Stigma and Lack of Social Support Contribute to Loss-To-Follow-Up in a Cervical Cancer Prevention Program in Western Kenya

Background While highly preventable, cervical cancer remains a leading contributor to the global burden of cancer among women globally, with disproportionate impacts in Sub-Saharan Africa. Human papillomavirus (HPV) testing is a cost-effective screening strategy with the potential to increase screening uptake; however, the two-visit requirement often leads to substantial loss-to-follow-up (LTFU) for treatment. Understanding modifiable factors that contribute to LTFU is essential to ensuring maximal program impact. Methods We carried out a mixed-methods study to understand factors related to LTFU following an HPV-based cervical cancer screening campaign in rural Western Kenya. We randomly selected participants among women testing HPV positive as part of an existing intervention study to complete quantitative surveys, seeking equal numbers of treated and LTFU women. A subset of women from both groups was selected for in-depth interviews (IDIs). Results Sixty-one treated and 39 LTFU women completed the quantitative survey, and 10 women from each group completed IDIs. Cost of transportation and distance to the hospital were barriers among all women, who often depended on their partners to facilitate this. Among treated women 67% (n = 41) reported that their peers knew their HPV test result, compared to 38% (n = 15) among LTFU women (p = .007). Stigma and lack of partner and peer support emerged as strong barriers among LTFU women. Women proposed peer encouragement, including men in educational sessions, bringing facilities closer, and providing transportation as facilitators to treatment access. Conclusion Lack of partner and social support emerged as key barriers to treatment uptake among LTFU women. Future interventions should explore stigma reduction, male involvement, peer support, and alternative transportation options as potential facilitators to treatment seeking.