Community mobilisation and outreach for cervical cancer screening and premalignant lesion treatment in Uasin Gishu County, Kenya

Cervical cancer ranks fourth in incidence and mortality globally with the greatest burden of the disease being in Sub-Saharan Africa. In Kenya, cervical cancer is the leading cause of cancer deaths among women with a low national cervical cancer screening rate. To assess the implementation of cervical cancer screening using Visualization with Acetic Acid (VIA) and Visualization using Lugol’s Iodine (VILI) and treatment of screen-detected pre-malignant cervical lesions at primary level care facilities. To evaluate the willingness of women, healthcare providers, and community stakeholders to engage in screening and treatment services, to examine the availability of trained personnel, supplies, and infrastructure required to deliver screening and treatment at primary care facilities, to assess the extent to which primary care providers and facilities have initiated and integrated screening and treatment into routine service delivery, to determine the proportion of eligible women reached by screening and treatment services, and to assess adherence of providers to nationally recommended guidelines and strategies in the implementation of screening and treatment of screen-detected premalignant lesions. We conducted an implementation science research study guided by the Implementation Outcomes Framework IOF to assess cervical cancer screening using VIA and VILI, and treatment of screen-detected premalignant lesions at primary care facilities. Quantitative facility assessments were used to measure the outcomes of acceptability, feasibility, adoption, penetration (reach), and fidelity in line with nationally recommended guidelines and strategies. Data sources included facility service registers, provider questionnaires, structured observations of VIA and VILI procedures, exit interviews to capture perceptions, review of service delivery records to measure adoption, reach, and adherence. Descriptive statistics were used to analyse quantitative indicators. A total of 3,710 were screened of whom 3,082 were women aged 25–49, achieving a 127% of the annual cumulative target for the participating health facilities. Of 3,710 screenings, 59% were CHP community referrals and 41% from outreaches or walk-ins. VIA/VILI positivity was 3.7%, with 85% treated by thermoablation or cryotherapy. Twelve women (0.3%) had suspicious lesions, aged between 25–71. HCWs’ median knowledge scores improved from 60 (IQR 55–70) to 80 (IQR 70–85) post-training (z = 4.426, p < 0.001). Among 279 women surveyed, 62% knew of cervical cancer, but only 21% had ever been screened. Structured health education, screening campaigns, collaboration with County health officials and communities, and CHP training significantly enhanced community mobilization and uptake of VIA/VILI screening and treatment in low-resource settings.