Barriers and facilitators to implementing a single-visit, screen-and-treat approach with thermal ablation for cervical cancer prevention in Kenya

Résumé

Cervical cancer continues to be a major global threat to women's health, with approximately 660,000 women diagnosed annually, 94% of whom are in low- and middle-income countries (LMICs). The high disease burden in LMICs is partly due to suboptimal adoption and widespread implementation of effective preventive interventions. This study explored drivers of implementation success and failure for a future single-visit, screen, and treat approach with thermal ablation (SV-SAT + TA), referred to as TIBA in Kenya. Guided by the Consolidated Framework for Implementation Research (CFIR framework), we conducted in-depth interviews with 34 participants (frontline health workers, health facility managers, and policymakers) between May and August 2022 in Kiambu, Embu, and Murang'a Counties in Kenya. All interviews were audio recorded and transcribed verbatim. We applied deductive and inductive coding for emerging themes. The participants reported the relative advantage of thermal ablation for the single-visit, screen-and-treat approach, emphasizing its lower start-up and maintenance costs and lower complexity compared to cryotherapy. Additionally, participants expressed confidence in their ability to implement TIBA, and a strong commitment from the leadership to support TIBA implementation was reported. These factors were perceived as drivers of successful TIBA implementation. In contrast, barriers, including lack of essential commodities and equipment, shortage of trained providers, staff redeployment, inadequate space, recruitment challenges, and silos within the healthcare system, were identified as drivers of implementation failure. To optimize cervical cancer prevention efforts in LMICs, it is critical to address both systemic and contextual factors through a coordinated, integrated, and system-wide approach that involves all the key stakeholders.

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