Currently accepted at: Journal of Medical Internet Research
Date Submitted: Aug 15, 2019
Open Peer Review Period: Aug 15, 2019 - Oct 10, 2019
Date Accepted: Dec 19, 2019
(closed for review but you can still tweet)
One-way text messages versus no text messages on attendance to follow-up cervical cancer screening among HPV-positive Tanzanian Women (Connected2Care): a parallel-group randomized controlled trial
Rapid HPV DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV-positive.
We conducted a randomized controlled trial to determine if one-way text messages improved attendance to a 14-months follow-up cervical cancer screening among HPV-positive women.
This multi-centre, parallel-group randomized controlled trial was conducted at three hospitals in Tanzania. Eligible participants were between 25-60 years, had tested positive to a rapid HPV-test during a patient-initiated screening, been informed of their HPV-result, and had a private mobile phone with a valid number. Participants were randomly assigned 1:1 into the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance to a 14-months health provider-initiated follow-up screening. Participants were not blinded but outcome assessors were. The analysis was intention-to-treat.
Between August 2015 and July 2017, 4080 women were screened for cervical cancer of which 705 were included into this trial; 358 were allocated to the intervention group and 347 to the control group. Sixteen women were excluded prior to analysis due to developing cervical cancer or dying (eight from each group). In the intervention group, 84 women (24%) attended their follow-up screening, and in the control group 80 women (24%) attended (RR: 1.02; 95% CI: 0.79-1.33).
Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV-testing as a primary screening method at clinic level entails a challenge of ensuring a proper follow-up of women. Clinical Trial: ClinicalTrials.gov; NCT02509702.
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