Table 3 Table of evidence

 Adonis 2017 [79]

To evaluate what type of framed email messaging has the best impact on Pap smear uptake among health-insured females

South Africa

Pap smear

Educate: educational email

Penetration: Pap smear screening coverage

Screening rate in the control group was 9.58%, 5.71% in the gain-framed group, and 8.53% in the loss-framed group. Statistically, there was no difference between groups.

Fair

 Modibbo 2017 [82]

To investigate whether self-collection of cervicovaginal samples for HPV DNA tests would be associated with increased uptake and quality of screening compared with clinic-based collection of samples

Nigeria

HPV DNA test

Restructure: remote self-collection vs. clinic-based physician collection

Fidelity: sensitivity and specificity between clinician- and self- collected samples

Most participants in the self-collection arm (93%) submitted their samples while only 56% of those invited to the hospital for sample collection attended and were screened during the study period (p < 0.001)

Fair

 Okeke 2013 [80]

Determine the effect of cost on screening uptake by providing randomly priced subsidies to eligible women

Nigeria

VIA

Finance: lottery for varied prices of screening and treatment subsidies (0, 50, and 100 Naira)

Penetration: VIA screening coverage

Price of screening had a significant effect on the demand for screening: reducing the price by 10 cents increased uptake by 1%.

Fair

 Risi 2004 [77]

Evaluate the effectiveness of two media interventions—a photo-comic and a radio-drama—in increasing cervical screening uptake

South Africa

Pap smear

Educate: educational photo-comic and radio-drama

Penetration: Pap smear screening coverage

7% (18 of 269) of women who received the intervention photo-comic reported cervical screening during the 6-month follow-up, compared with 6% (25 of 389) of controls (p = 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (9 of 53, 17%) than those who did not (19 of 429, 4%; p < 0.001).

Good

 Rosser 2015 [78]

Evaluate a health talk’s impact on cervical cancer knowledge, attitudes, and screening rates in a rural setting

Kenya

Unspecified screening

Educate: 30-min didactic lecture

Acceptability: reasons for refusal Adoption: willingness to screen

Penetration: screening coverage

Mean knowledge scores increased by 26.4% in the intervention arm compared to only 17.6% in the control arm (p < 0.01). Screening uptake was moderate in both the intervention and control arms, with no difference between the groups (58.9 vs. 60.9%, p = 0.60).

Fair

 Sossaeuer 2014 [26]

Evaluate whether an educational intervention would improve women’s knowledge and confidence in the Self-HPV method

Cameroon

HPV DNA test

Educate: individual counseling (all), educational video (intervention group

Acceptability: confidence, embarrassment, pain, anxiety, discomfort, degree of relaxation and confidence

Participants who received the educational intervention had significantly higher knowledge about HPV and cervical cancer than the control group but no significant difference on self-HPV acceptability and confidence in the method.

Fair

 Van Wijgert 2006 [29]

Assess the validity, feasibility, and acceptability of two methods of self-sampling (tampon or vaginal swab) compared to clinician sampling during a speculum examination

South Africa

HPV DNA test

Restructure: self-administration with tampon or vaginal swab vs. clinician collected swabs

Acceptability: perceived pain, satisfaction

Feasibility: proportion of invalid labs

Fidelity: sensitivity and specificity between clinician-and self-collected samples

Sensitivity for high-risk HPV was good for vaginal swabs (79.8%) and moderate for tampons (59.5%). Self- and clinician- sampling were rated as good or okay by the majority of women

Poor

 Watson-Jones 2012 [81]

Compare coverage achieved by two different delivery strategies (class-based vs. age-based) for HPV vaccine among schoolgirls

Tanzania

HPV vaccine

Educate: community outreach with lectures, pamphlets, posters, radio messages, and dramas

Restructure: change delivery models class-based vs. age-based

Acceptability: reasons for refusal

Penetration: HPV vaccine coverage and 3 dose adherence

For each dose, coverage was higher in class-based schools than in age-based schools (dose 1: 86.4 vs 82.0% [p = .30]; dose 2: 83.8 vs 77.8% [p = .05]; and dose 3: 78.7 vs 72.1% [p = .04]).

Poor

 Mutyaba 2009 [83]

Evaluate the efficacy of male partner involvement in reducing loss to follow-up among women in Uganda referred for colposcopy after a positive cervical cancer screening test

Uganda

VIA,VILI, colposcopy

Educate: group lecture, incentivize follow-up with inclusion of male partner by sending educational pamphlet home for partners

Penetration: screening coverage, loss to follow-up

Intervention group was significantly more likely to return for colposcopy than the control group, with 16 and 34%, respectively, lost to follow-up.

Poor

 Abiodun 2014 [67]

Determine the effect of health education on the awareness, knowledge and perception of cervical cancer and screening among women in rural communities

Nigeria

Unspecified screening

Educate: 1-day health education intervention with group didactic lectures and an educational movie

Penetration: screening coverage

There was a statistically significant difference in cervical cancer awareness, perception, knowledge and screening uptake between intervention and control groups. Proportion of women in the intervention group who had undertaken screening rose from 4.3 to 8.3% (p = .038).

Good

 Adamu 2012 [70]

Assess the effect of health education on the knowledge, attitude, and uptake of Pap smear among female teachers

Nigeria

Pap smear

Educate: individual counseling on cervical cancer, complications, cost, importance of screening

Finance: free coupon for pap test

Penetration: Pap smear screening coverage

The proportion of respondents with a reported practice of Pap smear was low and similar in both groups (1.1 in the intervention group and 4.9% in the control group, p = 0.16). Uptake was poor at post-intervention phase for both groups (p = .45).

Good

 Caster 2017 [71]

Assess the acceptability, feasibility and effectiveness of a tablet-based cervical cancer educational intervention

Malawi

Unspecified screening

Educate: 30-min tablet-based education

Acceptability: participants’ preference for tablet vs. in-person education

Feasibility: ease of tablet use, number of times participants need assistance with tablet

Adoption: intention to screen

The median pretest score was 11 out of 20 and the median posttest score was 18 (p < 0.001). 226 participants (93%) stated that they would like to obtain cervical cancer screening

Fair

 Chigbu 2017 [72]

Determine the impact of trained community health educators on the uptake of cervical and breast cancer screening and HPV vaccine in rural communities

Nigeria

HPV vaccine

Educate: house-to-house education given on a one-on-one basis by community health workers on cervical and breast cancer prevention

Penetration: screening and HPV vaccination coverage

Of the 1327 enrolled women, 42 (3.2%) had undergone screening pre-intervention and 897 (67.6%) received screening afterwards (p < .0001). Only 2 (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 (33.2%) after the intervention (p < .001).

Fair

 De Groot 2017 [73]

Provide information on STI knowledge and vaccine acceptance after an educational session

Mali

HPV vaccine

Educate: educational session to inform adults and adolescents about HPV and cervical cancer, symptoms and causes, benefits and availability of the HPV vaccine

Adoption: parent and child reported willingness to accept the HPV vaccine

The education session increased the HPV vaccine acceptance in all groups, especially among adolescents (from 75.3 to 91.8%, p < .01).

Fair

 Dreyer 2015 [68]

Measure changes in knowledge and screening behavior after an educational intervention provided to mothers of adolescent HPV vaccine recipients

South Africa

Pap smear, HPV DNA test

Educate: 15 min didactic lecture and educational pamphlets

Restructure: integrate screening of mothers into child HPV vaccination program

Penetration: screening coverage

Knowledge about symptoms (p < .005), screening (p < .005), and vaccination (p < .05) improved significantly at 6 month retesting. Improvement for reported screening in the past 12 months was more favorable in Gauteng (41%) with self-sample than in Western Cape with Pap smear (26%).

Fair

 Levine 2011 [75]

Determine the effectiveness of an educational program in VIA knowledge and skills retention among healthcare providers in 2 countries

Uganda

VIA

Educate: 5 day educational program for providers with didactic lectures and procedural training in VIA

Acceptability: provider reported comfort with skills

Sustainability: skill assessment at 6-month follow-up

Mean test scores increased significantly after participation in the training session (62% vs. 81%, p < .001). Self-reported comfort level for identifying cellular abnormalities also increased (2.1 vs. 3.3; p < 0.001 There was no significant difference between initial and 6-month follow-up test scores (80 vs. 79%).

Poor

 Mbachu 2017 [74]

Assess the effectiveness of peer health education on perception, willingness to screen and uptake of cervical cancer screening of women during Anglican church meetings

Nigeria

Pap Smear, VIA, VILI

Educate: three 45–60 min sessions repeated monthly of peer health education on cervical cancer burden, risk factors, symptoms and prevention

Penetration: Pap smear and VIA/ VILI screening coverage

Adoption: willingness to screen

Screening rate increased by 6.8% and the observed difference was statistically significant (p = 0.02).

Fair

 Miller 2007 [76]

Evaluate a train the trainer program for cervical screening implementation and assess pre-post knowledge of the implementation process

Nigeria

VIA, VILI, Pap smear, Cryotherapy

Educate: train the trainer in implementation

None

Of the 41 evaluable exams, 9 saw no change, 31 showed improvement, 1 scored worse.

Poor

 Wright 2010 [69]

Evaluate the effect of a health education program on knowledge of cervical cancer among market women in an urban area

Nigeria

Pap smear

Educate: develop pamphlets, community outreach

None

Significant increase in proportions were found in the intervention/experimental group on awareness of cervical cancer (61.7%), associated symptoms and risk factors such as early sexual debut, promiscuity and smoking.

Fair

 Adamson 2015 [42]

Determine the acceptability and accuracy of tampon-based self-collection for hrHPV mRNA testing in HIV-infected women

South Africa

HPV RNA test

Restructure: self- vs. physician-HPV RNA sampling

Acceptability: care, privacy, embarrassment, discomfort, pain, preference

Fidelity: concordance between physician- and self- collected samples

There was no difference in test positivity between clinician-collection, 36.7%, and tampon- collection, 43.5% (p value = 0.08). Using clinician-collection as the reference, the sensitivity and specificity for hrHPV mRNA of tampon-collection were 77.4 and 77.8%, respectively.

Good

 Adepoju 2016 [59]

Determine sociodemographic characteristics, awareness and uptake of a free cancer screening program

Nigeria

Pap smear

Educate: public sensitization with women groups and mass media campaign

Finance: free screening

Penetration: Pap smear screening coverage

287 women were screened but uptake of cervical cancer screening was low since most women did not come for the program despite the public sensitization.

Poor

 Asgary 2016 [22]

Evaluate the feasibility and efficacy of ongoing, smartphone-based support in sustaining VIA skills for community health nurses

Ghana

VIA, digital imaging

Educate: 2-week didactic and procedural training for VIA and digital imaging, ongoing consultation

Quality: audit and feedback for digital images via smartphone messaging within 24 h

Fidelity: inter-rater agreement for VIA between nurses and expert physician

Feasibility: VIA picture quality

Agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. Cohen κ statistic was 0.67 (95% CI = 0.45–0.88). Images for 9 patients, taken by 6 CHNs, were unclear.

Fair

 Awua 2017 [49]

Compare the uptake of screening between a community-based vs. hospital-based strategies for collecting HPV DNA samples

Ghana

HPV DNA test

Educate: community lectures at churches

Restructure: community-based vs. hospital-based specimen collection

Quality: patient phone reminders

Penetration: HPV DNA testing coverage

Response rates were higher for community-based (95.1%) than short-term (46.6%) or long-term (38.5%) hospital-based appointments

Fair

 Catarino 2015 [48]

Evaluate the use of smartphone telemedicine for off-site diagnosis of cervical intraepithelial neoplasia

Madagascar

VIA, VILI, HPV DNA test, Digital imaging

Restructure: on-site vs. off-site evaluation of VIA digital images

Fidelity: sensitivity and specificity between on-site physician diagnosis and off-site assessment via digital images

The on-site physician had a sensitivity of 66.7% and a specificity of 85.7%; the off-site physician consensus sensitivity was 66.7% with a specificity of 82.3%.

Good

 Crofts 2015 [61]

Report on women’s acceptance of HPV self-sampling following an education intervention on cervical cancer and HPV

Cameroon

HPV DNA test

Educate: 20 min didactic lecture and educational pamphlet with instructions for HPV self-samplings

Acceptability: embarrassment, pain, anxiety, confidence, discomfort, relaxation, complexity

Overall, participants showed high acceptability scores for HPV self-testing (6.986 of 24), with lower scores being more favorable. However, there was no difference in acceptability between participants with good vs. poor knowledge scores.

Fair

 DeGregorio 2017 [57]

Evaluate a nurse-led, fee-for-service cervical cancer screening program using visual inspection with acetic acid-enhanced by digital cervicography in the setting of a large faith-based health care system

Cameroon

VIA, VILI, Digital imaging, Cryotherapy, LEEP, Biopsy

Quality: quarterly meeting to review cervicographs with expert clinician

Educate: peer educators with group lectures in the community

Finance: fee-for-service sliding scale based on community demographics

Restructure: integrate with family planning, breast exams, STI testing

Penetration: VIA screening coverage

In 8 years, 44,979 women were screened for cervical cancer.

Poor

 Dim 2015 [62]

Assess willingness to pay out-of-pocket for Pap smear among HIV positive women after provided information about cervical cancer and screening

Nigeria

Pap smear

Educate: individual counseling on increased risk for cervical cancer, Pap smear protocol, and costs

Adoption: willingness to pay for Pap smear

378 (94.5%) respondents were willing to pay for Pap smear, irrespective of the cost. Willingness to pay showed no trend across age groups (p = . 148), marital status groups (p = . 890), educational status groups (p = . 337), and parity groups (p = . .611).

Fair

 Firnhaber 2015 [41]

Determine whether a quality assurance program using digital cervicography improved the performance of VIA to detect cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in HIV-infected women

South Africa

VIA, digital imaging

Educate: 2-week VIA training

Quality: audit and feedback of VIA cervical images by expert gynecologist in weekly QA meetings

Fidelity: sensitivity and specificity of VIA compared between nurses’ visual assessment and physician digital image assessment

There was substantial agreement between the VIA real-time readings of the nurse and that of the physician with digital cervicography (k statistic = 0.69). There was no statistical difference between the ability of nurses to detect CIN 2+ at the beginning and at the end of the study.

Poor

 Goldhaber-Fiebert 2009 [65]

Determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments

South Africa

Unspecified screening, colposcopy, biopsy

Quality: patient reminder system with community health worker (CHW) home visits to encourage attendance to follow-up appointments

Costs: total CHW program cost, average cost per women screened

Penetration: screening coverage, total CHW home visits completed, patient adherence to appointments

Adherence increased from 74 to 90%; 55 to 87%; 48 to 77%; and 56 to 80% for 6-, 12-, 24-, and 36-month appointments. The CHW program cost R194,018 with 1576 additional appointments attended. Average per-woman costs increased by R14–R47.

Good

 Horo 2012 [23]

Determine effect of a phone based tracking system on follow-up rates

Cote d’Ivoire

VIA, VILI, colposcopy, biopsy

Educate: individual counseling, group patient teaching, and educational pamphlets

Quality: phone based patient reminder system with maximum of 3 calls (one per week)

Acceptability: patient reasons for loss to follow-up

Penetration: colposcopy loss to follow-up rates

The use of a phone-based tracking enabled a significant reduction of women not attending medical consultation after initial positive screening from 36.5 to 19.8% (p < 10–4). Reasons for not following up include cost, transportation, fear and time

Poor

 Huchko 2011 [50]

Assess the impact of a cervical cancer screening prevention pilot project implemented into an established AIDS program

Kenya

VIA, colposcopy, biopsy, LEEP

Educate: 1-week training for providers in VIA, colposcopy, and lab specimen processing, individual patient counseling and community outreach

Restructure: increase lab capacity, embed in HIV program

Quality: ongoing for consultation for program protocol through CCSP

Acceptability: reasons for patients refusing screening, provider satisfaction with training and program implementation

Penetration: VIA screening coverage, provider training coverage

Feasibility: challenges to implementing the program

High coverage (87%). Reasons for declining screening included partner support, menstruation, and fear. 28 (90%) clinical officers underwent training in VIA and colposcopy.

The main challenges reported were related to infrastructure limitations (lack of water, electricity and supplies; and long waits in the clinic) and perceived patient barriers

Poor

 Kapambwe 2013 [60]

To evaluate knowledge transfer after training of traditional marriage counselors (alangizi) to integrate cervical cancer lessons into their routine counseling

Zambia

VIA, Digital imaging

Plan: develop trust between alangizi and research team

Educate: one-day training on basic cervical cancer knowledge for traditional marriage counselors

Restructure: integrate cervical cancer messaging into marriage counseling

Feasibility: perceived barriers and facilitators of integrating screening

A majority of the trainees correctly associated cervical

cancer with HPV (35.6%) and multiple sexual partnerships (28.9%).

Poor

 Khozaim 2014 [51]

Determine the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system

Kenya

VIA, VILI, digital imaging, colposcopy, biopsy, cryotherapy, LEEP

Educate: community outreach, mass media

Restructure: embed in HIV care

Quality: patient reminder system with calls and text messages for upcoming appointments

Penetration: loss to follow-up rates

31.5% lost to follow-up (27.9% colposcopy to biopsy, 49.3% biopsy to LEEP, 59.6% colposcopy to chemo or hysterectomy)

Poor

 Lack 2005 [31]

Compare two

self-administered techniques for detecting HPV (tampons and swabs) with a clinician directed technique (cervical cytobrush)

Gambia

HPV DNA test

Restructure: self-administration- vs. physician-collected swabs

Fidelity: sensitivity and specificity compared between self- and physician collected cervical swabs

Penetration: screening coverage

Self-administered swabs showed a sensitivity of 63.9% and tampons showed a sensitivity of 72.4% compared to the cervical cytobrush as the gold standard. The acceptability of these two tests was 97.1 and 84.6%, respectively.

Poor

 Ladner 2012 [44]

Assess the effectiveness of school vs. clinic based delivery models on HPV vaccine coverage in 7 different countries

Cameroon

HPV vaccine

Restructure: change service sites of HPV vaccination (school, clinic, and mixed models)

Penetration: Vaccine coverage and adherence

High coverage (88%) and adherence (91%) across programs. Mixed model in both school and clinic settings was most effective.

Fair

 LaMontagne 2011 [45]

Assess the effectiveness of school vs. clinic based delivery models on HPV vaccine coverage in 4 different countries

Uganda

HPV vaccine

Educate: community outreach and educational pamphlets

Restructure: change service sites of HPV vaccination (health center, school, and integrated with other health program)

Acceptability: reasons for vaccine acceptance or refusal

Penetration: HPV vaccination coverage

High school coverage (88.9%) but low health center coverage. Reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g., school absenteeism) than by opposition to the vaccine.

Poor

 Maree 2012 [53]

Determine whether cervical screening uptake could be improved when breast and cervical screening are combined

South Africa

VIA

Educate: one-on-one patient counseling

Restructure: combine cervical cancer and breast cancer screenings

Acceptability: patient reasons for screening refusal

Penetration: VIA screening coverage

Moderate coverage (65.4). Major reason for refusal was menstruation.

Good

 Megevand 1996 [46]

Determine the feasibility of providing a cervical screening facility to the underprivileged communities through an educational program and mobile clinic

South Africa

Pap smear, colposcopy, LEEP

Educate: community outreach

Restructure: change service site to mobile clinic with same day Pap smear results and treatment if indicated

Quality: audit and feedback for 100 of every 300 cytology slides

Penetration: loss to follow-up rates

Loss to follow-up rates were much lower for minimal delay, mobile delivery (3%) compared to longer delay, clinic delivery (66%)

Poor

 Mehotra 2014 [58]

Assess the impact of enrollment in an incentive program on receipt of eight preventive care services including Pap smear

South Africa

Pap smear

Finance: insurance incentive program

Penetration: Pap smear screening coverage

65.5% (2,742,268) of health plan members enrolled in the incentive program at some point. Odds ratio for receipt of Pap test is 2.17

Good

 Michelow 2006 [66]

Determine if rapid review of reportedly negative cervical smears is a useful internal quality assurance modality in an unscreened population with very high rates of cervical carcinoma

South Africa

Pap smear

Quality: quality monitoring system for randomly selected Pap smear slides by a senior cytotechnologist

Fidelity: sensitivity and specificity

An amended report was sent out in 373 (0.59%) of the 62,866 cervical smears. The false-negative proportion for HSIL and ASC-H (combined) in this study was 5.76%.

Fair

 Moodley 2013 [52]

Demonstrate the capacity of school health teams to carry out vaccinations within a school environment

South Africa

HPV vaccine

Restructure: integrated with cervical cancer screening program for mothers

Educate: staff training in program policy, sensitize school leadership, community outreach

Penetration: HPV vaccine coverage and 3 dose adherence

High coverage and adherence of the vaccine was found to be high: 99.7, 97.9, and 97.8% for the first, second, and third doses, respectively.

Poor

 Moon 2013 [54]

Assess the feasibility, successes and challenges of integrating a VIA program into an existing HIV program

Mozambique

VIA, Cryotherapy, LEEP, Colposcopy

Educate: 1-week didactic and procedural training in VIA and cryotherapy Restructure: change service sites—embed in HIV care

Feasibility: reasons for delay in treatment provision

Penetration: cryotherapy and LEEP follow-up rates

Sustainability: percentage of providers still performing VIA in 1 year

High and improved follow-up rates between first (53%) and the last quarter

(96%) cryotherapy same day coverage rates. High (88%) referral follow-up rates. 0% physicians and 50% nurses continued VIA screening 1 year after training. Delays in treatment include equipment theft and malfunction.

Poor

 Obiri-Yeboah 2017 [43]

Determine the acceptability, feasibility and performance of alternative self-collected vaginal samples for HPV detection

Ghana

HPV DNA test

Restructure: self- vs. physician-HPV DNA sampling

Acceptability: ease of use, preference

Fidelity: concordance between physician- and self- collected samples

The overall HPV detection concordance was 94.2% and kappa value of 0.88 (p < 0. 0001), showing excellent agreement. 57.7% preferred self- to physician collection.

Fair

 Ogembo 2014 [47]

Inform the Cameroon Ministry of Health of the acceptability, feasibility, and optimal delivery strategies for HPV vaccine

Cameroon

HPV vaccine

Educate: community awareness campaign using mass media, pamphlets, and posters

Restructure: change delivery sites (clinic, school, community/mobile), integrate with screening of mothers

Quality: patient reminder system with peer tracking (school)

Feasibility: vaccines lost/damaged/expired, adverse events

Penetration: vaccine coverage, refusal rate, 3 dose adherence

Total of 6851, 6517 and 5796 girls were immunized with the first, second and third doses of HPV vaccine, respectively, achieving 84.6% full dosage coverage of the adolescents who received the first dose. Only 63 of the 19,200 doses received were lost, damaged or expired. CBCHS charged a fee of US$8 per 3-dose series only to those who were able to pay. Despite the fee, 84.6% of the 6851 girls who received the first dose received all three doses.

Poor

 Quinley 2011 [25]

Examine the diagnostic agreement between off-site expert diagnosis using photographs of the cervix (photographic inspection with acetic acid, PIA) and in-person VIA

Botswana

HPV DNA test, VIA, digital imaging

Quality: quality assurance for digital cervical images

Feasibility: rate of equipment malfunction

Fidelity: inter-rater reliability with expert, concordance between VIA and PIA

Moderate to high agreement (69–100%) with expert, varied for each nurse

High concordance (70%) between PIA and VIA results

31 images were insufficient for reading.

Fair

 Ramogola-Masire 2012 [24]

Determine the feasibility and efficiency of the “see and treat” approach using visual inspection acetic acid (VIA) and enhanced digital imaging (EDI) for cervical cancer prevention in HIV-infected women

Botswana

VIA, VILI, cryotherapy, digital imaging

Educate: 3-day didactic teaching and 8 weeks of procedural training in VIA, digital imaging, and cryotherapy

Restructure: embed in HIV care

Quality: audit and feedback of cervical images by expert gynecologist in weekly quality control meetings

Fidelity: sensitivity, specificity, inter-rater reliability of VIA assessments between nurses and expert gynecologist

Penetration: cryotherapy follow-up rates

High agreement between nurses and the gynecologist in the evaluation of digital pictures (83.3%)

Overall follow-up 709 of 842 (84.2%)

Fair

 Safaeian 2007 [28]

Compare human papillomavirus (HPV) DNA testing between self-administered vaginal swabs and physician-administered cervical swabs

Uganda

HPV DNA test

Restructure: self-administration vs. physician collected swabs

Fidelity: sensitivity and specificity between self- and physician- collected samples

Penetration: screening coverage

Compliance with self-collected swabs was > 86%; however, only 51% accepted a pelvic examination. Agreement among paired observations was 92% with a kappa statistic of 0.75.

Good

 Synman 2015 [55]

Investigate the feasibility of linking HPV self-testing for mothers with a two-dose HPV vaccination schedule of their daughters

South Africa

HPV DNA test, HPV vaccine

Educate: educational pamphlets sent home with children for mothers

Restructure: integrate HPV DNA self-sample kit for mothers into vaccination program for daughters

Penetration: HPV DNA self-testing coverage

Of the 1135 self-screen kits handed out to eligible girls to be passed on to their female guardians, 160 women participated in the self-screening (14.1%).

Poor

 Ting 2013 [27]

Compare the performance of hrHPV mRNA testing of physician- and self-collected specimens for detecting cytological high-grade squamous intraepithelial lesions or more severe (QHSIL) and examined risk factors for hrHPV mRNA positivity in female sex workers

Kenya

HPV RNA test, Pap smear

Restructure: self-administration vs. physician-collected swabs

Fidelity: sensitivity and specificity compared between self- and physician collected cervical swabs

Overall sensitivity of hrHPV testing for detecting QHSIL was similar in physician-collected (86%) and self-collected specimens (79%). Overall specificity of hrHPV mRNA for QHSIL was similar in both physician-collected (73%) and self-collected (75%) specimens.

Good

 Tum 2013 [64]

Determine if a community health worker and education intervention could increase screening uptake

South Africa

Unspecified screening

Educate: health worker training, community education

Acceptability: patient perceived value of community health worker

Penetration: screening coverage

Low coverage (3%). All found value in health worker through informing, teaching, and motivating.

Fair

 Untiet 2014 [30]

Test differences in performance between self-HPV versus physician-HPV and their ability to detect abnormal cytology results

Cameroon

HPV DNA test

Restructure: self-administration vs. physician collected swabs

Fidelity: sensitivity and specificity compared between self- and physician collected cervical swabs

HPV prevalence was 14.6 and 12.7% for self-HPV and physician-HPV, respectively (Cohen’s kappa = 0.74). HPV positivity by cytological diagnosis for ASC-US+ was similar with the two tests

Good

 Wamai 2012 [63]

Evaluate the effectiveness of a campaign in sensitizing parents to HPV vaccination and influencing uptake of vaccine for their children

Cameroon

HPV vaccine, VIA, digital imaging

Educate: Community outreach, mass media, education program

Acceptability: reasons to vaccinate or not

Adoption: willingness to vaccinate

Penetration: VIA screening coverage, sensitization campaign coverage

High willingness to vaccinate among parents. Low coverage (35.3%) of VIA screening among parents. Low education program coverage with 5.9% surveyed parents learning about cervical cancer from program. Top reasons not to vaccinate include effectiveness (31.8%), safety (18.4%), provider recommendations (17.8%) and cost (16.6%).

Fair

 Were 2010 [56]

Pilot test and assess the feasibility of integrating VIA screening into an existing maternal child health and family planning program

Kenya

VIA, VILI

Educate: VIA/VILI training

Restructure: change service- embed in maternal child health and family planning

Penetration: VIA/VILI screening coverage and loss to follow-up

Moderate coverage and follow-up. 435 invited—216 declined 219 accepted. 24 of 40 went for colposcopy.

Poor