Title : Follow-up care cervical cancer screening results in public health programs within African countries: A scoping review
Abstract:
Objectives: Over 90% of cervical cancer cases occur in LMICs. A Lancet publication from Singh et al. (2023) has found that the highest incidence rates are found in Africa. For significant reductions in incidence and mortality rates in those settings, the successful follow-up and management (i.e., colposcopy, triage, and/or treatment) of abnormal, suspicious and/or positive cases is critical. Yet, completion is not well-documented in limited-resource settings. This scoping review explores the evidence on follow-up care in routine screening programs in Africa.
Methods: We sought peer-reviewed studies published between 2010-2024 from PubMed, Embase, Scopus, Web of Science on cervical cancer, screening, treatment, and adherence. Manuscripts presenting follow-up outcomes after screening in public health programs in Africa were selected. All co-authors participated in at least one of the review phases, with two co-authors leading the consensus reviews of screened titles, abstracts, full texts and extracted data including screening setting, program design, and programmatic outcomes.
Results: Of a total of 4733 publications initially screened, 14 (21.2%) fit our criteria and initial data extraction from 17 programs in 15 African countries are presented. All regions were represented, with most of the countries being from East Africa (n=5) and using VIA (n=12) or cytology (n=3) for screening. Management strategies included immediate treatment (n=9, 53%), colposcopy (n=6, 35.3%,), and cytology/VIA triage visit (n=2 11.8%). The average follow-up rates varied with 67.7% (range: 40.4% (Kenya)-91.1% (Tanzania)), 61.4% (range: 49% (South Africa)-75% (Zambia)), and 45.3% (range: 38% (South Africa)-52.8% (Nigeria)) for immediate treatment, colposcopy and triage, respectively.
Conclusions: This review finds that screening programs in Africa face critical challenges with follow-up to meet the WHO Elimination Goal for treatment of 90%. Significant efforts should focus on improving the standard of treatment and care to ensure appropriate follow-up and management of abnormal/suspicious/positive cases.
