Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study

• Published in: Journal of cancer education Vol. 36; no. 6; pp. 1170 - 1185
• Main Authors: Liebermann, Erica, Van Devanter, Nancy, Frías Gúzman, Natalia, Hammer, Marilyn J., Ompad, Danielle
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2021; Springer Nature B.V
• Subjects: Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Cervical cancer; Disease prevention; Dominican Republic; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Human papillomavirus; Humans; Mass Screening; Medical screening; Mixed methods research; Pap smear; Papanicolaou Test; Papillomavirus Infections - diagnosis; Papillomavirus Infections - prevention & control; Patient Acceptance of Health Care; Pharmacology/Toxicology; Screening Tests; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Vaginal Smears; Dominican Republic; Dominican Republic; HPV testing; Cervical cancer prevention; Latin America and the Caribbean
• ISSN: 0885-8195; 1543-0154
• DOI: 10.1007/s13187-020-01746-w

Creating effective programs for cervical cancer
prevention
is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)–driven mixed methods study, we conducted in-depth interviews (
N
 = 21) and surveys (
N
 = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.