Cancers (May 2023)

Results from Two HPV-Based Cervical Cancer Screening-Family Planning Integration Models in Malawi: A Cluster Randomized Trial

  • Jennifer H. Tang,
  • Fan Lee,
  • Maganizo B. Chagomerana,
  • Kachengwa Ghambi,
  • Patani Mhango,
  • Lizzie Msowoya,
  • Tawonga Mkochi,
  • Irene Magongwa,
  • Eneli Mhango,
  • Jacqueline Mbendera,
  • Eunice Mwandira,
  • Erik Schouten,
  • Leah Gardner,
  • Jennifer S. Smith,
  • Luis Gadama,
  • Lameck Chinula

DOI
https://doi.org/10.3390/cancers15102797
Journal volume & issue
Vol. 15, no. 10
p. 2797

Abstract

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We conducted a cluster randomized trial of two models for integrating HPV self-collection into family-planning (FP) services at 16 health facilities in Malawi between March 2020–December 2021. Model 1 involved providing only clinic-based HPV self-collection, whereas Model 2 included both clinic-based and community-based HPV self-collection. An endline household survey was performed in sampled villages and households between October-December 2021 in the catchment areas of the health facilities. We analyzed 7664 surveys from 400 villages. Participants from Model 2 areas were more likely to have ever undergone cervical cancer screening (CCS) than participants from Model 1 areas, after adjusting for district, facility location (urban versus rural), and facility size (hospital versus health center) (adjusted odds ratio = 1.73; 95% CI: 1.29, 2.33). Among participants who had ever undergone CCS, participants from Model 2 were more likely to report having undergone HPV self-collection than participants from Model 1 (50.5% versus 22.8%, p = 0.023). Participants from Model 2 were more likely to be using modern FP (adjusted odds ratio = 1.01; 95% CI: 1.41, 1.98) than Model 1 participants. The integration of FP and HPV self-collection in both the clinic and community increases CCS and modern FP uptake more than integration at the clinic-level alone.

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