Abstract
BACKGROUND: Effective management of cervical precancerous lesions requires appropriate posttreatment follow-up. In Cameroon like in many Low-and-Middle-Income Countries (LMICs), most women treated for cervical precancers do not present for posttreatment follow-up. The aim of this study was to investigate if a telephone reminder sent to women about missed follow-up appointment could reduce the proportion of those who fail to attend the recommended follow-up, and to examine the association of telephone reminders with posttreatment follow-up adherence. METHODS: We carried out a randomized controlled trial nested within a cohort of women screened and treated for cervical precancer (based on positive VIA/VILI results) in a screen-and-treat cervical cancer prevention program in Cameroon. Women who had met clinical criteria for posttreatment follow-up of cervical precancer and did not attend the follow-up appointment within 3 years of precancer treatment were randomly selected and allocated in a 1:1 ratio to the intervention group (receiving a telephone call and text message reminder in addition to the counselling done at the clinic after precancer treatment) and the control group (no telephone reminder after the in-clinic counselling following precancer treatment, per standard of care). Women in the intervention group were contacted by phone, reminded on the importance of posttreatment follow-up they had missed, and invited to return to the clinic for follow-up. The telephone calls were followed by a text message to enhance the understanding of the telephone conversation. The rate of posttreatment follow-up in the intervention group was compared to that of the control group six months after the telephone reminders. A logistic regression analysis was carried out to examine the association between telephone reminders and posttreatment follow-up adherence. Statistical significance was set at p < 0.05. RESULTS: Between 2022 and 2023, up to 203 women treated for cervical precancers who failed to return to the hospital for posttreatment follow-up within 3 years of receiving precancer treatment were enrolled in this study. Posttreatment follow-up following the telephone reminders was 25.6 % (22/86) and 6.1 % (6/99) in the intervention and control groups, respectively (p<0.001). In the logistic regression analysis, women who received the telephone reminders were four times [aOR = 3.97, 95 %CI (1.29--12.17), p=0.016)] more likely to return for precancer posttreatment follow-up compared to those who did not receive the telephone reminders. Women treated for low-grade cervical precancerous lesions were over five times [aOR=5.44, 95%CI (1.00 29.63), p = 0.059] more likely to attend posttreatment follow-up compared to those treated for high-grade lesions. HIV status was not associated with adherence to posttreatment follow-up. The overall posttreatment follow-up rate increased significantly (p = 0.0024) from 26.45 % (73/276) at baseline, to 36.59 % (101/276) following the intervention. CONCLUSION: Telephone reminders of women treated for cervical precancer who missed their posttreatment appointment in screen-and-treat program in Cameroon significantly increased adherence to posttreatment follow-up. Despite these promising findings, the overall rate of missed posttreatment appointment remained high, suggesting that beyond the lack of education, other factors such as cultural, financial and geographic barriers may play a role in the observed poor adherence to posttreatment follow-up in LMICs. Incorporating telephone reminders into the health package of services for cervical precancer prevention in these settings can improve adherence to posttreatment follow-up.