Adaptation and implementation of a patient navigation program for cervical cancer screening across contexts in Senegal

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PROJECT SUMMARY ABSTRACT Cervical cancer mortality is expected to increase by 42% to 442,926 deaths worldwide by 2030. Currently 85% of incident cervical cancers and 87% of cervical cancer deaths occur in low- and middle-income countries (LMIC). Due in large part to the low utilization of cervical cancer screening services, Senegal ranks 17th in the world for cervical cancer incidence. For women ages 40 to 49 in rural regions of the country the cervical cancer screening rate is very low at less than 2%. As a result women often present with mostly preventable late stage cancers. Secondary prevention programs (cervical cancer screening) are critical to effectively achieving global progress toward the elimination of human papillomavirus related cancers. However, considerable context variation across geographic- and health system-levels in LMICs markedly obstructs the community responsiveness of an implemented program. Lessons learned from higher resource countries show that incidence and mortality rates decline and early deaths are prevented with early detection and appropriate follow- up and treatment. Prior efforts and pilot studies in Senegal show that there is slow uptake, poor follow-up, and low treatment rates for women who are screened positive. Patient navigation is a strategy to eliminate barriers to screening, timely diagnosis, and follow-up to improve cancer outcomes in vulnerable populations. In high-income countries, patient navigation has demonstrated considerable effectiveness in its ability to address communication, information, medical system, and emotional barriers to timely care across all phases of the cancer care continuum, including detection, diagnosis, treatment, and post-treatment quality of life. Patient navigation programs enhance access to care, promote self-efficacy, and sustain patient engagement with care, and have been shown to improve cancer outcomes, particularly among marginalized groups, rural populations, and impoverished communities. The goal of this project is to prevent unnecessary deaths due to cervical cancer in Senegal. This mixed methods research responds to identified intrapersonal- and community-level barriers to early cervical cancer screening uptake, follow-up, and treatment among women there. We will apply the Dynamic Adaptation Process to study the adaptation of an evidence-based cervical cancer patient navigation program in urban and rural contexts of Senegal, measure the intervention effectiveness, and evaluate programmatic implementation outcomes. By studying the process of adaptation of a patient navigation program in a low- and middle-income country, we will apply implementation science to a novel context. With a particular focus on how the adaptation responds to cancer-related stigma and women’s autonomy in healthcare decision-making, our project demonstrates additional innovation. The process knowledge generated will further our long-term goal to inform the national cervical cancer prevention and control programs in Senegal and other low- and middle-income countries.