A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya.

BACKGROUND: Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact. MATERIALS AND METHODS: This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers. RESULTS: Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support. CONCLUSIONS: Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.

Protocol for the first large-scale emergency care-based longitudinal cohort study of recovery after sexual assault: the Women's Health Study.

INTRODUCTION: Worldwide, an estimated 10%-27% of women are sexually assaulted during their lifetime. Despite the enormity of sexual assault as a public health problem, to our knowledge, no large-scale prospective studies of experiences and recovery over time among women presenting for emergency care after sexual assault have been performed. METHODS AND ANALYSIS: Women ≥18 years of age who present for emergency care within 72 hours of sexual assault to a network of treatment centres across the USA are approached for study participation. Blood DNA and RNA samples and brief questionnaire and medical record data are obtained from women providing initial consent. Full consent is obtained at initial 1 week follow-up to analyse blood sample data and to perform assessments at 1 week, 6 weeks, 6 months and 1 year. These assessments include evaluation of survivor life history, current health and recovery and experiences with treatment providers, law enforcement and the legal system. ETHICS AND DISSEMINATION: This study is approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB) and the IRB of each participating study site. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.