Health System Strategies to Improve the Uptake of Cervical Cancer Screening in Sub-Saharan Africa: A Scoping Systematic Review.

Abstract

Globally, Sub-Saharan Africa (SSA) has the highest rate of cervical cancer incidence and mortality. Cervical cancer screening (CCS) is essential for identifying and treating pre-cancer and early-stage cancer. However, CCS rates throughout SSA are substantially low due to a multitude of health system barriers, including poor access to CCS services and limited skilled providers and or resources. The aim of this scoping systematic review was to identify evidence-based health system-level strategies addressing barriers to implementing CCS in SSA. A systematic literature search was conducted across multiple databases, including PubMed and EMBASE, published in English from January 2010 to March 2024. The article review process involved independent screening by three trained research team members using Covidence software. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The systematic search returned 4,682 articles, 42 of which were included in the final analysis. The included studies were conducted in 17 SSA countries. Most effective implementation strategies included offering women the option of human papillomavirus (HPV) self-collection, single-visit CCS and treatment, providing CCS services at nonclinical community settings, training nonclinical providers to deliver CCS via task-sharing, and integrating CCS into existing nonprimary care or gynecologic settings such as HIV screening clinics. We identified successful strategies to address health system barriers to CCS in SSA. Health care systems should consider implementing these strategies to maximize the outcome of reaching the World Health Organization's cervical cancer elimination goal of screening 70% of women.