Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya

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ABSTRACT This application is submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-23- 038 “Administrative Supplements for NCI Global Oncology Mentored Research” and proposes an administrative supplement to our parent award R01CA258590. Background While prevention and treatment strategies exist for cervical cancer, it remains the leading cause of mortality in Sub-Saharan Africa. The timely screening, early diagnosis and treatment of precancerous cervical lesions is key in reducing the disease burden. Current treatment goals have focused on ablative methods but there are women who require different treatment either by excision, hysterectomy, or radiotherapy. We will conduct a mixed methods study on Kenyan women with precancerous cervical lesions who are not amendable to ablative therapy and referred by our study for other treatment- little research is available for this group. Women will be recruited from the parent grant TIBA clinics. We will evaluate this via the following two aims: AIM 1: Evaluate the barriers and facilitators (health system, health care provider and client levels) in the referral and linkage to care for women who screen positive for pre-cancerous lesions and not amenable to ablative therapy. We shall conduct semi-structured surveys, focused group discussions and in-depth interviews to gain information on the barriers and facilitators from the health care providers and clients. AIM 2a: Determine the proportion of women with pre-cancerous cervical lesions and not amenable to ablation therapy who access treatment within a four-month period. All women who are screen-positive and not eligible for ablative therapy will be invited to participate in this study and followed up for a period of four months to determine whether they are treated or not. AIM 2b: Conduct flow mapping of existing referral services for women who screen positive for pre-cancer lesions and not amenable for ablative therapy with a focus on identifying the steps that create barriers to treatment access. A sample of four to five women who screen positive for pre-cancer lesions but who are not amenable to thermal ablation and health care providers will be interviewed to perform flow mapping. Barriers and facilitators to treatment access will be catalogued during the flow mapping process The objective of this study is to understand the bottlenecks in the cervical cancer care continuum following referral and linkage of these women. This will form the basis of future studies that will enhance seamless integration for women with precancerous cervical lesions referred for treatment.