Recruitment strategies to promote uptake of cervical cancer screening in West Cameroon

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Abstract Objectives World Health Organization’s (WHO) global strategy for cervical cancer elimination has set for 2030 that all countries reach the target of 70% coverage screening rate. Communities’ sensitization through media is often used but community health workers’ (CHW) involvement may contribute to improve screening coverage. We aimed to assess effectiveness and costs of two cervical cancer screening recruitment strategies conducted in a low resource setting. Methods The study was conducted in West region of Cameroon precisely in Dschang Health District, a community of 300’000 people. From September 2018 to February 2020, we recruited and screened women in a cervical cancer single-visit prevention campaign at Dschang District Hospital. For the first nine months, recruitment was only based on Community Information Channels (CIC) (i.e. street banners). Since the tenth month, participation of CHW was added for recruitment in the community after training for cervical cancer counselling. Population recruitment was compared between the two strategies by assessing the number of recruited women, and direct costs (CHW costs include recruitment, teaching, certification, identification badge, flyers, transport, and salary). Interventions’ cost-effectiveness is expressed using an incremental cost-effectiveness ratio (ICER). Results and discussion During the period under study, 1940 women were recruited, HPV positive rate was 18.6% (n = 361) and 39 cervical intraepithelial neoplasia grade 2 or worse (CIN2+) (10,8% of HPV-positive women) were diagnosed. Among participants, 69.9% (n = 1356) of women were recruited through CIC as compared to 30.1% (n = 584) by CHW. The cost per screened woman and CIN2 + diagnosed was higher in the CHW group as compared to the CIC group. The ICER was 6.45 USD or 16.61 2021Int’l$ per screened woman recruited by CHW. In rural areas, recruitment increased from 12.1–61.4% between CIC-led and CHW-led intervention. These outcomes highlight the importance of training, preparing, and deploying CHWs to screen hard-to-reach women, considering that up to 45% of the Cameroon population lives in a rural area. Conclusion CHW offer an important complement to CIC for expanding coverage in a rural sub-Saharan Africa setting like West Cameroon. CHW have a central role in building awareness and motivation for improving cervical cancer screening participation.

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