ASPIRE Kiseni

Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The ASPIRE project was first launched in Kisenyi, a neighbourhood in Kampala, Uganda, facilitating a number of community-based cervical cancer screening initiatives to improve access to reproductive health.

The study began by assessing women’s willingness to collect their own cervical samples for HPV testing, finding high willingness to participate. Qualitative work on the role of embarrassment in gynecological screening was later pursued.

Further research led to the implementation of a trial comparing screening uptake and compliance with follow-up in two arms:

(1) Community-based (ie, home or workplace) self-collected HPV testing (facilitated by community health workers) with clinic-based visual inspection with acetic acid (VIA) triage of HPV-positive women (‘HPV-VIA’) and

(2) Clinic-based VIA (‘VIA’). Cost effectiveness analysis found community-based self-collected HPV testing followed by treatment for HPV-positive women has the potential to be an effective and cost-effective screening strategy.

Findings from ASPIRE Kisenyi have prompted further research into self-collection HPV-based screening under the ASPIRE Umbrella.