Implementation of human papillomavirus video education for women participating in mass cervical cancer screening in Tanzania

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Publisher: Elsevier B.V.
Document Type: Report
Length: 708 words

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Key words Africa; cervical cancer; global health; human papillomavirus; patient education; visual inspection with acetic acid Background Because the global disease burden of cervical cancer is greatest in Africa, the World Health Organization has endorsed visual inspection with acetic acid screening with cryotherapy triage for the screen-and-treat approach. With the lowest doctor-to-patient ratio worldwide (1:50,000), Tanzania has nearly 10,000 new cases of cervical cancer and 7000 deaths annually. Objective We report on the feasibility of visual inspection with acetic acid in the severely resource-limited Mwanza district and on the impact of intervening education on baseline human papillomavirus and cervical cancer knowledge. Study Design Two 5-day free visual inspection with acetic acid (VIA) clinics in urban Buzuruga and rural Sangabuye on the shores of Lake Victoria were approved by our university institutional review board and local Tanzanian health authorities. Participants completed a demographic survey and a 6-question (1 point per question) multiple choice test written in Kiswahili to assess baseline knowledge. A 15-minute educational video in Kiswahili (MedicalAidFilms: Understanding screening, treatment, and prevention of cervical cancer) was followed by repeated assessment using the same test, visual inspection with acetic acid screening, and optional HIV testing. Pre- and postvideo scores and change of score were analyzed via t test, analysis of variance, and multivariate regression. Significance was considered at P Results From July 2, 2018 to July 6, 2018, 825 women were screened, and 207 women (25.1%) were VIA positive (VIA+). One hundred forty-seven VIA+ nonpregnant women received same-day cryotherapy. Seven hundred sixty women participated in an educational intervention--61.6% of whom were from an urban site and 38.2% from a rural site. The mean age was 36.4 (standard deviation, 11.1). Primary languages were Kiswahili (62.2%) and Kisukuma (30.6%). Literacy was approximately 73%, and average education level was equivalent to the seventh grade (United States). Less than 20% of urban and rural women reported access to healthcare providers. Mean score of the participants before watching the video was 2.22 (standard deviation, 1.76) and was not different between VIA+ and VIA negative groups. Mean score of the participants after watching the video was 3.86 (standard deviation, 1.78). Postvideo scores significantly improved regardless of age group, clinic site, primary language, education level, literacy, or access to healthcare provider (P Conclusion Visual inspection with acetic acid screening for cervical cancer is feasible and accepted in northern Tanzania. Short video-based educational intervention improved baseline knowledge on the consequences of human papillomavirus infection in the studied populations. The impact was greater in the urban setting than in the rural setting. Author Affiliation: (a) Department of Medical Education, University of California, Irvine College of Medicine, Irvine, CA (b) Department of Epidemiology, University of California, Irvine College of Medicine, Irvine, CA (c) Department of Obstetrics & Gynecology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA (d) Bowdoin College, Brunswick, ME (e) Division of Gynecologic Oncology, University of California Irvine Medical Center, Orange, CA * Corresponding author: Emma C. Cooper, BS. Article History: Received 6 April 2020; Revised 30 June 2020; Accepted 14 July 2020 (footnote) The authors report no conflict of interest. (footnote) This study was funded by the School of Medicine Fundraising Campaign and the University of California Irvine Institute for Clinical and Translational Science. (footnote) Cite this article as: Cooper EC, Maher JA, Naaseh A, et al. Implementation of human papillomavirus video education for women participating in mass cervical cancer screening in Tanzania. Am J Obstet Gynecol 2021;224:105.e1-9. Byline: Emma C. Cooper, BS [coopere@uci.edu] (a,*), Justine A. Maher, BA, MPH (a), Ariana Naaseh, BA (a), Elizabeth W. Crawford, BA, BS (a), Justine O. Chinn, BS (a), Ava S. Runge, BS (a), Alexa N. Lucas, BS (a), Danielle C. Zezoff, BS (a), Kevin R. Bera, BS (a), Andreea I. Dinicu, BS (a), Kayla M. White, BS (a), Sujata E. Tewari, HSD (d), Anjali Hari, MD (c), Megan Bernstein, MD (c), Jenny Chang, PhD (b), Argyrios Ziogas, PhD (b), Diana C. Pearre, MD (e), Krishnansu S. Tewari, MD, FACOG, FACS, FRSM (d,e)

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Gale Document Number: GALE|A648966091