Demystifying cervical cancer care pathways in private facilities in Kenya

Background Despite advances in HPV vaccination and screening technologies, the uptake of these preventive measures remains low in Kenya, particularly within private healthcare settings. This study evaluates the integration of routine HPV testing into cervical cancer screening programs in private facilities across Kenya, providing evidence to inform scalable interventions aligned with the 90-70-90 global targets for cervical cancer elimination. Methods A convergent parallel mixed-methods design was employed to investigate barriers, facilitators, and contextual factors influencing HPV testing in 30 private healthcare facilities across 15 counties in Kenya. Quantitative data were retrospectively extracted from facility records. Qualitative data from 19 key informant interviews with healthcare providers were thematically analyzed. Results The study found that only 9% of facilities provided HPV DNA testing, with the majority relying on visual inspection with acetic acid (VIA) as the primary screening method. Financial constraints and inadequate infrastructure emerged as significant barriers, compounded by training gaps, fragmented referral pathways, and lengthy turnaround times for test results. However, self-sampling and community health promoter outreach were identified as key facilitators for increasing participation. Facilities with trained personnel and robust community engagement reported higher screening rates. Discussion Public-private partnerships and innovative funding mechanisms could play a pivotal role in overcoming cost barriers and improving service delivery. Addressing systemic barriers, fostering public-private collaborations, and leveraging community-based interventions are pivotal in bridging gaps in service delivery and improving health outcomes for women. This study provides actionable insights to guide national policy and programmatic strategies for sustainable and equitable cervical cancer prevention.