Interventions involving community health workers and their effect on cervical cancer screening uptake in sub-Saharan Africa: a systematic review

BACKGROUND: Sub-Saharan Africa (SSA) has the highest incidence and mortality rates of cervical cancer (CC), largely due to limited screening coverage. Community health workers (CHWs) are lay health providers who strengthen healthcare delivery; however, their influence on cervical cancer screening (CCS) uptake remains insufficiently explored. This systematic review evaluates the impact of CHW-involved interventions on CCS uptake in SSA. METHODS: A systematic search of MEDLINE, EMBASE, and Cochrane databases was conducted in June 2023 and updated in May 2025. Studies were included if they: (1) were conducted in SSA among females eligible for CCS and published between January 2003 and May 2025; (2) compared CHW-based interventions with standard or non-CHW approaches; and (3) reported CCS uptake, linkage to triage and/or treatment after primary screening or attendance to follow-up visits. Only studies using a controlled design were included. A descriptive analysis was performed. PROSPERO registration: CRD42024495220. RESULTS: Six studies met the inclusion criteria. Despite methodological limitations, all studies involved CHWs in health education and counseling. CHWs conducted home visits to recruit participants for CCS, rescheduled follow-up appointments, facilitated access to care, and provided childcare during screening attendance. Interventions involving CHWs significantly increased CCS uptake in three of the five studies assessing it as the primary outcome and improved follow-up attendance in the single study examining this indicator. CONCLUSION: The effectiveness of CHW-based interventions varies by type and context but shows potential to enhance CCS uptake in SSA.