The state of cervical cancer screening services and barriers to uptake in Abidjan, Cte DIvoire in 2017: A mixed methods study

Cervical cancer (CC) remains a public health concern in Cote d’Ivoire. The national policy for the prevention of cervical cancer has been introduced more than 10 years ago, while the coverage of the target population is still suboptimal. We aimed at describing the barriers to screening among women in Abidjan. A mixed method study was completed from February to August 2016. Stakeholders were interviewed according to their role in the cervical cancer screening program while women were requested to participate in focus groups. Subjects discussed included knowledge, risk factors and prevention of CC, as well as barriers to CC screening. In addition, a site assessment was carried out among 27 CC visual inspection-based screening sites in order to describe the structural barriers to CC screening. Overall, 10 (37.0%), 3 (11.1%) and 2 (7.4%) proposed Pap test colposcopy and HPV testing, respectively. Cryotherapy and Loop Excision Procedure (LEEP) were available in 13 (48.2%) and 3(11.1%) sites, respectively. During the last twelve months, the provision of CC screening services has been interrupted in 9 (33.3%) and 18 (66.7%) sites due to staff turnover and shortage of essential supplies, respectively. The main barriers to screening for women were the lack of knowledge about CC, the fear of the results and the lack of support from the male partner. From stakeholders’ perception, lack of human resources and fund mobilization, logistic and monitoring issues were the bottleneck for the sustainability of the CC screening program. Structural barriers, lack of knowledge and the suboptimal link between stakeholders and users remain challenges to be faced in order to ensure a resilient, systematic and organized program in Côte d’Ivoire. Key words: Barriers, cervical cancer, screening, Côte d’Ivoire.