Acceptability and sustainability of a point-of-care HPV ‘self-collect, screen-and-treat’ for cervical cancer prevention in Papua New Guinea: A qualitative exploration of key informants’ perspectives

Abstract

AbstractIntroductionInnovative technologies over the past decade have emerged to increase uptake in cervical cancer early detection and treatment that could significantly improve screening and precancerous treatment. The changing landscape in cervical cancer screening algorithms and technologies calls for critical inquiries into their implementation in all settings, but especially in low-resource settings with the heaviest burden of disease. Papua New Guinea (Papua New Guinea) has among the highest estimated burden of cervical cancer globally yet has no organized national cervical screening programs. To better understand key informants’ perspectives of a same day point-of-care HPV screen-and-treat program, we conducted key informant interviews to capture their insights into the factors impacting the acceptability and sustainability of the intervention.MethodsWe conducted a total of 26 semi-structured interviews with a purposive sample of 20 health care workers and six policymakers from Well Woman Clinics in Madang (Madang Province) and Mt. Hagen (Western Highlands Province). Interviews were conducted in English, transcribed, and analysed using thematic analysis, highlighting factors impacting the acceptability and sustainability of the program from these key informants’ perspectives.ResultsThe participants perceived the intervention as culturally fit and valuable. Health care workers agreed that the technological elements of the intervention were easy to use and provided the benefit of same day screen-and-treat, which helped to significantly reduce loss to follow-up. Factors such as planning for key resources (i.e., financing, and human resources) and political support were recognised as essential to ensure long-term sustainability by policymakers. The intervention was valued as ‘scalable, portable and simple’, emphasizing that key political support and a comprehensive national cervical cancer prevention strategy could help Papua New Guinea make considerable headway toward cervical cancer elimination.ConclusionIn light of the burden of cervical cancer in the country, all participants agreed that a national cervical screening program, explicitly same day screen-and-treat services using self-collection, addressed an immense unmet need and salient cultural and systemic barriers.Contribution to literatureThis study is the first to explore factors impacting the acceptability and sustainability of a point-of-care HPV self-collect same day screen-and-treat in a low resource settingThe intervention was positively welcomed and assessed by all key informantsBoth health care workers and policymakers agree that this service is culturally congruent, easy to use and implement, and is sustainable with consistent political and financial supportKey socio-cultural and systemic factors were identified as caveats that, if raised, could potentially increase acceptability and sustainability of the program