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. 2024 Aug 6;24(1):2121.
doi: 10.1186/s12889-024-19436-3.

Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention

Rachel M Morse  1 , Joanna Brown  2 , E Jennifer Ríos López  2 , Bryn A Prieto  1 , Anna Kohler-Smith  2 , Karina Gonzales Díaz  3 , Magaly Figueredo Escudero  3 , Daniel Lenin Del Cuadro  3 , Giannina Vásquez Del Aguila  3 , Henrry Daza Grandez  4 , Graciela Meza-Sánchez  5 , J Kathleen Tracy  6 , Patti E Gravitt #  7 , Valerie A Paz-Soldan #  8   9 ; Proyecto Precancer Study Group
Collaborators, Affiliations

Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention

Rachel M Morse et al. BMC Public Health. .

Abstract

Background: Cervical cancer is a preventable cancer; however, decreasing its prevalence requires early detection and treatment strategies that reduce rates of loss to follow-up. This study explores factors associated with loss to follow-up among HPV-positive women after implementation of a new HPV-based screen-and-treat approach for cervical cancer prevention in Iquitos, Peru.

Methods: We conducted semi-structured interviews with "obstetras" (i.e., midwives) (n = 15) working in cervical cancer prevention and women (n = 24) who were recorded as lost to follow-up after positive HPV results. We used the Health Care Access Barriers Model to guide analyses. We utilized manifest content analysis to describe barriers to follow-up according to the obstetras and thematic analysis to report themes from the women's perspectives. We also report the steps and time taken to contact women.

Results: We found an incomplete and fragmented patient monitoring system. This incomplete system, in conjunction with challenges in contacting some of the women, led to structural barriers for the obstetras when attempting to deliver positive results. Women in this study expressed a desire to receive treatment, however, faced cognitive barriers including a lack of understanding about HPV results and treatment procedures, fear or anxiety about HPV or treatment, and confusion about the follow-up process. Women also reported having important work matters as a barrier and reported frequently using natural medicine. Reported financial barriers were minimal.

Conclusion: This study highlights the barriers to follow-up after implementation of a primary-level HPV-based screen-and-treat approach. While some barriers that have previously been associated with loss to follow-up were not as prominently observed in this study (e.g., financial), we emphasize the need for screen-and-treat programs to focus on strategies that can address incomplete registry systems, structural challenges in results delivery, cognitive barriers in understanding results and treatment, and work-related barriers.

Keywords: Cervical cancer; HPV screening; Lost to follow-up; Post-implementation; Screen-and-treat.

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Conflict of interest statement

Patti E. Gravitt reports receiving other commercial research support from Cepheid. No potential conflicts of interest were disclosed by the other authors.

Figures

Fig. 1
Fig. 1
PRISMA chart depicting the sample selection process
Fig. 2
Fig. 2
Summary of barriers to the completion of care according to the obstetras
Fig. 3
Fig. 3
Continuum of care model depicting where women were LTFU or completed care according to the women themselves
See this image and copyright information in PMC

Update of

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