study of hypertensive disorders of pregnancy (HDP) management in Indonesian primary care settings. BMC Fam Pract. 2020;21(1):242.CrossRefPubMedPubMedCentral
23.
go back to reference Ekawati FM, Emilia O, Gunn J, Licqurish S, Lau P. Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care. BMC Pregnancy Childbirth. 2021;21(1):507.CrossRefPubMedPubMedCentral Ekawati FM, Emilia O, Gunn J, Licqurish S, Lau P. Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care. BMC Pregnancy Childbirth. 2021;21(1):507.CrossRefPubMedPubMedCentral
25.
go back to reference International Q. Nvivo (Software) version 12.2.0 (3262). 2019. International Q. Nvivo (Software) version 12.2.0 (3262). 2019.
26.
go back to reference Patton MQ. Qualitative research & evaluation methods / Michael Quinn Patton: Thousand Oaks, Calif.: Sage Publications, c2002. 3rd ed.; 2002. Patton MQ. Qualitative research & evaluation methods / Michael Quinn Patton: Thousand Oaks, Calif.: Sage Publications, c2002. 3rd ed.; 2002.
27.
go back to reference O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Medicine: J Association Am Med Colleges. 2014;89(9):1245–51.CrossRef O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Medicine: J Association Am Med Colleges. 2014;89(9):1245–51.CrossRef
29.
go back to reference Ekawati FM, Claramita M. Indonesian General practitioners’ experience of practicing in primary care under the implementation of Universal Health Coverage Scheme (JKN). J Prim Care Community Health. 2021;12:21501327211023707.CrossRefPubMedPubMedCentral Ekawati FM, Claramita M. Indonesian General practitioners’ experience of practicing in primary care under the implementation of Universal Health Coverage Scheme (JKN). J Prim Care Community Health. 2021;12:21501327211023707.CrossRefPubMedPubMedCentral
30.
go back to reference Setiawan D, Miranti I, Partiwi TD, Puspitasari DA, Ramadhan FN. The willingness for cervical cancer screening among sexually active women in Indonesia: lesson learned from two districts. Int J Gynecol Obstet. 2022;159(1):145–51.CrossRef Setiawan D, Miranti I, Partiwi TD, Puspitasari DA, Ramadhan FN. The willingness for cervical cancer screening among sexually active women in Indonesia: lesson learned from two districts. Int J Gynecol Obstet. 2022;159(1):145–51.CrossRef
31.
go back to reference Winarto H, Dorothea M, Winarno AS, Ibrahim NAA, Putri YM, Purbadi S, et al. Knowledge, attitude, and practice on cervical Cancer and HPV vaccination among medical students in Jakarta, Indonesia: a cross-sectional study. Open Access Macedonian J Med Sci. 2022;10(E):1221–6.CrossRef Winarto H, Dorothea M, Winarno AS, Ibrahim NAA, Putri YM, Purbadi S, et al. Knowledge, attitude, and practice on cervical Cancer and HPV vaccination among medical students in Jakarta, Indonesia: a cross-sectional study. Open Access Macedonian J Med Sci. 2022;10(E):1221–6.CrossRef
32.
go back to reference Winata IGS, Juniarti SE. Cervical Cancer Screening in COVID-19 Pandemic Era. 2020. Winata IGS, Juniarti SE. Cervical Cancer Screening in COVID-19 Pandemic Era. 2020.
33.
go back to reference Spagnoletti BRM, Bennett LR, Wahdi AE, Wilopo SA, Keenan CA. A qualitative study of parental knowledge and perceptions of human papillomavirus and cervical cancer prevention in rural central Java, Indonesia: understanding community readiness for prevention interventions. Asian Pac J cancer Prevention: APJCP. 2019;20(8):2429.CrossRef Spagnoletti BRM, Bennett LR, Wahdi AE, Wilopo SA, Keenan CA. A qualitative study of parental knowledge and perceptions of human papillomavirus and cervical cancer prevention in rural central Java, Indonesia: understanding community readiness for prevention interventions. Asian Pac J cancer Prevention: APJCP. 2019;20(8):2429.CrossRef
34.
go back to reference Robbers GML, Bennett LR, Spagnoletti BRM, Wilopo SA. Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review. Global Health Action. 2021;14(1):1979280.CrossRefPubMedPubMedCentral Robbers GML, Bennett LR, Spagnoletti BRM, Wilopo SA. Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review. Global Health Action. 2021;14(1):1979280.CrossRefPubMedPubMedCentral
Metadata
Title
Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders’ perspectives
Authors
Fitriana Murriya Ekawati
Putri Listiani
Sri Idaiani
Jarir At Thobari
Firdaus Hafidz
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2024
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-024-02946-y

Other articles of this Issue 1/2024

BMC Women's Health 1/2024 Go to the issue