PhD project:
Connected to Care: Use of Mobile Short Message Services to Improve HPV Care – A randomised control trial among HPV-positive Tanzanian Women
Main supervisor: Vibeke Rasch, professor, Research Unit of Gynaecology and Obstetrics
Co-supervisors: Marianne Skovsager Andersen, professor, OUH; Julius Mwaiselage, dr, Ocean Road Cancer Institute; Susanne Krüger Kjær, professor, Rigshospitalet og Kræftens Bekæmpelse; Jan Sørensen, professor, Institut for Sundhedstjenesteforskning, SDU; Tine Gammeltoft, professor; Institut for Antropologi, Københavns Universitet
Background
Globally, Hunman Papilloma Virus (HPV) is the most common Sexually Transmitted Disease (STD), and approximately 80% of all sexually active persons will be infected with HPV at some point during their lifetime. Persistent High-Risk (HR) HPV infection is a necessary first step in order to develop precancerous lesions of which a smaller number progress to invasive cervical cancer over a period of 10-20 years. In Tanzania, the prevalence of HR HPV is 20.1%, and cervical cancer accounts for 38.4% (n=7300) and 34.3% (n=4200) of all cancers and cancer-related deaths among women, respectively. Cervical cancer often affects women at reproductive age, who are breadwinners and family caretakers. Thus, it is a public health concern with enormous social and economic impact. Screening programmes can be efficient tools to reduce the number of cervical cancer cases, but they are difficult to maintain due to low knowledge of cervical cancer and low acceptance of screening programmes, especially in Low Income Countries (LIC). Mobile Health (mHealth) interventions have proved to be an innovative and effective tool to tackle health issues in LIC. Randomised Clinical Trials (RCTs) in Kenya and Zanzibar showed that sms-reminders increased adherence to antiretroviral therapy and skilled delivery attendance.
Purpose/ Aim
The purpose of Connected to Care is to improve the follow-up of women who attend cervical cancer screening and test HPV-positive in Dar es Salaam and Moshi, Tanzania. The objective is to (1) assess the effect of the mobile phone intervention Connected to Care on the attendance rate to cervical cancer screening check-up appointments. Further, to (2) assess the cost-effectiveness of the intervention, and (3) to assess the acceptability of being Connected to Care.
Method/ Design
Connected to Care is a two-site RCT, in which the effect of an mHealth intervention is compared to standard of care in a group of women who are of women who are screened for cervical cancer and tested for HR HPV. A follow-up appointment at 14 months is offered to all women on the day of the screening, and in the period between the screening appointment and the follow-up visit, the intervention group receives educative mHealth messages about cervical cancer and how it can be prevented by regular screening; quizzes based on the mHealth messages; and sms-reminders for the check-up appointment. To estimate the cost-effectiveness of Connected to Care, a conventional Cost-Effectiveness Analysis (CEA) based on the RCT is carried out. The analysis is conducted with the perspective of the Tanzanian health care system and includes a 14-months time perspective corresponding to the duration from inclusion until the follow-up contact. The effect measure is the same as in the RCT (14-months check-up attendance rates for HR HPV-positive women). Acceptability of being Connected to Care is assessed in a combined quantitative and qualitative sub-study. The quantitative study is incorporated into the RCT and includes questionnaire items on participants’ acceptability of receiving mHealth information. In order to pursue in-depth perspectives of acceptability, a qualitative study runs parallel to the RCT. Twentyfive women who attend cervical cancer screening in a separate study site are Connected to Care as if they were part of the RCT, but they are treated as core cases and closely followed in the 14-month period. Close to the time these women receive mHealth messages, personal semi-structured interviews are conducted with all women.
Results
Enrolment of study participants started on 17 August 2015 and there are currently no prelimary results. The primary hypothesis is that the intervention increases the attendance rate with 15%.
Collaborating partners
The study is part of the five-year research project Comprehensive Cervical Cancer Prevention in Tanzania (CONCEPT). Collaborating partners are:
• Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania
• Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania