Implementing and Evaluating the Cancer Tracking System (CATSystem): A systems level intervention to improve Cervical Cancer screening, treatment referral and follow up in Kenya

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Abstract In Kenya, cervical cancer (CC) contributes to over 80% of female reproductive-tract cancers,4 yet only 16.4% of eligible women are screened for CC.5 This is far below the World Health Organization's (WHO) target if 70% screening coverage; prioritizing access among women living with HIV given their higher risk of developing CC. Women who are screened and referred for treatment onsite (precancerous lesions) or off-site (cancerous lesions) experience high rates of loss to follow up (30-60%) during treatment. Many system and patient level barriers continue to exist resulting in significant morbidity and mortality that could be prevented. Innovative and feasible eHealth strategies have improved clinical outcomes and patient retention in low resource settings and could be key to reaching global targets for CC screening and treatment coverage in Kenya. To help address system level barriers to CC screening, treatment, and follow-up, our team worked with end-users (providers and patients) to develop the Cancer Tracking System (CATSystem), a web-based, algorithm generated tool to promote guideline adherent CC screening and retention through treatment. We piloted the CATSystem in a Kenyan hospital and found that rates of onsite treatment for precancerous lesions and referral for treatment for women with positive screens were higher (2.5 to 5-fold improvement) during the pilot compared to service provision six months prior. The goal of this project is to rigorously evaluate the efficacy, implementation, and cost-effectiveness of the CATSystem to improve rates of screening, treatment, referral, and follow-up care in a matched, cluster randomized controlled trial in 10 Kenyan government hospitals (5 intervention, 5 standard of care (SOC)). Specific aims (SA) of the study are to (1) Implement and evaluate the efficacy of CATSystem to improve guideline adherent CC screening, treatment, referral and follow up, (2) Assess feasibility and acceptability of implementation of CATSystem in government run facilities using a human centered design approach, and (3) Calculate the costs and cost-effectiveness of the CATSystem to increase quality adjusted life years gained. CC cancer deaths can be prevented with early detection and treatment. This study will evaluate the public health impact of the CATSystem in improving CC screening, treatment, referral, follow-up, and the feasibility of scale up to other low resource settings.