Global Health & Medicine 2026;8(5):332-341.

Assessing an educational strategy to improve community health provider-led provision of cervical cancer screening services in western Kenya: A secondary analysis of the Elimisha-HPV cluster-randomized controlled trial

Chepkoech P, Jordan SB, Makhulo B, Ambaka J, Odhiambo F, Otieno EO, Egger J, Huchko M

Cervical cancer disproportionately impacts women in low- and middle-income countries (LMICs), where over 90% of global cervical cancer deaths occur. Lay health workers, such as community health promoters (CHPs), with appropriate training and support, can play a pivotal role in cervical cancer prevention. Our team developed a multi-level intervention, Elimisha-HPV, to support CHP-delivered human papillomavirus (HPV) testing in Kenya. The present analysis evaluates impact of Elimisha-HPV on the following CHP outcomes: i) knowledge of screening delivery and privacy, confidentiality, and professionalism; ii) stigma associated with cervical cancer, human immunodeficiency virus (HIV), and HPV; and iii) confidence to counsel in screening delivery. We used descriptive statistics and linear mixed effects regression models to evaluate intervention effects (intervention group, n = 64; control group, n = 60). For knowledge and privacy, no statistically significant effects were observed (knowledge: β = −0.08 [95% CI, −0.22 to 0.07]; privacy: β = 0.04 [95% CI, −0.05 to 0.13]). No statistically significant intervention effects were observed for stigma associated with cervical cancer, HIV, or HPV (cervical cancer: β = 0.02 [95% CI, −0.13 to 0.16]; HIV: β = 0.01 [95% CI, −0.11 to 0.13]; HPV: β = 0.02 [95% CI, −0.11 to 0.14]). For the confidence to counsel Likert scale-style questions, evaluated using descriptive and regression approaches, proportional increases were observed across both arms, but the main effect was not statistically significant (β = 0.01 [95% CI, −0.09 to 0.11]). Our findings align with previous work demonstrating that stigma surrounding cervical cancer in LMICs is difficult to effectively influence, and provide a foundation for shaping future stigma-reduction campaigns. ClinicalTrials.gov identifier: NCT05736588.

DOI: 10.35772/ghm.2026.01062

Full Text: