Abstract
In Kenya, cervical cancer (CC) contributes to over 80% of female reproductive-tract cancers,4 yet only 16.4%
of eligible women are screened for CC.5 This is far below the World Health Organization's (WHO) target if 70%
screening coverage; prioritizing access among women living with HIV given their higher risk of developing CC.
Women who are screened and referred for treatment onsite (precancerous lesions) or off-site (cancerous
lesions) experience high rates of loss to follow up (30-60%) during treatment. Many system and patient level
barriers continue to exist resulting in significant morbidity and mortality that could be prevented. Innovative and
feasible eHealth strategies have improved clinical outcomes and patient retention in low resource settings and
could be key to reaching global targets for CC screening and treatment coverage in Kenya. To help address
system level barriers to CC screening, treatment, and follow-up, our team worked with end-users (providers and
patients) to develop the Cancer Tracking System (CATSystem), a web-based, algorithm generated tool to
promote guideline adherent CC screening and retention through treatment. We piloted the CATSystem in a
Kenyan hospital and found that rates of onsite treatment for precancerous lesions and referral for treatment for
women with positive screens were higher (2.5 to 5-fold improvement) during the pilot compared to service
provision six months prior. The goal of this project is to rigorously evaluate the efficacy, implementation, and
cost-effectiveness of the CATSystem to improve rates of screening, treatment, referral, and follow-up care in a
matched, cluster randomized controlled trial in 10 Kenyan government hospitals (5 intervention, 5 standard of
care (SOC)). Specific aims (SA) of the study are to (1) Implement and evaluate the efficacy of CATSystem to
improve guideline adherent CC screening, treatment, referral and follow up, (2) Assess feasibility and
acceptability of implementation of CATSystem in government run facilities using a human centered design
approach, and (3) Calculate the costs and cost-effectiveness of the CATSystem to increase quality adjusted life
years gained. CC cancer deaths can be prevented with early detection and treatment. This study will evaluate
the public health impact of the CATSystem in improving CC screening, treatment, referral, follow-up, and the
feasibility of scale up to other low resource settings.
