Barriers limiting access to follow-up care after HPV screening for cervical cancer in global settings: A systematic review

Abstract

Follow-up care after a positive human papillomavirus (HPV) screening result is essential for cervical cancer prevention, yet many individuals do not complete diagnostic evaluation or treatment. We conducted a systematic review to synthesize barriers to follow-up care after a positive HPV screening result across diverse international settings. The protocol was registered in PROSPERO (CRD420251062691). We searched MEDLINE, Embase, Scopus, and Web of Science for English language studies published from 2015 to 2025. Two reviewers independently screened studies, and findings were narratively synthesized. Fifteen studies met inclusion criteria, and were conducted across 12 locations in Africa, Europe, North America, and South America. Five barrier groups emerged: health system barriers (lack of local treatment, long wait times, limited follow-up capacity), knowledge and communication barriers (confusion about HPV results and next steps), psychological and emotional barriers (fear of treatment, stigma surrounding HPV, distrust in medical systems), social and relational barriers (partner influence, gender roles, lack of peer support), and structural and logistical barriers (transportation, costs, work conflicts). Across settings, missed follow-up after positive HPV screening appeared more strongly linked to health-system and structural barriers than lack of motivation. Strengthening referral pathways, patient tracking systems, communication of results, navigation support, and timely treatment access may improve follow-up completion and enhance the effectiveness of HPV-based screening programs.