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Bonful HA, Addo-Lartey AA, Sefenu RS, Nwameme A, Abagre TA, Awua AK, Adu-Aryee NA, Dedey F, Adanu RMK, Okuyemi KS. Developing a culturally tailored short message service (SMS) intervention for improving the uptake of cervical cancer screening among Ghanaian women in urban communities. BMC Womens Health 2022; 22:154. [PMID: 35538476 PMCID: PMC9092690 DOI: 10.1186/s12905-022-01719-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background There has been extensive research across the globe to understand the barriers and facilitators of cervical cancer (CC) screening. However, few studies have focused on how such information has been used to develop text messages for mHealth screening programs, especially in resource-poor countries. This study elicited information on barriers and facilitators, the preferences of women regarding the modalities for delivery of health SMS messages on screening for cervical cancer, and demonstrates how this information was used to create a health screening program among women in the Greater Accra Region of Ghana. Methods Four main activities were carried out, including (1) a total of five focus group discussions, (2) a baseline survey involving 62 female bankers and 68 women from the communities, (3) a stakeholder meeting involving experts in cervical cancer research and clinical care, and (4) pilot testing of the text messages. Focus group discussions and the baseline survey data were collected concurrently between February and May 2017 and the results were used to develop 5 specific communication objectives during the stakeholder engagements held in June 2017. Results In all, 32 text messages were developed and pretested in July 2017(13 addressed knowledge on CC; 6 highlighted the importance of early detection; 5 allayed fear as a barrier to CC screening; 5 encouraged women to have time for their health, and 3 messages contained information on where to go for screening and the cost involved). Although awareness about the disease was high, knowledge of CC screening was low. For two-thirds of respondents (22/33), perceived lack of time, high cost, and fear (of cc, screening procedure, and potential for negative outcome) accounted for the reasons why respondents will not go for screening, while education on CC, especially from health workers and the mass media enabled uptake of CC screening. Conclusion Several factors prevent women from accessing screening services for CC, however, barriers such as low levels of education on CC, lack of time, and fear can be targeted in SMS messaging programs.
Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01719-9.
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Affiliation(s)
- Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Ransford Selasi Sefenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioral Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Timothy Agandah Abagre
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Adolf Kofi Awua
- Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Kwabenya, Accra, Ghana
| | - Nii Armah Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Comparative assessment of test characteristics of cervical cancer screening methods for implementation in low-resource settings. Prev Med 2022; 154:106883. [PMID: 34785209 DOI: 10.1016/j.ypmed.2021.106883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/31/2022]
Abstract
Cervical cancer disproportionately affects low-resource settings. Papanicolaou, human papillomavirus (HPV), and visual inspection of cervix with acetic acid (VIA) testing, each with different characteristics, will reduce cervical cancer burden. We conducted a critical literature review using PubMed, Cochrane, WHO, and grey literature from 1994 to 2020. We examined efficacy, harms, and comparative effectiveness of screening methods by age, human immunodeficiency virus, provider characteristics, and assessed implementation challenges in low-resource settings. Comprehensive data on utility and efficacy of screening tests indicates that each screening has strengths and shortcomings but all confer acceptable performance. HPV and VIA appear more promising. Primary HPV test-and-treat, self-testing, and co-testing have been studied but data on triage plans, cost, support system, implementation and sustainability is unclear in low-resource settings. HPV testing could help target subgroups of older or higher risk women. VIA offers local capacity-building and scalability. Quality VIA technique after HPV testing is still required to guide post-screening treatments. VIA competencies decline gradually with current standard trainings. Stationary cervicography improves VIA quality but isn't scalable. Affordable smartphones eliminate this barrier, enhance training through mentorship, and advance continuing education and peer-to-peer training. Smartphone-based VIA facilitates cervical image storage for patient education, health promotion, record-keeping, follow-up care, remote expert support, and quality control to improve VIA reliability and reproducibility and reduce mis-diagnoses and burden to health systems. Rather than ranking screening methods using test characteristics alone in study or higher-resource settings, we advocate for scalable strategies that maximize reliability and access and reduce cost and human resources.
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Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer : A retrospective single institution study. Wien Klin Wochenschr 2021; 133:1155-1161. [PMID: 34674038 DOI: 10.1007/s00508-021-01958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Given the lack of primary and secondary prevention programs and cancer awareness in general, cervical cancer remains one of the main causes of cancer-related death in developing countries, such as Bosnia and Herzegovina. Optimization of combinations of external radiation therapy (ERT), brachytherapy and chemotherapy is still needed to improve outcomes in the treatment of advanced cervical cancer. PATIENTS AND METHODS We retrospectively analyzed 48 consecutive patients with Fédération Internationale de Gynecologie et d'Obstetrique (FIGO) 2009 stage IB2-IVA, who were treated with primary concomitant chemobrachyradiotherapy (CCBRT) and consolidation chemotherapy at the Department of Oncology, University Hospital Mostar, Bosnia and Herzegovina between December 2012 and June 2020. Patients were treated with ERT plus two cycles of concomitant chemobrachytherapy with ifosfamide and cisplatin and low-dose rate (LDR) brachytherapy followed by four cycles of consolidation chemotherapy at 3‑week intervals. We evaluated local control rate (LCR), disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and toxicity. RESULTS After 45.5 months (interquartile range, IQR = 47 months) of median follow-up, 5‑year DFS was 72.8% (95% confidence interval. CI 59-78%), OS was 76.6% (95% CI 60-79%), and DSS was 88% (95% CI 71-86%) with acceptable toxicity. LCR was 94%. CONCLUSION Primary CCBRT and consolidation chemotherapy applied in standard clinical practice in the treatment of locally advanced cervical cancer (LACC) produce respectable outcomes.
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Kakani P, Kojima N, Banda BA, Lewis S, Suri R, Chibwana F, Chivwara M, Sullivan L, Chimombo M, Sigauke H, Tymchuk C, Kahn D. Increasing cervical cancer screening at a non-government medical center in Lilongwe, Malawi. Int J STD AIDS 2021; 32:933-939. [PMID: 33910402 DOI: 10.1177/09564624211007260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malawi has the highest incidence of and mortality rate due to cervical cancer in the world. This is largely because of inadequate screening and high rates of human immunodeficiency virus (HIV) infection, which greatly increases cervical cancer risk. We describe the implementation of a quality improvement program to increase use of cervical cancer screening at a non-government medical center in Lilongwe, Malawi. The intervention, developed and launched from March to August 2017, aimed to promote education among patients and clinicians about the importance of cervical cancer screening and improve accessibility of screening information within medical records. Visual inspection with acetic acid (VIA) was used to screen for cervical cancer. Women with a positive VIA were offered treatment using thermocoagulation. The number of VIA screenings conducted in 2016 (pre-intervention), 2017 (intervention), and 2018 (post-intervention) was 125, 234 and 456, respectively. Of the 815 women screened during this period, 36 (4.4%) had a VIA-positive result and 12 (1.5%) had suspect cancer. Of the VIA-positive women, 13 (36.1%) received same-day treatment with thermocoagulation. An interrupted time series regression revealed that there was a sustained increase in monthly screenings between the pre- and post-intervention period (β = 30.84; p = 0.006; 95% CI 9.72-51.97), suggesting that the intervention likely was effective in increasing cervical cancer screening. Our results demonstrate that focusing on developing sustainable solutions and improving system processes, without additional equipment or funding, significantly increased the number of women screened and should be considered in other settings to enhance cervical cancer prevention services.
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Affiliation(s)
- Preeti Kakani
- 12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Noah Kojima
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Samuel Lewis
- 12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rajat Suri
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Lauren Sullivan
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Chris Tymchuk
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel Kahn
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
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5
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Torres-Roman JS, Ronceros-Cardenas L, Valcarcel B, Arce-Huamani MA, Bazalar-Palacios J, Ybaseta-Medina J, La Vecchia C, Alvarez CS. Cervical cancer mortality in Peru: regional trend analysis from 2008-2017. BMC Public Health 2021; 21:219. [PMID: 33499858 PMCID: PMC7836503 DOI: 10.1186/s12889-021-10274-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/19/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cervical cancer is the third leading cause of cancer-related death among Latin American women. Peru has the sixth highest mortality rate for cervical cancer in the region with regional variations. We aimed to determine overall and regional cervical cancer mortality rates and trends in Peru between 2008 and 2017. METHODS We performed an ecological study on the number of deaths by cervical cancer in Peru. Deaths were extracted from the Peruvian Ministry of Health mortality database. Age-standardized mortality rates (ASMR) were estimated per 100,000 women-years using the world standard Segi population. We computed mortality trends using the Joinpoint regression program, estimating the annual percent change (APC). For spatial analysis, GeoDA software was used. RESULTS Peru showed downward trends in the last decade (from 11.62 in 2008 to 9.69 in 2017 (APC = - 2.2, 95% CI: - 4.3, - 0.1, p < 0.05). According to regional-specific analysis, the highest ASMR was in the rainforest region, although this declined from 34.16 in 2008 to 17.98 in 2017 (APC = - 4.3, 95% CI: - 7.2, - 1.3, p < 0.01). Concerning spatial analysis and clustering, the mortality rates from 2008 to 2017 showed a positive spatial autocorrelation and significant clustering (Moran's I: 0.35, p < 0.001) predominantly in the neighboring North-East departments (Loreto, Ucayali, and San Martin). CONCLUSIONS Although mortality trends in the entire population are decreasing, mortality rates remain very high, mainly in the rainforest region. Our results encourage a need for further development and improvement of the current health care delivery system in Peru.
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Affiliation(s)
- J Smith Torres-Roman
- Universidad Científica del Sur, Lima, Peru. .,Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru.
| | | | - Bryan Valcarcel
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
| | - Miguel A Arce-Huamani
- Universidad Científica del Sur, Lima, Peru.,Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
| | - Janina Bazalar-Palacios
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru.,Universidad Católica Los Ángeles de Chimbote, Instituto de Investigación, Chimbote, Peru
| | - Jorge Ybaseta-Medina
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru.,Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133, Milan, Italy
| | - Christian S Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Gottschlich A, Rivera-Andrade A, Bevilacqua K, Murchland AR, Isak E, Alvarez CS, Ogilvie G, Carey TE, Prince M, Dean M, Mendoza-Montano C, Meza R. Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis. BMC Public Health 2020; 20:1406. [PMID: 32933512 PMCID: PMC7493167 DOI: 10.1186/s12889-020-09478-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala. Methods A cohort of 956 women was recruited in 2016 and followed for 2 years for the HPV Multiethnic Study (HPV MES). At baseline, women answered a questionnaire assessing cervical cancer screening history and were offered self-collection HPV testing. Women were re-contacted yearly to determine receipt of additional screening. Statistical changes in screening behavior before and throughout study participation, stratified by self-collection status, were assessed using McNemar pair tests for proportions. Alluvial plots were constructed to depict changes in individual screening behavior. The odds of changes in Pap-compliance (screened in past 3 years), given collection status, were assessed using multivariate logistic regressions. Results Reported screening rates increased 2 years after enrollment compared to rates reported for the 3 years before study entry among women who collected a sample (19.1% increase, p < 0.05), received results of their test (22.1% increase, p < 0.05), and received positive (24.2% increase, p < 0.1) or negative results (21.7% increase, p < 0.05). However, most increases came from one community, with minimal changes in the other. The adjusted odds of becoming Pap compliant were higher for women who collected a sample vs. did not (OR: 1.48, 95% CI: 0.64, 3.40), received their result vs. did not (OR: 1.29, 95% CI: 0.52, 3.02), and received a positive result vs. negative (OR: 2.43, 95% CI: 0.63, 16.10). Conclusions Participation in self-collection HPV testing campaigns may increase likelihood of involvement in screening programs. However, results varied between communities, and reporting of screening histories was inconsistent. Future work should identify what community-specific factors promote success in HPV testing programs and focus on improving education on existing cervical cancer interventions.
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Affiliation(s)
- Anna Gottschlich
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA. .,, Vancouver, Canada.
| | - Alvaro Rivera-Andrade
- Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Kristin Bevilacqua
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Audrey R Murchland
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ergest Isak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Christian S Alvarez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Gina Ogilvie
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Thomas E Carey
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA.,Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Dean
- Laboratory of Translational Genomics, Division of Cancer, Epidemiology and Genetics, National Cancer Institute, Gaithersburg, MD, USA
| | | | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Shaaban AN, Morais S, Peleteiro B. Healthcare Services Utilization Among Migrants in Portugal: Results From the National Health Survey 2014. J Immigr Minor Health 2019; 21:219-229. [PMID: 29644552 DOI: 10.1007/s10903-018-0744-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Migrants' health is attracting substantial global interest. We aimed to identify barriers and differences in healthcare services utilization between migrants and natives in a nationally representative sample using data from the National Health Survey 2014. A total of 18,165 participants providing information on country of birth and nationality were included, and comparison of healthcare services utilization was made by using participants born in Portugal and with Portuguese nationality as the reference group. Migrants reported a lower frequency of medical visits, a higher consumption of medication without a prescription and less use of preventive care services. The main reasons for not attending medical consultations among migrants were the absence of need and financial difficulties. This study illustrates inequalities in healthcare use among migrants in Portugal, and provides useful information for enlightening policymakers and healthcare providers to develop health policies that can address migrants' needs.
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Affiliation(s)
- A Nabil Shaaban
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Gottschlich A, Nuntadusit T, Zarins KR, Hada M, Chooson N, Bilheem S, Navakanitworakul R, Nittayaboon K, Virani S, Rozek L, Sriplung H, Meza R. Barriers to cervical cancer screening and acceptability of HPV self-testing: a cross-sectional comparison between ethnic groups in Southern Thailand. BMJ Open 2019; 9:e031957. [PMID: 31685510 PMCID: PMC6858097 DOI: 10.1136/bmjopen-2019-031957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cervical cancer rates are higher in low-resourced countries than high, partly due to lower rates of screening. Incidence in Thailand is nearly three times higher than in the USA (16.2 vs 6.5 age-standardised incidence), even with Thailand's universal health coverage, which includes screening, suggesting that alternative methods are needed to reduce the burden. We investigated barriers to screening, as well as acceptability of self-collection human papillomavirus (HPV) testing as a primary form of cervical cancer screening among Buddhist and Muslim communities in Southern Thailand. METHODS 267 women from the Buddhist district of Ranot and Muslim district of Na Thawi, Songkhla were recruited to complete a survey assessing knowledge and risk factors of HPV and cervical cancer. Participants were offered an HPV self-collection test with a follow-up survey assessing acceptability. Samples were processed at Prince of Songkhla University and results were returned to participants. RESULTS 267 women participated in the study (132 Buddhist, 135 Muslim), 264 (99%) self-collecting. 98% reported comfort and ease, and 70% preferred it to doctor-facilitated cytology. The main predictor of prior screening was religion (92% Buddhist vs 73% Muslim reporting prior Pap). After adjustment with multivariate logistic models, Muslim women had an OR of prior Pap of 0.30 compared with Buddhist (95% CI: 0.12 to 0.66). CONCLUSIONS Self-collection HPV testing was highly acceptable across religious groups, suggesting that it could be beneficial for cervical cancer reduction in this region. Focus should be put into educating women from all backgrounds about the importance of screening to further improve screening rates among Thai women.
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Affiliation(s)
- Anna Gottschlich
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Thanatta Nuntadusit
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Katie R Zarins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Manila Hada
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nareerat Chooson
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Surichai Bilheem
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | | | - Kesara Nittayaboon
- Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Shama Virani
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Laura Rozek
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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9
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Asgary R, Cole H, Adongo P, Nwameme A, Maya E, Adu-Amankwah A, Barnett H, Adanu R. Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana: mHealth and cervical cancer screening. BMJ Open 2019; 9:e030528. [PMID: 31315879 PMCID: PMC6661590 DOI: 10.1136/bmjopen-2019-030528] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography. DESIGN In 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2). SETTING Community health centres (CHCs) in Accra, Ghana. RESULTS The 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective. CONCLUSIONS Our findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries.
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Affiliation(s)
- Ramin Asgary
- Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
- Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Helen Cole
- Environmental Science and Technology, Autonomous University of Barcelona Barcelona Catalunya Spain, Barcelona, Spain
| | - Philip Adongo
- Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Ada Nwameme
- Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Ernest Maya
- Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
- Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Amanda Adu-Amankwah
- Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Hannah Barnett
- Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Richard Adanu
- Dean, University of Ghana School of Public Health, Accra, Ghana
- Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
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10
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Fernandez LM, Becker JA. Women’s Select Health Issues in Underserved Populations. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Liebermann EJ, VanDevanter N, Hammer MJ, Fu MR. Social and Cultural Barriers to Women's Participation in Pap Smear Screening Programs in Low- and Middle-Income Latin American and Caribbean Countries: An Integrative Review. J Transcult Nurs 2018; 29:591-602. [PMID: 29366369 DOI: 10.1177/1043659618755424] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Pap smear screening programs have been ineffective in reducing cervical cancer mortality in most Latin American and Caribbean countries, in part due to low screening rates. The purpose of this review was to analyze recent studies to identify demographic, social, and cultural factors influencing women's participation in Pap screening programs in Latin America and the Caribbean. DESIGN/METHOD For this integrative review, cervical cancer screening in Latin America and the Caribbean was searched using PubMed, CINAHL, EMBASE, and PsycINFO databases. Findings/Results: Demographic barriers to screening were socioeconomic status, education, race/ethnicity, and geography. Social barriers included lack of uniformity in screening guidelines, lack of knowledge regarding cervical cancer, and lack of preventive culture. Cultural barriers were fear/embarrassment and gender roles. CONCLUSIONS There are multilevel barriers to Pap smear utilization among women in Latin America and the Caribbean. IMPLICATIONS FOR PRACTICE Findings highlight a need for health system engagement, promotion of preventive care, and community-generated educational programs and solutions.
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Affiliation(s)
| | | | | | - Mei R Fu
- 1 New York University, New York, NY, USA
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12
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Gottschlich A, Rivera-Andrade A, Grajeda E, Alvarez C, Mendoza Montano C, Meza R. Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala. J Glob Oncol 2017; 3:444-454. [PMID: 29094082 PMCID: PMC5646882 DOI: 10.1200/jgo.2016.005629] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cervical cancer rates in Latin America are higher than those in developed countries, likely because of the lower prevalence of screening. Specifically, less than 40% of women in Guatemala are regularly screened and even fewer women are screened in indigenous communities. Current screening strategies-Pap smears and visual inspection with acetic acid-might not be the most effective methods for controlling cancer in these settings. We thus investigated the potential of self-collection of cervical samples with testing for human papillomavirus (HPV) to help prevent cervical cancer in an indigenous community in Guatemala. PATIENTS AND METHODS A community representative random sample of 202 indigenous women age 18 to 60 years residing in Santiago Atitlan, Guatemala, were surveyed to assess knowledge of and risk factors for HPV and cervical cancer. Women were then invited to self-collect a cervical sample using HerSwab collection kits to assess the prevalence of HPV and the acceptability of self-sampling. RESULTS Of 202 women who completed the survey, 178 (89%) provided a self-sample. In all, 79% of these women found the test comfortable, 91% found the test easy to use, and 100% reported they were willing to perform the test periodically as a screening method. Thirty-one samples (17%) were positive for at least one of 13 high-risk HPV types, and eight (4.5%) were positive for HPV 16/18. CONCLUSION HPV testing by using self-collected samples was well accepted, suggesting that it is a plausible modality for cervical cancer screening in indigenous communities. Further studies are needed to assess rates of follow-up after a positive test and to determine whether these findings extend to other indigenous and nonindigenous communities in Guatemala and Latin America.
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Affiliation(s)
- Anna Gottschlich
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Alvaro Rivera-Andrade
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Edwin Grajeda
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Christian Alvarez
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Carlos Mendoza Montano
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Rafael Meza
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
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Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: A systematic review. Int J Cancer 2017; 141:437-446. [DOI: 10.1002/ijc.30695] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 01/15/2023]
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Damião PDA, Oliveira-Silva M, Moreira MÂ, Poliakova N, de Lima MER, Chiovo J, Nicol AF. Human Papillomavirus types distribution among women with cervical preneoplastic, lesions and cancer in Luanda, Angola. Pan Afr Med J 2017; 24:268. [PMID: 28154623 PMCID: PMC5267858 DOI: 10.11604/pamj.2016.24.268.9678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/10/2016] [Indexed: 11/12/2022] Open
Abstract
Introduction Cervical cancer is the leading cause of cancer deaths among females in Angola and human papillomavirus (HPV) is the main risk factor for the development of pre-cancerous squamous intraepithelial lesions. The diversity and frequency of HPV types in Angola has yet to be reported. Aim To determine the frequency of HPV among women with squamous intraepithelial lesions from women in Luanda, Angola. Methods Study participants included women diagnosed with cytological abnormalities that voluntarily provided Pap smears (n = 64). Genomic DNA was extracted from the samples for use as templates in the PCR amplification of HPV sequences. PCR products were sequenced to determine HPV type. Results HPV DNA was detected in 71.9% (46/64) in the samples. A higher diversity of HPV types was found in the cytological lesions, such as ASCUS and LSIL (HPV16, 6, 18, 31, 58, 66, 70 and 82, in order of frequency) than that detected for HSIL and SSC (HPV16, 18, 6 and 33). The most prevalent HPV type were: HPV16, HPV6 and HPV18. Conclusion This is the first report on HPV type diversity and frequency in woman of Angola. The results suggest that large-scale studies across Africa would improve our understanding of interrelationship between HPV infections and cervical cancer. More directly, the identification of the HPV types most prevalent suggests that women in Angola would benefit from currently available HPV vaccines.
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Affiliation(s)
| | - Michelle Oliveira-Silva
- Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil; Division of Genetic, National Institute of Cancer, Rio de Janeiro, Brazil
| | | | - Natalia Poliakova
- Departamento de Anatomia Patológica do Hospital Militar Principal, Instituto Superior, Luanda, Angola
| | - Maria Emilia Rt de Lima
- Departamento de Anatomia Patológica do Hospital Militar Principal, Instituto Superior, Luanda, Angola
| | - José Chiovo
- Departamento de Anatomia Patológica do Hospital Militar Principal, Instituto Superior, Luanda, Angola
| | - Alcina Frederica Nicol
- Laboratory of Interdisciplinary Medical Research, LIPMED, IOC, Fiocruz, Rio de Janeiro, Brazil
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Abstract
The purpose of this article is to review women's health issues that affect underserved populations. Certain groups have a lack of health care resources or inability to access resources. Individuals encounter barriers to accessing health care due to socioeconomic status, transportation, intimate partner issues, and distrust of the health care system. These factors lead to health care disparities and a lack of appropriate care or quality care as it pertains to breast cancer screening, cervical cancer screening, and obtaining contraceptive care. Identifying available resources in response to community-based needs assessment is among the tools available to combat these inequalities.
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Affiliation(s)
- Luz M Fernandez
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA
| | - Jonathan A Becker
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA.
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Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health 2016; 16:29. [PMID: 27259656 PMCID: PMC4893293 DOI: 10.1186/s12905-016-0306-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/21/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. METHODS We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories. RESULTS A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts. CONCLUSIONS Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.
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Affiliation(s)
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - May Maloba
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Florence Ndikum-Moffor
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA
| | - Elizabeth Bukusi
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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Handler MZ, Handler NS, Majewski S, Schwartz RA. Human papillomavirus vaccine trials and tribulations: Clinical perspectives. J Am Acad Dermatol 2016; 73:743-56; quiz 757-8. [PMID: 26475534 DOI: 10.1016/j.jaad.2015.05.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/20/2015] [Accepted: 05/23/2015] [Indexed: 01/05/2023]
Abstract
Human papillomavirus (HPV) affects hundreds of millions of people worldwide and is associated with both benign and malignant neoplasms in men and women. It is a double-stranded DNA virus with an icosahedral capsid. Forty HPV types are known to infect mucosal keratinocytes. If not cured by the immune system, the infection can lead to genital warts, mucosal dysplasia, or cancer. The most common oncogenic types are 16 and 18. The vaccine to prevent HPV and its associated morbidity and mortality has existed since 2006. Several variations protect against an increasing number of HPV types. The recommended vaccination age is before sexual exposure; administration of the vaccine to children has been controversial. This continuing medical education review evaluates the current HPV vaccines available to clinicians. Part I focuses on the debate over who should be vaccinated, at what age, and in which populations.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey
| | - Nancy S Handler
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey; University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska
| | - Slawomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Robert A Schwartz
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey; Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey; Pediatrics, Rutgers University New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers University New Jersey Medical School, Newark, New Jersey; School of Public Affairs and Administration, Rutgers University, Newark, New Jersey.
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Abstract
BACKGROUND In Latin America and the Caribbean, the epidemiological transition has been occurring in an unequal manner. Infectious-contagious diseases share space with the increase of chronic nontransmissible diseases, such as cancer, which already represents the second most common cause of death, after cardiovascular illnesses. OBJECTIVES This study provides a global picture of the burden of cancer in Latin America and the Caribbean, as well as the challenges faced when controlling this disease in these regions. FINDINGS Epidemiological information on cancer in Latin America originates mainly from mortality registries and from a limited number of population-based cancer registries. Estimates indicate increases of 72% in the incidence of cancer and 78% in the mortality of men between 2012 and 2030, and for women the rates are 62% and 74%, respectively. These increases in incidence rates, accompanied by disproportionally high mortality rates, when compared with other regions of the world, reveal the magnitude of the challenge of controlling cancer in Latin America and the Caribbean. Although neoplasms are among the main causes of death, the control strategies are faced with issues such as organization and development of the health system, and the public policy formulation mechanism. CONCLUSIONS Establishing knowledge on the real impact of incidence, mortality, and survival in Latin America and the Caribbean is quite a challenge due to the lack of an updated and dynamic information system on mortality and incidence, although some improvement has been made in the information systems of some countries within the most recent decade. Other obstacles for cancer control are the uneven allocation of resources, lack of investments in equipment and infrastructure, and the concentration of health care professionals in large urban centers, which contribute to the reproduction of socioeconomic iniquities in the assistance of populations that suffer from cancer.
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Pairing community health workers with HPV self-sampling for cervical cancer prevention in rural Haiti. Int J Gynaecol Obstet 2014; 128:206-10. [DOI: 10.1016/j.ijgo.2014.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 09/15/2014] [Accepted: 10/30/2014] [Indexed: 01/07/2023]
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Chary AN, Rohloff PJ. Major challenges to scale up of visual inspection-based cervical cancer prevention programs: the experience of Guatemalan NGOs. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:307-17. [PMID: 25276590 PMCID: PMC4168631 DOI: 10.9745/ghsp-d-14-00073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
Scale up of visual inspection with acetic acid (VIA) in Guatemala encountered major challenges, including high attrition of people trained, didactic training without hands-on skills building, lack of continued supervision, and provision of VIA alone without immediate on-site provision of cryotherapy. Background: Like many other low- and middle-income countries, Guatemala has adopted visual inspection with acetic acid (VIA) as a low-resource alternative to the Pap smear for cervical cancer screening. Nongovernmental organizations (NGOs) introduced VIA to Guatemala in 2004, and a growing number of NGOs, working both independently and in collaboration with the Guatemalan Ministry of Health, employ VIA in cervical cancer prevention programs today. While much research describes VIA efficacy and feasibility in Latin America, little is known about NGO involvement with VIA programming or experiences with VIA outside the context of clinical trials and pilot projects in the region. Methods: To explore challenges faced by NGOs implementing VIA programs in Guatemala, we conducted semi-structured interviews with 36 NGO staff members involved with 20 VIA programs as direct service providers, program administrators, and training course instructors. Additionally, we collected data through observation at 30 NGO-sponsored cervical cancer screening campaigns, 8 cervical cancer prevention conferences, and 1 week-long NGO-sponsored VIA training course. Results: Frequently highlighted challenges included staff turnover, concerns over training quality, a need for opportunities for continued supervision, and problems with cryotherapy referrals when immediate treatment for VIA-positive women was unavailable. Conclusions: Reducing staff turnover, budgeting to train replacement providers, standardizing training curricula, and offering continued supervision are key strategies to improve VIA service quality and program sustainability. Alternative training methods, such as on-the-job mentoring and course prerequisites of online learning, could help increase training time available for clinical supervision. Efforts should be made to ensure that VIA testing is coupled with immediate cryotherapy, that providers trained in VIA are also trained in cryotherapy, and that cryotherapy supplies and equipment are maintained. Where this is not possible and only VIA screening is available, referral systems must be strengthened.
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Affiliation(s)
- Anita Nandkumar Chary
- Washington University in St. Louis, School of Medicine and Department of Anthropology , St. Louis, MO. , USA
| | - Peter J Rohloff
- Harvard Medical School, Brigham and Women's Hospital , Boston, MA. , USA
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Rosenbaum AJ, Gage JC, Alfaro KM, Ditzian LR, Maza M, Scarinci IC, Felix JC, Castle PE, Villalta S, Miranda E, Cremer ML. Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador. Int J Gynaecol Obstet 2014; 126:156-60. [DOI: 10.1016/j.ijgo.2014.02.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/19/2014] [Accepted: 04/27/2014] [Indexed: 11/25/2022]
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Cervical cancer screening in high- and low-resource countries: implications and new developments. Obstet Gynecol Surv 2013; 67:658-67. [PMID: 23112073 DOI: 10.1097/ogx.0b013e3182732375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The implementation of cytology-based screening programs for precancerous lesions of the cervix has decreased the incidence of and mortality from cervical cancer in much of the developed world. Countries without the resources to install such frequent and laboratory-dependent screening programs have more and more options at their disposal. A screening program based on cytology analysis requires too much training, infrastructure, and repeated screening to be feasible. Visual inspection with acetic acid, often used throughout the world, is inexpensive and both sensitive and specific, but it lacks reproducibility. Although human papillomavirus (HPV) testing is too expensive for widespread use, its negative predictive value and sensitivity make it a promising method of screening. Utilizing HPV vaccines as a primary mode of prevention may not be financially feasible and does not obviate the need for screening. Cervical cancer has been considered an AIDS-defining illness, with HPV and HIV often coexisting, and screening methods have been shown to be as reliable for women with HIV as those without. Ultimately, the most clinically effective and cost-effective methods for reducing cervical cancer incidence are those that limit the number of visits that women are required to attend. Providing immediate cryotherapy for those with a positive screen, whether by visual inspection or HPV testing, is promising to have quite an impact, although the type of program implemented will depend on the needs and expectations of each country.
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Audet CM, Silva Matos C, Blevins M, Cardoso A, Moon TD, Sidat M. Acceptability of cervical cancer screening in rural Mozambique. HEALTH EDUCATION RESEARCH 2012; 27:544-551. [PMID: 22307215 DOI: 10.1093/her/cys008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In Zambézia province, Mozambique, cervical cancer (CC) screening was introduced to rural communities in 2010. Our study sought to determine whether women would accept screening via pelvic examination and visual inspection with acetic acid (VIA) at two clinical sites near the onset of a new CC screening program. A cross-sectional descriptive study of 101 women was undertaken in two rural communities in north-central Mozambique. We assessed a woman's willingness to be screened, knowledge about CC symptoms and treatment, and her recommendations for best methods to deliver information to other women. After the interview, we offered CC screening. Fully 86% of women accepted VIA screening when it was offered, but uptake was 100% at one clinic and only 68% at another. The cause of CC was thought to be associated with promiscuous activity (49%) and curses placed on the woman (42%). All women in one rural Mozambique clinic and two-thirds at a second clinic underwent CC screening. Knowledge about CC screening was significantly associated with uptake, suggesting educational campaigns need to be undertaken. However, educators need to be cautious about linking screening with high-risk behaviors, as women who understood the link trended toward refusing screening.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37203, USA.
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