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

Abstract

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.

Trial registration: ClinicalTrials.gov NCT02124252.

Keywords: Cervical cancer screening; HPV testing; Micro-costing; Rural Kenya.

Conflict of interest statement

Ethics approval and consent to participate

We obtained IRB approval from the Kenya Medical Research Institute (KEMRI), Duke University, and University of California – San Francisco. The identification for KEMRI is SERU 2918, for Duke is Pro0007742, and for UCSF is CHR 14-13,698. We obtained written informed consent from all participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

a Personnel team and activities of CHCs across 3 phases: outreach, screening, and notification. b Personnel team and activities of Clinics across 3 phases: outreach, screening, and notification

Fig. 2

a and b CHC and clinic average cost per screening estimates, color coded by cost type and phase

Fig. 3

Bar graph of CHC and clinic personnel cost estimate breakdowns, by cadre