Implementing community-based human papillomavirus self-sampling with SMS text follow-up for cervical cancer screening in rural, southwestern Uganda

Abstract

Background Self-collected HPV screening may improve cervical cancer screen¬ing coverage in low resource countries, yet data guiding implementation and fol¬low-up of abnormal results are sparse. Methods This is a prospective cohort implementation study of HPV self-testing program in Mbarara, Uganda with mobile phones to facilitate result notification and referral for treatment at a regional hospital. The effectiveness of the interven¬tions was analyzed using Proctor’s model of implementation. Women were inter¬viewed following screening and at 6 months to assess acceptability and barriers to follow-up. Data were analyzed using descriptive statistics. Results 159 of 194 (82%) of eligible women underwent HPV self-sampling; of these, 27 (17%) returned positive for high-risk HPV subtypes. We sent SMS mes¬sages providing test results and follow-up instructions to all participants. Seven¬teen (63%) hrHPV-positive participants reported receiving SMS text instructions for follow-up, of whom 6 (35%) presented for follow-up. The most common rea¬sons for not returning were: lack of transportation (n = 11), disbelief of results (n = 5), lack of childcare (n = 4), and lack of symptoms (n = 3). Confidence in test results was higher for self-screening compared to VIA (Likert score 4.8 vs 4.4, P = 0.001). Conclusions Despite the use of SMS text-based referrals, only one-third of wom¬en presented for clinical follow-up after abnormal HPV testing.