Assessing cervical precancer treatment rate among people utilising the Johannesburg public sector through record linkage of laboratory data
More details
Hide details
Department of Community Health, Wits School of Public Health, University of the Witwatersrand
Gauteng Department of Health, Charlotte Maxeke Johannesburg Academic Hospital
Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, University of the Witwatersrand
Department of Anatomical Pathology, School of Pathology, University of the Witwatersrand
Cytology Unit, National Health Laboratory Services
Public Health Unit, Ekurhuleni Health District, Gauteng Department of Health
School of Health Systems and Public Health, University of Pretoria
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1464
Background and Objectives: Cervical cancer, the commonest cause of cancer deaths in women in South Africa, is preventable through screening. Reductions in incidence are only possible if women who screen positive undergo precancer treatment. Routine monitoring of the screening cascade does not take place, presenting an opportunity to use sources outside the health information system to assist programme monitoring. This study analysed the follow-up, over two years, of people who screened positive in Johannesburg, 2017. Methods: A retrospective cohort of 67208 people was performed using probabilistic record linkage of laboratory records – cytology with high-grade squamous intraepithelial lesions (HSIL) and histology results – as a proxy for follow-up. HSIL prevalence; follow-up, confirmation, and precancer treatment rates; and time between procedures were calculated. Variables were analysed for significant differences across age, HIV status, screening facility type and subdistrict, and through logistic regression for association. Results: HSIL prevalence was 6.2% with greatest odds in people with HIV (OR:3.02; 95%CI:2.75-3.31). Of 4182 people who screened positive (HSIL), 26.6% underwent follow-up procedures. People had greatest odds of follow-up and treatment when screened at community health centres (CHCs) (follow-up OR:1.28, 95%CI:1.03-1.58; treatment OR:1.34, IQR:1.04-1.72) or hospitals (follow-up OR:1.61, 95%CI:1.26-1.90; treatment OR:1.63, IQR:1.28-2.09), or in subdistrict B (follow-up OR:2.68, 95%CI:2.02-3.45; treatment OR:2.47, IQR:1.70-3.58). Treatment at first follow-up was received by 475 (62.0%) people, and the remaining 38.0% had confirmatory tests, of which 49.5% subsequently received treatment. Precancer treatment rate overall was 16.1%. Median times from the screening test to any follow-up procedure was 131 days (IQR:80-189); to confirmatory test, 123 days (IQR:51-175); and overall time to precancer treatment was 151 days (IQR:101-246). Conclusions: Precancer treatment rates are far below WHO’s elimination target. Simpler screening cascades; benchmarking against high-performing subdistricts; and monitoring through record linkage may assist increase precancer treatment, reducing cervical cancer incidence.
Journals System - logo
Scroll to top