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Implementation Science
Published in: Implementation Science 1/2018

Open Access 01-12-2018 | Systematic review

Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

Authors: Lauren G. Johnson, Allison Armstrong, Caroline M. Joyce, Anne M. Teitelman, Alison M. Buttenheim

Published in: Implementation Science | Issue 1/2018

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Abstract

Background

Developed countries, such as the USA, have achieved significant decreases in cervical cancer burden since the introduction of Pap smear-based programs in the 1960s. Due to implementation barriers and limited resources, many countries in sub-Saharan Africa (SSA) have been unable to attain such reductions. The purpose of this review is to evaluate implementation strategies used to improve the uptake and sustainability of cervical cancer prevention programs in SSA.

Methods

A reviewer (LJ) independently searched PubMed, Ovid/MEDLINE, Scopus, and Web of Science databases for relevant articles with the following search limits: English language, peer reviewed, and published between 1996 and 2017. The 4575 search results were screened for eligibility (CJ, LJ) to identify original research that empirically evaluated or tested implementation strategies to improve cervical cancer prevention in SSA. Fifty-three articles met criteria for inclusion in the final review. AA, CJ, and LJ abstracted the included articles for implementation-related content and evaluated them for risk of bias according to study design with the National Heart, Lung, and Blood Institute’s (NHLBI) Quality Assessment Tools. Results were reported according to PRISMA guidelines.

Results

The 53 included studies are well represented among all sub-Saharan regions: South (n = 16, 30.2%), West (n = 16, 30.2%), East (n = 14, 26.4%), and Middle (n = 7, 13.2%). There are 34 cross-sectional studies (64.2%), 10 pre-posttests (18.9%), 8 randomized control trials (15.1%), and one nonrandomized control trial (1.9%). Most studies are “fair” quality (n = 22, 41.5%). Visual inspection with acetic acid (VIA) (n = 19, 35.8%) was used as the main prevention method more frequently than HPV DNA/mRNA testing (n = 15, 28.3%), Pap smear (n = 13, 24.5%), and HPV vaccine (n = 9, 17.0%). Effectiveness of strategies to improve program implementation was measured using implementation outcomes of penetration (n = 33, 62.3%), acceptability (n = 15, 28.3%), fidelity (n = 14, 26.4%), feasibility (n = 8, 15.1%), adoption (n = 6, 11.3%), sustainability (n = 2, 3.8%), and cost (n = 1, 1.9%). Education strategies (n = 38, 71.7%) were used most often but have shown limited effectiveness.

Conclusion

This systematic review highlights the need to diversify strategies that are used to improve implementation for cervical cancer prevention programs. While education is important, implementation science literature reveals that education is not as effective in generating change. There is a need for additional organizational support to further incentivize and sustain improvements in implementation.
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Literature
1.
2.
Safaeian M, Solomon D, Castle PE. Cervical cancer prevention—cervical screening: science in evolution. Obstet Gynecol Clin N Am. 2007;34(4):739–60. ixCrossRef
3.
Jemal A, Bray F, Forman D, O'Brien M, Ferlay J, Center M, et al. Cancer burden in Africa and opportunities for prevention. Cancer. 2012;118(18):4372–84.CrossRefPubMed
4.
5.
McFarland DM, Gueldner SM, Mogobe KD. Integrated review of barriers to cervical cancer screening in sub-Saharan Africa. J Nurs Scholarsh. 2016;48(5):490–8.CrossRefPubMed
6.
7.
Chidyaonga-Maseko F, Chirwa ML, Muula AS. Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors. Pan Afr Med J. 2015;21:231.CrossRefPubMedPubMedCentral
8.
Denny L, Quinn M, Sankaranarayanan R. Chapter 8: screening for cervical cancer in developing countries. Vaccine. 2006;24(Suppl 3):S3/71–7.
9.
De Vuyst H, Alemany L, Lacey C, Chibwesha CJ, Sahasrabuddhe V, Banura C, et al. The burden of human papillomavirus infections and related diseases in sub-saharan Africa. Vaccine. 2013;31(Suppl 5):F32–46.CrossRefPubMedPubMedCentral
10.
Mapanga W, Elhakeem A, Feresu SA, Maseko F, Chipato T. Prevention of cervical cancer in HIV-seropositive women from developing countries: a systematic review protocol. Syst Rev. 2017;6(1):91. -017-0484-9CrossRefPubMedPubMedCentral
11.
12.
Anorlu RI. Cervical cancer: the sub-Saharan African perspective. Reprod Health Matters. 2008;16(32):41–9.CrossRefPubMed
13.
Louie KS, de Sanjose S, Mayaud P. Epidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review. Tropical Med Int Health. 2009;14(10):1287–302.CrossRef
14.
15.
Denny L, Anorlu R. Cervical cancer in Africa. Cancer Epidemiol Biomark Prev. 2012;21(9):1434–8.CrossRef
16.
17.
Fiander AN. The prevention of cervical cancer in Africa. Womens Health (Lond). 2011;7(1):121–32.CrossRef
18.
Cancers of the female reproductive organs. In: Stewart B, Wild C, editors. World cancer report 2014 Lyon: International Agency for Research on Cancer; 2014. p. 465.
19.
20.
Adefuye PO, Broutet NJ, de Sanjose S, Denny LA. Trials and projects on cervical cancer and human papillomavirus prevention in sub-Saharan Africa. Vaccine. 2013;31(Suppl 5):F53–9.CrossRefPubMed
21.
Sankaranarayanan R, Anorlu R, Sangwa-Lugoma G, Denny LA. Infrastructure requirements for human papillomavirus vaccination and cervical cancer screening in sub-Saharan Africa. Vaccine. 2013;31(Suppl 5):F47–52.CrossRefPubMed
22.
Asgary R, Adongo PB, Nwameme A, Cole HVS, Maya E, Liu M, et al. mHealth to train community health nurses in visual inspection with acetic acid for cervical cancer screening in Ghana. J Low Genit Tract Dis. 2016;20(3):239–42.CrossRefPubMedPubMedCentral
23.
Horo A, Jaquet A, Ekouevi DK, Toure B, Coffie PA, Effi B, et al. Cervical cancer screening by visual inspection in Cote d’Ivoire, operational and clinical aspects according to HIV status. BMC Public Health. 2012;12:237.CrossRefPubMedPubMedCentral
24.
Ramogola-Masire D, de Klerk R, Monare B, Ratshaa B, Friedman HM, Zetola NM. Cervical cancer prevention in HIV-infected women using the “see and treat” approach in Botswana. J Acquir Immune Defic Syndr. 2012;59(3):308–13.CrossRefPubMed
25.
Quinley KE, Gormley RH, Ratcliffe SJ, Shih T, Szep Z, Steiner A, et al. Use of mobile telemedicine for cervical cancer screening. J Telemed Telecare. 2011;17(4):203–9.CrossRefPubMedPubMedCentral
26.
Sossauer G, Zbinden M, Tebeu PM, Fosso GK, Untiet S, Vassilakos P, et al. Impact of an educational intervention on women’s knowledge and acceptability of human papillomavirus self-sampling: a randomized controlled trial in Cameroon. PLoS One. 2014;9(10):e109788.CrossRefPubMedPubMedCentral
27.
Ting J, Mugo N, Kwatampora J, Hill C, Chitwa M, Patel S, et al. High-risk human papillomavirus messenger RNA testing in physician- and self-collected specimens for cervical lesion detection in high-risk women, Kenya. Sex Transm Dis. 2013;40(7):584–9.CrossRefPubMed
28.
Safaeian M, Kiddugavu M, Gravitt PE, Ssekasanvu J, Murokora D, Sklar M, et al. Comparability of self-collected vaginal swabs and physician-collected cervical swabs for detection of human papillomavirus infections in Rakai, Uganda. Sex Transm Dis. 2007;34(7):429–36.PubMed
29.
van de Wijgert J, Altini L, Jones H, de Kock A, Young T, Williamson A, et al. Two methods of self-sampling compared to clinician sampling to detect reproductive tract infections in Gugulethu, South Africa. Sex Transm Dis. 2006;33(8):516–23.CrossRefPubMed
30.
Untiet S, Vassilakos P, McCarey C, Tebeu P, Kengne-Fosso G, Menoud P, et al. HPV self-sampling as primary screening test in sub-Saharan Africa: implication for a triaging strategy. Int J Cancer. 2014;135(8):1911–7.CrossRefPubMed
31.
Lack N, West B, Jeffries D, Ekpo G, Morison L, Soutter WP, et al. Comparison of non-invasive sampling methods for detection of HPV in rural African women. Sex Transm Infect. 2005;81(3):239–41.CrossRefPubMedPubMedCentral
32.
Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: emerging technologies and policy choices. World J Clin Oncol. 2015;6(6):281–90.CrossRefPubMedPubMedCentral
33.
Lorincz A, Castanon A, Lim A, Sasieni P. New strategies for HPV-based cervical screening. Women's Health (Lond Engl). 2013;9(5):443–52.
34.
Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69(2):123–57.CrossRefPubMed
35.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34.CrossRefPubMed
36.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62(10):1006-1012.
37.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;38(2):65–76.CrossRef
38.
Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Admin Pol Ment Health. 2009;36(1):24–34.CrossRef
39.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50-5908-4-50.CrossRef
40.
41.
Firnhaber C, Mao L, Levin S, Faesen M, Lewis DA, Goeieman BJ, et al. Evaluation of a cervicography-based program to ensure quality of visual inspection of the cervix in HIV-infected women in Johannesburg, South Africa. J Low Genit Tract Dis. 2015;19(1):7–11.CrossRefPubMed
42.
Adamson PC, Huchko MJ, Moss AM, Kinkel HF, Medina-Marino A. Acceptability and accuracy of cervical cancer screening using a self-collected tampon for HPV messenger-RNA testing among HIV-infected women in South Africa. PLoS One. 2015;10(9):e0137299.CrossRefPubMedPubMedCentral
43.
Obiri-Yeboah D, Adu-Sarkodie Y, Djigma F, Hayfron-Benjamin A, Abdul L, Simpore J, et al. Self-collected vaginal sampling for the detection of genital human papillomavirus (HPV) using careHPV among Ghanaian women. BMC Womens Health. 2017. https://​doi.​org/​10.​1186/​s12905-017-0448-1.
44.
Ladner J, Besson MH, Hampshire R, Tapert L, Chirenje M, Saba J. Assessment of eight HPV vaccination programs implemented in lowest income countries. BMC Public Health. 2012;12:370-2458-12-370.CrossRef
45.
LaMontagne DS, Barge S, Le NT, Mugisha E, Penny ME, Gandhi S, et al. Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. Bull World Health Organ. 2011;89(11):821–830B.CrossRefPubMedPubMedCentral
46.
Megevand E, Van Wyk W, Knight B, Bloch B. Can cervical cancer be prevented by a see, screen, and treat program? A pilot study. Am J Obstet Gynecol. 1996;174(3):923–8.CrossRefPubMed
47.
Ogembo JG, Manga S, Nulah K, Foglabenchi LH, Perlman S, Wamai RG, et al. Achieving high uptake of human papillomavirus vaccine in Cameroon: lessons learned in overcoming challenges. Vaccine. 2014;32(35):4399–403.CrossRefPubMed
48.
Catarino R, Vassilakos P, Scaringella S, Undurraga-Malinverno M, Meyer-Hamme U, Ricard-Gauthier D, et al. Smartphone use for cervical cancer screening in low-resource countries: a pilot study conducted in Madagascar. PLoS One. 2015;10(7):e0134309.
49.
Awua AK, Wiredu EK, Afari EA, Tijani AS, Djanmah G, Adanu RMK. A tailored within-community specimen collection strategy increased uptake of cervical cancer screening in a cross-sectional study in Ghana. BMC Public Health. 2017;18(1):80.
50.
Huchko MJ, Bukusi EA, Cohen CR. Building capacity for cervical cancer screening in outpatient HIV clinics in the Nyanza province of western Kenya. Int J Gynaecol Obstet. 2011;114(2):106–10.CrossRefPubMedPubMedCentral
51.
Khozaim K, Orang'o E, Christoffersen-Deb A, Itsura P, Oguda J, Muliro H, et al. Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya. Int J Gynecol Obstet. 2014;124(1):12–8.CrossRef
52.
Moodley I, Tathiah N, Mubaiwa V, Denny L. High uptake of Gardasil vaccine among 9-12-year-old schoolgirls participating in an HPV vaccination demonstration project in KwaZulu-Natal, South Africa. S Afr Med J. 2013;103(5):318–21.CrossRefPubMed
53.
Maree JE, Lu XM, Wright SC. Combining breast and cervical screening in an attempt to increase cervical screening uptake. An intervention study in a South African context. Eur J Cancer Care (Engl). 2012;21(1):78–86.CrossRef
54.
Moon TD, Silva-Matos C, Cordoso A, Baptista AJ, Sidat M, Vermund SH. Implementation of cervical cancer screening using visual inspection with acetic acid in rural Mozambique: successes and challenges using HIV care and treatment programme investments in Zambézia Province. J Int AIDS Soc. 2013;15(2):17406.
55.
Snyman LC, Dreyer G, Visser C, Botha MH, van der Merwe FH. The Vaccine and Cervical Cancer Screen project 2 (VACCS 2): linking cervical cancer screening to a two-dose HPV vaccination schedule in the South-West District of Tshwane, Gauteng, South Africa. S Afr Med J. 2015;105(3):191–4.CrossRefPubMed
56.
Were E, Nyaberi Z, Buziba N. Integrating cervical cancer and genital tract infection screening into mother, child health and family planning clinics in Eldoret, Kenya. Afr Health Sci. 2010;10(1):58–65.PubMedPubMedCentral
57.
Degregorio G, Manga S, Kiyang E, Manjuh F, Bradford L, Cholli P, et al. Implementing a fee-for-service cervical cancer screening and treatment program in Cameroon: challenges and opportunities. Oncologist. 2017;22(7):850–9.CrossRefPubMedPubMedCentral
58.
Mehrotra A, An R, Patel DN, Sturm R. Impact of a patient incentive program on receipt of preventive care. Am J Manag Care. 2014;20(6):494–501.PubMedPubMedCentral
59.
Adepoju EG, Ilori T, Olowookere SA, Idowu A. Targeting women with free cervical cancer screening: challenges and lessons learnt from Osun state, southwest Nigeria. Pan Afr Med J. 2016;24:319.CrossRefPubMedPubMedCentral
60.
Kapambwe S, Parham G, Mwanahamuntu M, Chirwa S, Mwanza J, Amuyunzu-Nyamongo M. Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counseling in Zambia. Glob Health Promot. 2013;20(4 Suppl):57–64.CrossRefPubMed
61.
Crofts V, Flahault E, Tebeu P, Untiet S, Fosso GK, Boulvain M, et al. Education efforts may contribute to wider acceptance of human papillomavirus self-sampling. Int J Womens Health. 2015;7:149–54.CrossRefPubMedPubMedCentral
62.
Dim CC, Onyedum CC, Dim NR, Chukwuka JC. Cervical cancer screening among HIV-positive women in Nigeria: an assessment of use and willingness to pay in the absence of donor support. J Int Assoc Provid AIDS Care. 2015;14(3):241–4.CrossRefPubMed
63.
Wamai RG, Ayissi CA, Oduwo GO, Perlman S, Welty E, Manga S, et al. Assessing the effectiveness of a community-based sensitization strategy in creating awareness about HPV, cervical cancer and HPV vaccine among parents in North West Cameroon. J Community Health. 2012;37(5):917–26.CrossRefPubMed
64.
Tum SJ, Maree JE, Clarke M. Creating awareness and facilitating cervical and breast cancer screening uptake through the use of a community health worker: a pilot intervention study. Eur J Cancer Care (Engl). 2013;22(1):107–16.CrossRef
65.
Goldhaber-Fiebert JD, Denny LA, De Souza M, Kuhn L, Goldie SJ. Program spending to increase adherence: South African cervical cancer screening. PLoS One. 2009;4(5):e5691.CrossRefPubMedPubMedCentral
66.
Michelow P, McKee G, Hlongwane F. Rapid rescreening of cervical smears as a quality control method in a high-risk population. Cytopathology. 2006 Jun;17(3):110–5.CrossRefPubMed
67.
Abiodun OA, Olu-Abiodun OO, Sotunsa JO, Oluwole FA. Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Public Health. 2014;14:814-2458-14-814.CrossRef
68.
Dreyer G, van der Merwe FH, Botha MH, Snyman LC, Constant D, Visser C, et al. School-based human papillomavirus vaccination: an opportunity to increase knowledge about cervical cancer and improve uptake of screening. S Afr Med J. 2015 Nov;105(11):912–6.CrossRefPubMed
69.
Wright KO, Kuyinu YA, Faduyile FA. Community education on cervical cancer amongst market women in an urban area of Lagos, Nigeria. Asian Pac J Cancer Prev. 2010;11(1):137–40.PubMed
70.
Adamu AN, Abiola AO, Ibrahim M. The effect of health education on the knowledge, attitude, and uptake of free Pap smear among female teachers in Birnin-Kebbi, North-Western Nigeria. Niger J Clin Pract. 2012;15(3):326–32.CrossRefPubMed
71.
Caster MM, Norris AH, Butao C, Carr Reese P, Chemey E, Phuka J, et al. Assessing the acceptability, feasibility, and effectiveness of a tablet-based cervical cancer educational intervention. J Cancer Educ. 2017;32(1):35–42.CrossRefPubMed
72.
Chigbu CO, Onyebuchi AK, Onyeka TC, Odugu BU, Dim CC. The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria. Int J Gynecol Obstet. 2017;137(3):319–24.CrossRef
73.
De Groot AS, Tounkara K, Rochas M, Beseme S, Yekta S, Diallo FS, et al. Knowledge, attitudes, practices and willingness to vaccinate in preparation for the introduction of HPV vaccines in Bamako, Mali. PLoS One. 2017;12(2):e0171631.
74.
Mbachu C, Dim C, Ezeoke U. Effects of peer health education on perception and practice of screening for cervical cancer among urban residential women in south-east Nigeria: a before and after study. BMC Womens Health. 2017;17(1):41.
75.
Levine LD, Chudnoff SG, Taylor K, Baganizi M, Banks E. A 5-day educational program for teaching cervical cancer screening using visual inspection with acetic acid in low-resource settings. Int J Gynaecol Obstet. 2011;115(2):171–4.CrossRefPubMed
76.
Miller D, Okolo CA, Mirabal Y, Guillaud M, Arulogun OS, Oladepo O, et al. Knowledge dissemination and evaluation in a cervical cancer screening implementation program in Nigeria. Gynecol Oncol. 2007;107(1 Suppl 1):S196–207.CrossRefPubMed
77.
Risi L, Bindman JP, Campbell OM, Imrie J, Everett K, Bradley J, et al. Media interventions to increase cervical screening uptake in South Africa: an evaluation study of effectiveness. Health Educ Res. 2004 Aug;19(4):457–68.CrossRefPubMed
78.
Rosser JI, Njoroge B, Huchko MJ. Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: the effects of an educational intervention in rural Kenya. Patient Educ Couns. 2015;98(7):884–9.CrossRefPubMedPubMedCentral
79.
Adonis L, Paramanund J, Basu D, Luiz J. Framing preventive care messaging and cervical cancer screening in a health-insured population in South Africa: implications for population-based communication? J Health Psychol. 2017;22(11):1365–75.CrossRefPubMed
80.
Okeke EN, Adepiti CA, Ajenifuja KO. What is the price of prevention? New evidence from a field experiment. J Health Econ. 2013;32(1):207–18.CrossRefPubMed
81.
Watson-Jones D, Baisley K, Ponsiano R, Lemme F, Remes P, Ross D, et al. Human papillomavirus vaccination in Tanzanian schoolgirls: cluster-randomized trial comparing 2 vaccine-delivery strategies. J Infect Dis. 2012;206(5):678–86.CrossRefPubMedPubMedCentral
82.
Modibbo F, Iregbu KC, Okuma J, Leeman A, Kasius A, De Koning M, et al. Randomized trial evaluating self-sampling for HPV DNA based tests for cervical cancer screening in Nigeria. Infect Agents Cancer. 2017;12(1):1–9.CrossRef
83.
Mutyaba T, Mirembe F, Sandin S, Weiderpass E. Male partner involvement in reducing loss to follow-up after cervical cancer screening in Uganda. Int J Gynaecol Obstet. 2009;107(2):103–6.CrossRefPubMed
84.
Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health. 2016;16:29-016-0306-6.CrossRef
85.
Brownson R, Colditz G, Proctor E. Dissemination and implementation research in health: translating science to practice. New York: Oxford University Press, Inc.; 2012.CrossRef
86.
Green LW, Ottoson JM, Garcia C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health. 2009;30:151–74.CrossRefPubMed
87.
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington D.C.: National Academies Press; 2001. 
88.
Fixsen D, Naaom S, Blase K, Friedman R, Wallace F. Chapter 3: a conceptual view of implementation. Implementation research: a synthesis of the literature. Tampa: National Implementation Research Network, Louis de la Parte Florida Mental Health Institute; 2005. p. 11.
89.
Helfrich CD, Weiner BJ, McKinney MM, Minasian L. Determinants of implementation effectiveness: adapting a framework for complex innovations. Med Care Res Rev. 2007;64(3):279–303.CrossRefPubMed
Metadata
Title
Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review
Authors
Lauren G. Johnson
Allison Armstrong
Caroline M. Joyce
Anne M. Teitelman
Alison M. Buttenheim
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2018
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-018-0718-9

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