Community Co-produced Action for Improved Access to Cervical Cancer Screening in Cameroon (Act4CC)

Co-produced Community Action for Improved Access to Cervical Cancer Screening (Act4CC): a Mixed-methods Study in Rural Areas of the Mifi Health District

Background - The burden of cervical cancer is unequally distributed globally, with over 90% of deaths occurring in low- and middle-income countries (LMICs), mainly due to insufficient uptake of preventive measures such as screening. In 2020, the World Health Organization launched a global initiative for the worldwide elimination of cervical cancer as a public health issue, setting a target of 70% of women screened with a high-performance test. In Cameroon, this target is far from being reached, and rural communities are disproportionately affected by low uptake of screening services. Recently, a new cervical cancer screening program has launched in the Bafoussam Regional Hospital, in the capital of the Mifi Health District, as part of a larger research project. To develop a context-specific strategy improving access to screening for women living in rural areas of the district, the active participation of community members for the co-development and implementation of local strategies for cervical cancer screening may be key to improving population screening coverage.

Objective - The aim of this study is to evaluate the use of community co-produced action (CCA) for the development and implementation of HPV-based cervical cancer screening strategies compared to a traditional hospital-based approach in rural areas of the Mifi Health District in Cameroon.

Methods - Using a cluster-randomized study design, participatory workshops with community members will be led in 7 rural health areas assigned to the intervention arm, with the aim of codeveloping local strategies for HPV-based cervical cancer screening adapted to the setting. The co-produced strategies may include raising awareness among eligible women (aged 30-49 years, or 25-49 years if HIV-positive), as well as facilitating access to screening tests, results and follow-up. Women living in one of the 7 health areas assigned to the control arm will be invited by community health workers to undergo screening at the Bafoussam Regional Hospital. In both study arms, screened women will be included in the GENOVA study, a cervical cancer screening trial offering free-of- charge HPV testing followed by triage by visual inspection or genotyping for HPV-positive women, and free treatment according to triage results. CCA will be evaluated by assessing its effectiveness for screening uptake. Screening coverage among eligible women will be estimated during one year after implementation of screening strategies in both study arms, based on population statistics provided by the Mifi health district for each health area.

Expected results - Developing context-sensitive solutions to cervical cancer screening through a community-based participatory approach in rural areas of the Mifi health district is expected to improve screening participation rate.

Study Overview

• Status: Recruiting
• Conditions: Cervical Cancer Screening
• Intervention / Treatment: Other: Community co-produced action; Other: Standard screening strategy

• Study Type: Interventional
• Enrollment (Estimated): 800
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ania M Wisniak, MD; Phone Number: +41223724270; Email: ania.wisniak@hug.ch

Study Locations

• Cameroon
  • Mifi
    • Bafoussam, Mifi, Cameroon, 00237
      • Recruiting
      • Bafoussam Regional Hospital
      • Contact: Loïc Djommo, MSc; Phone Number: +237696254802; Email: metchehe00@gmail.com
      • Principal Investigator: Georges Enow Orock, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Women aged 30-49 years old (25-49 years old if HIV-positive)
• Residency in one of the 14 rural health areas of Mifi health district
• Ability to give signed informed consent

Exclusion Criteria:

• known cervical cancer
• symptoms compatible with cervical cancer
• previous hysterectomy
• terminal disease other than cervical cancer
• cervical cancer screening test in the last 5 years (3 years if HIV-positive)
• pregnancy at the time of screening
• lack of discernment capacity

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Community co-produced action; Participatory workshops will be conducted with community members by a multidisciplinary team with the aim to co-develop a strategy for cervical cancer screening adapted to the local setting (including primary HPV screening, triage of HPV-positive patients and treatment of patients triaged positive).	Other: Community co-produced action; Participatory workshops will be conducted with community members by a multidisciplinary team with the aim to co-develop a strategy for cervical cancer screening adapted to the local setting (including primary HPV screening, triage of HPV-positive patients and treatment of patients triaged positive). This intervention is referred to as 'community co-produced action'. Possible strategies co-developed may include collaboration with community health workers or local associations, awareness campaigns, development of health education materials, integration of primary HPV screening at local integrated health centers, organization of group transportation to the district screening center, etc. Using purposive sampling methods, approximately 15 participants will be invited to take part in the workshops in each health area of the intervention, including approximately 3 health care providers, 3 community health workers or members of women's associations, 3 men and 6 eligible women for screening.
Active Comparator: Standard screening strategy; Recruitment of study participants will be coordinated centrally at district level (from the Bafoussam Regional Hospital) following procedures previously established in a cervical cancer screening program in the health district of Dschang.	Other: Standard screening strategy; Recruitment of study participants will be coordinated centrally at district level (from the Bafoussam Regional Hospital) following procedures previously established in a cervical cancer screening program in the health district of Dschang. This standard procedure includes the training of 2 community health workers (CHW) by health area to raise awareness around cervical cancer. After an initial theoretical and practical training in cervical cancer prevention, CHWs recruit women by going door-to-door or through community meetings in their respective health areas. Through a system of nominal invitation vouchers distributed to eligible women, CHWs receive a financial incentive for each woman that shows up for cervical cancer screening. Twice a year, CHWs of all health areas are invited to a feedback session to discuss difficulties encountered on the field and propose solutions to face any identified challenges.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of women having completed screening for cervical cancer	Complete screening (defined as an HPV test +/- triage for HPV-positive women) among the eligible population in both study arms.	HPV test within 12 months after implementation of the screening strategy at health-area level, and triage within 6 months of the HPV test if positive.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of women having completed primary screening	Rate of primary screening (HPV test) among the eligible population in both study arms.	Within 12 months after implementation of the screening strategy at health-area level
Number of HPV-positive women attending a follow-up visit at 12 months	Proportion of HPV-positive women who attend the follow-up visit at 12 months after primary screening (HPV test) in both study arms	From 11 to 15 months after primary screening
Number of women with different sociodemographic characteristics	Distribution of sociodemographic characteristics among screened women in both study arms	At enrollment
Number of HPV-positive women having completed triage and treatment when necessary	Proportion of women with positive primary screening who proceed to completing triage and treatment (when needed) in both study arms	Within 6 months after primary screening (HPV test)

Collaborators and Investigators

• Sponsor: Prof. Patrick Petignat
• Collaborators: London School of Hygiene and Tropical Medicine; University Hospital, Geneva; Bafoussam Regional Hospital, Cameroon
• Investigators: Principal Investigator: Patrick Petignat, PD, University Hospital, Geneva

Study record dates

Study Major Dates

• Study Start (Actual): April 13, 2024
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): February 1, 2027

Study Registration Dates

• First Submitted: October 10, 2024
• First Submitted That Met QC Criteria: October 10, 2024
• First Posted (Actual): October 15, 2024

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 8, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Uterine Neoplasms; Genital Neoplasms, Female; Uterine Cervical Diseases; Uterine Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Genital Diseases, Female; Uterine Cervical Neoplasms
• Other Study ID Numbers: 1020/31/01/2024/CE/CRERSH-OU/V; AO_2023-00019 (Other Identifier: Commission cantonale d'éthique de la recherche de Genève)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Anonymized IPD will be made available on an open-access repository alongside a data dictionary. All IPD used in the results publication will be published.
• IPD Sharing Time Frame: Upon result publication and for a minimum of 10 years.
• IPD Sharing Access Criteria: The anonymized IPD will be made available on an open-access data repository.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No