Search

# Background Global initiatives have emphasized the elimination of cervical cancer (CC) among female sex workers (FSW) in Africa. Yet screening remains low, and few interventions have been outlined to target this group. This scoping review sought to understand the knowledge, attitudes, and practices (KAP) among FSW in Africa regarding human papillomavirus (HPV) and CC prevention, and to identify the most effective intervention strategies. # Methods A systematic literature search was performed in PubMed, Scopus, Web of Science, and African Index Medicus for work published between January 2012 through August 2022. Eligible studies included those relating to HPV and CC prevention among FSW in Africa. Studies were categorized as KAP, intervention, or both. A Logic Model was used to guide content analysis of the interventions, and a thematic analysis of all studies was performed. # Results The search resulted in 79 articles of which 11 were included in the study. Six African countries were represented including South Africa, Mozambique, Uganda, Kenya, Ethiopia, and Nigeria. Five of the articles described KAP, while the other six described interventions. The intervention studies were categorized into 3 groups: "screen and treat", self-collection HPV testing, and a "diagonal intervention" which included a multi-faceted approach. # Conclusions Limited literature exists regarding KAP and interventions for HPV and CC prevention among FSW in Africa. While FSW in the literature had a moderate level of knowledge regarding HPV and CC prevention, studies identified a lack of detailed and nuanced knowledge. Successful uptake of screening was seen when services were provided at convenient locations, integrated into routine or HIV care, and recommended by healthcare providers. Future interventions should be context-specific, include improved counselling and education, and be integrated with other services.

Abstract Background Cervical cancer is one of the most common cancers and a major cause of morbidity among women globally. Chemoradiation therapy is the preferred standard treatment for women with stage IB to IVA. However, the benefits of this treatment can only be achieved if patients adhere to the treatment guidelines. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at Uganda Cancer Institute (UCI) was determined. Methods This was a cross-sectional study that reviewed data retrospectively for 196 cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB to IVA. Patient data and information on treatment uptake was obtained by review of the patient’s medical records. Treatment compliance was determined by calculating the number of participants who completed the prescribed treatment (definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy with weekly concurrent cisplatin followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks). Associations between patient factors and treatment adherence were determined using logistic regression analysis. In all statistical tests, a P- value of

# Background Cancer is increasingly diagnosed in Africa, with more than one million new diagnoses annually. In Uganda, the Uganda Cancer Institute (UCI) is the primary cancer care facility, with patients travelling long distances to this facility to receive care. During the COVID-19 pandemic, cancer care was disrupted on several levels, including prevention, screening, diagnosis, treatment, and follow-up. National lockdowns impeded patient access to UCI and halted cancer screening. # Methods This study used qualitative interviews to obtain primary data from professionals working at UCI. Interviews were conducted from April 2022 to January 2023. KI (key informants) ’s were purposively selected, identified by colleagues at UCI and recruited through email and WhatsApp messaging. Verbal consent was obtained. Thirty to 60-minute open-ended interviews conducted virtually and in person were audio recorded and transcribed verbatim. Transcripts were coded via MAXQDA software and analyzed to identify themes. # Results Thematic analysis revealed three major challenges to cancer care during COVID-19. First, UCI experienced logistical barriers such as travel restrictions, staff shortages, and insufficient protective gear. Second, staff adapted to the inflexible national lockdown policy for chronic health care with modifications to treatment regimens. Third, KI reported a significant mental health burden and reflected on how care should be improved. # Conclusions As colleagues got infected, UCI staff organized their training, discussed treatment plans with colleagues, and continued to care for patients at personal risk. Resilience characterized UCI’s response to COVID-19. They adapted treatment protocols to their setting, many of which remain the standard of care today. At the same time, there is a need for capacity building tailored to the Ugandan context to provide cancer care effectively in case of another pandemic.

PURPOSETo better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes.METHODSA comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria.RESULTSA total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life.CONCLUSIONSub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.

Introduction: In Kampala, Uganda, there is a strong cultural practice for patients to have designated caregivers for the duration of hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care on the gynecologic oncology wards at the Uganda Cancer Institute and Mulago Specialised Women and Neonatal Hospital. Methods: We developed, implemented, and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 – July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) post-operative surgical site infections, urinary tract infections, and pneumonia; 3) nursing documentation of medication administration, pain quality, and vital sign assessments, and 4) patient and caregiver education. Descriptive statistics, Fisher’s exact test, and independent samples t-test were applied. Results: Data were collected from 25 patients undergoing major gynecologic procedures. Pre- (N = 14) and post- (N = 11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks (3 to 8, p = 0.266) and intraoperative antibiotic administration (9 to 10, p = 0.180) in patient charts did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition. Conclusion: Our findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.