Assessing the impact of cervical cancer integration into reproductive health networks: operations research from Uganda

Abstract

The Cervical Cancer Screening and Preventive Therapy (CCS&PT) via Reproductive Health Networks initiative started in 2012, with the aim of improving health outcomes through the provision of services targeted at women at highest risk of cervical cancer (those aged 30-49). The project integrates CCS&PT into existing sexual and reproductive health service networks in four sub-Saharan African countries (Nigeria, Kenya, Tanzania, and Uganda). Operations research was conducted in Uganda to assess how well screening services were being provided within the existing networks and to describe the modes and effectiveness of referral methods for further treatment when required. A mixed-methods observational study design included analysis of routine data, quantitative cross-sectional surveys, in-depth interviews, and a referral assessment survey. Data were collected between October and November 2015. Public health impacts were demonstrated, with high proportions of clients reached who had never been screened before, and were in the target age group of 30-49. Opportunities to expand access to treatment were highlighted, with a need to overcome cost and other barriers. Providers reported both benefits and drawbacks of CCS introduction. Encouragingly, integrating CCS&PT provision into SRH care appeared to increase demand for other, complementary services, specifically family planning.