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Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

Publication ,  Journal Article
Shen, J; Olwanda, E; Kahn, JG; Huchko, MJ
Published in: BMC Health Serv Res
May 25, 2018

BACKGROUND: Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs. METHODS: We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to community health campaigns (CHCs), and six to screening at government clinics. All HPV-positive women were referred for cryotherapy at Migori County Hospital. We prospectively estimated direct costs from the health system perspective, using micro-costing methods. Cost data were extracted from expenditure records, staff interviews, and time and motion logs. Total costs per woman screening included three activities: outreach, HPV-based screening, and notification. Types of inputs include personnel, recurrent goods, capital goods, and services. We costed potential changes to implementation for scaling. RESULTS: From January to September 2016, 2899 women were screened in CHCs and 2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach, screening, and notification. The mean cost per woman screened was $25.00 for CHCs [median: $25.09; Range: $22.06-30.21] and $29.56 for clinics [$28.90; $25.27-37.08]. Clinics had higher costs than CHCs for personnel ($14.27 vs. $11.26) and capital ($5.55 vs. $2.80). Screening costs were higher for clinics at $21.84, compared to $17.48 for CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs. $0.17). After modeling a reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent to CHCs. CONCLUSIONS: HPV-based cervical cancer screening through community health campaigns achieved lower costs per woman screened, compared to screening at clinics. Periodic high-volume CHCs appear to be a viable low-cost strategy for implementing cervical cancer screening.

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Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

May 25, 2018

Volume

18

Issue

1

Start / End Page

378

Location

England

Related Subject Headings

  • Vaginal Smears
  • Uterine Cervical Neoplasms
  • Rural Health Services
  • Papanicolaou Test
  • Middle Aged
  • Kenya
  • Humans
  • Health Promotion
  • Health Policy & Services
  • Health Care Costs
 

Citation

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Shen, J., Olwanda, E., Kahn, J. G., & Huchko, M. J. (2018). Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya. BMC Health Serv Res, 18(1), 378. https://doi.org/10.1186/s12913-018-3195-6
Shen, Jennifer, Easter Olwanda, James G. Kahn, and Megan J. Huchko. “Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.BMC Health Serv Res 18, no. 1 (May 25, 2018): 378. https://doi.org/10.1186/s12913-018-3195-6.
Shen J, Olwanda E, Kahn JG, Huchko MJ. Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya. BMC Health Serv Res. 2018 May 25;18(1):378.
Shen, Jennifer, et al. “Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.BMC Health Serv Res, vol. 18, no. 1, May 2018, p. 378. Pubmed, doi:10.1186/s12913-018-3195-6.
Shen J, Olwanda E, Kahn JG, Huchko MJ. Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya. BMC Health Serv Res. 2018 May 25;18(1):378.
Journal cover image

Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

May 25, 2018

Volume

18

Issue

1

Start / End Page

378

Location

England

Related Subject Headings

  • Vaginal Smears
  • Uterine Cervical Neoplasms
  • Rural Health Services
  • Papanicolaou Test
  • Middle Aged
  • Kenya
  • Humans
  • Health Promotion
  • Health Policy & Services
  • Health Care Costs