Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention in Iquitos, Peru: a mixed methods study.

Autor:	Morse R; Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine., Brown J; Asociación Bené ca PRISMA., Ríos López EJ; Asociación Bené ca PRISMA., Prieto BA; Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine., Kohler-Smith A; Asociación Bené ca PRISMA., Gonzales Díaz K; Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto., Figueredo Escudero M; Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto., Del Cuadro DL; Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto., Vásquez Del Aguila G; Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto., Daza Grandez H; O cina de Servicios de Salud, Gerencia Regional de Salud., Meza G; Facultad de Medicina Humana, Universidad Nacional de la Amazonía Peruana., Tracy JK; Department of Medicine, University of Vermont College of Medicine., Gravitt PE; Department of Epidemiology and Public Health, University of Maryland School of Medicine., Paz-Soldan VA; Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine.
Jazyk:	angličtina
Zdroj:	Research square [Res Sq] 2023 Aug 23. Date of Electronic Publication: 2023 Aug 23.
DOI:	10.21203/rs.3.rs-3210614/v1
Abstrakt:	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 screen-and-treat approach with visual triage and ablative therapy for cervical cancer prevention in Iquitos, Peru. Methods: We conducted semi-structured interviews with nurse-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 analysis. We utilize manifest content analysis to describe barriers to follow-up according to the nurse-midwives and thematic analysis to report themes from the women's perspectives. We also report the steps and time taken to contact women and report discrepancies and concordances between nurse-midwives and women regarding reasons for loss to follow-up. Results: Women in this study expressed a desire to receive treatment. Barriers, including fragmented and incomplete registry systems, made receiving follow-up care more challenging. Nurse-midwives faced structural barriers in attempting to deliver positive results to women who were challenging to contact, and women did not have clear knowledge of how to receive their HPV results. Women 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. Reported financial barriers were minimal. There was agreement between women's and nurse-midwives' reported barriers to follow-up in slightly over half of the cases. 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 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. Competing Interests: Patti E. Gravitt reports receiving other commercial research support from Cepheid. No potential conflicts of interest were disclosed by the other authors.
Databáze:	MEDLINE
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