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Mkuu R, Salloum RG, Shenkman E, Schaefer N, Le T, Jorratt A, Meduri Y, Goede D, Lee JH, Staras SA. Screening for cervical cancer among women with behavioral health conditions-A systematic review. Prev Med Rep 2023; 34:102238. [PMID: 37273521 PMCID: PMC10236291 DOI: 10.1016/j.pmedr.2023.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Cervical cancer screening is credited with dramatically reducing cervical cancer mortality in the United States. There is a lack of consensus on whether women with behavioral health conditions (mental health or substance use) receive cervical cancer screening at rates similar to women without the conditions. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched for articles and abstracts of conference proceedings in PubMed, EMBASE, Web of Science and the EBSCO databases: CINAHL, PsycINFO, Psychosocial and Behavioral Science Collection, Academic Search Premier Databases, and the ProQuest database Applied Social Sciences Index and Abstracts from January 1, 2000 to July 31, 2020. Eligibility criteria included studies conducted in the United States, published in English, and comparing cervical cancer screening rates of women with and without behavioral health conditions. Of 1,242 unique articles screened, 52 were included in the full text review. And after title/abstract/and full-text review, 14 articles met the eligibility criteria. Six studies examined both mental health and substance use conditions, two studies only examined substance use disorders, and six studies examined only mental health conditions. Substance use disorders were associated with a decreased likelihood of receiving screening. This study yeilded inconclusive findings on the relationship between mental health conditions and cervical cancer screening. More research is needed to better understand the relationship between behavioral health conditions and cervical cancer screening.
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Affiliation(s)
- Rahma Mkuu
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
- Department of Health Science, University of Alabama, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Nancy Schaefer
- Health Science Center Libraries, University of Florida Communicore Building, SW Archer Rd, Gainesville, FL 32610, United States
| | - Tran Le
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Andrea Jorratt
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Yashaswini Meduri
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Dianne Goede
- Internal Medicine, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4th Floor, Suite 4592, Gainesville, FL 32610-3008, United States
| | - Ji-Hyun Lee
- Division of Quantitative Sciences at the University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Stephanie A.S. Staras
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
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Han H, Mendez KJW, Perrin N, Cudjoe J, Taylor G, Baker D, Murphy‐Stone J, Sharps P. Community-based health literacy focused intervention for cervical cancer control among Black women living with human immunodeficiency virus: A randomized pilot trial. Health Expect 2022; 26:172-182. [PMID: 36444391 PMCID: PMC9854322 DOI: 10.1111/hex.13644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health literacy plays an essential role in how individuals process health information to make decisions about health behaviours including cancer screening. Research is scarce to address health literacy as a strategy to improve cancer screening participation among women living with human immunodeficiency virus (HIV), particularly Black women who, despite the heavy burden of cervical cancer, report consistently low screening rates. AIM To assess the feasibility, acceptability and preliminary efficacy of a health literacy-focused intervention called CHECC-uP-Community-based, HEalth literacy focused intervention for Cervical Cancer control-among women living with HIV. METHODS We conducted a community-based, single-blinded randomized pilot trial. A total of 123 eligible women were enrolled and randomized to one of two conditions, control (i.e., cervical cancer brochure) or intervention (cervical cancer brochure plus 30-60 min health literacy-focused education followed by monthly phone counselling and navigation assistance for 6 months). Study assessments were done at baseline, 3 and 6 months. The final analysis sample included 58 women who completed all data points and whose Papanicolaou (Pap) test status was confirmed by medical records. RESULTS All intervention participants who completed the programme would recommend the CHECC-uP to other women living with HIV. However, adherence in the experimental conditions was low (49.6% attrition rate including 20 women who dropped out before the intervention began) due, in large part, to phone disconnection. Those who had received the intervention had a significantly higher Pap test rate compared to women in the control group at 6 months (50% vs. 21.9%, p = .025). Participation in the intervention programme was associated with improved health literacy and other psychosocial outcomes at 3 months but the trend was attenuated at 6 months. CONCLUSIONS The CHECC-uP was highly acceptable and led to improved Pap testing rates among Black women living with HIV. Future research should consider addressing social determinants of health such as phone connectivity as part of designing a retention plan targeting low-income Black women living with HIV. IMPLICATIONS The findings should be incorporated into a future intervention framework to fulfil the unmet needs of Black women living with HIV to facilitate their decision-making about Pap test screening. PATIENT OR PUBLIC CONTRIBUTION Nineteen community members including women living with HIV along with HIV advocates and care providers participated in four focus groups to develop cervical cancer screening decision-relevant information and the health literacy intervention. Additionally, a community advisory board was involved to provide guidance in the general design and conduct of the study.
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Affiliation(s)
- Hae‐Ra Han
- The Johns Hopkins University School of NursingBaltimoreMarylandUSA,The Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA,Center for Community ProgramsInnovation, and ScholarshipBaltimoreMarylandUSA
| | | | - Nancy Perrin
- The Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Joycelyn Cudjoe
- United States Government Accountability OfficeDistrict of ColumbiaWashingtonUSA
| | - Gregory Taylor
- University of Maryland School of MedicineBaltimoreMarylandUSA
| | - Dorcas Baker
- Older Women Embracing Life (OWEL)BaltimoreMarylandUSA
| | | | - Phyllis Sharps
- The Johns Hopkins University School of NursingBaltimoreMarylandUSA
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Sun CA, Chepkorir J, Jennifer Waligora Mendez K, Cudjoe J, Han HR. A Descriptive Analysis of Cancer Screening Health Literacy Among Black Women Living with HIV in Baltimore, Maryland. Health Lit Res Pract 2022; 6:e175-e181. [PMID: 35858186 PMCID: PMC9272572 DOI: 10.3928/24748307-20220616-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Black women living with HIV (WLH) have the highest HIV infection rate, cervical cancer mortality, and the lowest cancer screening use compared to other groups. However, there is a gap in knowledge about cancer screening health literacy in the Black WLH population. OBJECTIVE The purpose of this study was to assess the level of cancer screening health literacy, and to identify factors associated with health literacy among Black WLH. METHODS This study used baseline data from a community-based randomized controlled trial for a health literacy intervention called CHECC-uP (community-based health literacy intervention for cancer control). We recruited a convenience sample of Black WLH (N = 123) who understand English and had no Pap testing in the prior 12 months. The outcome was cancer screening health literacy measured with a validated health literacy tool-Assessment of Health Literacy in Cancer Screening. Predictors included age, marital status, education, income, and insurance type. The association between cancer screening health literacy and predictors was assessed with multivariate logistic regression. KEY RESULTS Almost one-half (49.6%) of study participants had a reading level at or below sixth grade. Older age (adjusted odds ratio [aOR] 1.05) and higher educational levels (aOR 5.13) were significantly associated with higher cancer screening health literacy among our sample of Black WLH in bivariate and multivariate analyses. CONCLUSIONS Educational materials and other approaches to empower patients should be tested with patients who have low health literacy to ensure efficacy. [HLRP: Health Literacy Research and Practice. 2022;6(3):e175-e181.] Plain Language Summary: Using a cancer screening health literacy tool, we found that about one-half of the Black WLH in the study had a reading level at or below sixth grade. Age and education level were related to their reading levels among the women. Researcher and clinicians need to test educational materials and other approaches with patients who have low health literacy to make sure they work.
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Affiliation(s)
- Chun-An Sun
- Address correspondence to Chun-An Sun, MPhil, RN, The Johns Hopkins University, School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205;
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Yadav A, Baveja P, Singh S. Spectrum of cervical epithelial abnormalities in immune surveillance patients and its association with CD4 count. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Barriers and Facilitators of Pap Testing for Women Living With HIV: A Focus Group Study. J Assoc Nurses AIDS Care 2020; 31:190-196. [PMID: 31567730 DOI: 10.1097/jnc.0000000000000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mapanga W, Singh E, Feresu SA, Girdler-Brown B. Treatment of pre- and confirmed cervical cancer in HIV-seropositive women from developing countries: a systematic review. Syst Rev 2020; 9:79. [PMID: 32276672 PMCID: PMC7149877 DOI: 10.1186/s13643-020-01345-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cervical cancer has become a major public health challenge in developing countries with a reported age-standardised incidence rate of about 17.9/100,000/year and lifetime risks approaching 1 in 20 in some settings. Evidence indicates that HIV-seropositive women are 2 to 12 times more likely to develop precancerous lesions that lead to cervical cancer than HIV-negative women. There is a lack of rigorous evidence on which treatment methods are being utilised for HIV-positive women, and this review aims to synthesise available evidence on treatment modalities for both cervical neoplasia and cervical cancer in HIV-seropositive women in developing countries. METHODS A systematic review guided by a published protocol was conducted. Online databases including MEDLINE/PubMed, Embase, CINAHL and Emerald (via EBSCOhost), PsycINFO, Cochrane Library, and health databases, which cover developing countries (3ie Systematic Reviews, WHO library and databases, World Bank website), were searched for published articles. Additional articles were found through citation, reference list tracking, and grey literature. Study design, treatment category, geographic country/region, and key outcomes for each included article were documented and summarised. RESULTS Thirteen research articles from sub-Saharan Africa, Asia, and South America were included. Eight (61.5%) articles focused on the treatment of cervical cancer with the remaining five (38.5%) assessed cervical neoplasia treatment. The available cervical cancer treatments, radiotherapy, chemotherapy, chemoradiation, and surgery are effective for HIV-seropositive patients, and these are the same treatments for HIV-negative patients. Both cryotherapy and LEEP are effective in reducing CIN2+ among HIV-seropositive women, and a choice between the treatments might be based on available resources and expertise. Radiation, chemotherapy, concurrent treatment using radiotherapy and chemotherapy, and surgery have shown the possibility of effectiveness among HIV-seropositive women. Cervical cancer stage, immunosuppressive level including those on HAART, and multisystem toxicities due to treatment are associated with treatment completion, prognostic, and survival outcomes. CONCLUSIONS Treatment of cervical cancer is based on the stage of cancer, and poor outcomes in most developing countries might be due to a lack of optimal treatment regimen. Those infected with HIV were younger and had advanced cervical cancer as compared to those who were HIV-negative. Facilitation and putting HIV-infected people on life-long ART is of importance and has been found to have a positive impact on cervical cancer treatment response. Research on precancerous lesions and cervical cancer management of HIV-seropositive patients focusing on the quality of life of those treated; the effectiveness of the treatment method considering CD4+ count and ART is required. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018095707.
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Affiliation(s)
- Witness Mapanga
- School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa.
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- , Brooklyn, South Africa.
| | - Elvira Singh
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Community Medicine Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Shingairai A Feresu
- Faculty of Health Sciences, The University of Fort Hare, P.O. Box 1054, 45 Church Street, Gasson Building, 7th Floor, East London, 5201, South Africa
| | - Brendan Girdler-Brown
- School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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de Pokomandy A, Burchell AN, Salters K, Ding E, O'Brien N, Bakombo DM, Proulx-Boucher K, Boucoiran I, Pick N, Ogilvie G, Loutfy M, Kaida A. Cervical cancer screening among women living with HIV: a cross-sectional study using the baseline questionnaire data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). CMAJ Open 2019; 7:E217-E226. [PMID: 30979726 PMCID: PMC6461544 DOI: 10.9778/cmajo.20180151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cisgender women with HIV experience an elevated risk of cervical cancer compared with HIV-negative women, but this cancer can be prevented through regular cervical cancer screening. Our study objective was to measure adherence to current national cervical cancer screening guidelines among women with HIV in 3 Canadian provinces and identify factors associated with delays. METHODS We conducted a cross-sectional study using the baseline questionnaire of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Participants were recruited through clinics, peers and community organizations in British Columbia, Ontario and Quebec. Women were eligible for inclusion if they were cisgender female with HIV, aged 21-70 years, and never had cervicectomy/hysterectomy. RESULTS Of 1189 eligible participants, 815 (68.5%) had received cervical cancer screening less than 1 year ago (i.e., as recommended), 211 (17.7%) 1-3 years ago (i.e., moderate delay) and 163 (13.7%) at least 3 years ago or never (i.e., long delay). Overall, 309 (26.0%) had never discussed the need for a Papanicolaou smear with a nurse/doctor. Factors associated with a long delay were living in Ontario (adjusted odds ratio [OR] 2.51, 95% confidence interval [CI] 1.29-4.88) or Quebec (adjusted OR 3.70, 95% CI 1.79-7.67) (v. BC), being sexually inactive in the past 6 months (adjusted OR 2.02, 95% CI 1.25-3.25), having unknown or < 200 cells/mm3 CD4 counts (adjusted OR 1.78, 95% CI 1.11-2.85) and having a male HIV care provider (adjusted OR 2.15, 95% CI 1.36-3.42). INTERPRETATION Over one-third of women reported cervical cancer screening delays, and one-quarter had never discussed cervical cancer screening recommendations with a health care provider. Additional efforts are needed to improve women's and health care providers' awareness of cervical cancer screening recommendations, particularly among women who are sexually inactive, who are immunosuppressed and who have male HIV care providers.
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Affiliation(s)
- Alexandra de Pokomandy
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont.
| | - Ann N Burchell
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Kate Salters
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Erin Ding
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Nadia O'Brien
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Dada Mamvula Bakombo
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Isabelle Boucoiran
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Neora Pick
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Gina Ogilvie
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Mona Loutfy
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Angela Kaida
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
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9
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Gupta K, Philipose CS, Rai S, Ramapuram J, Kaur G, Kini H, Gv C, Adiga D. A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India. Acta Cytol 2019; 63:50-55. [PMID: 30721904 DOI: 10.1159/000496211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/12/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ2 test was used to analyze the data and a p value < 0.05 was considered to be significant. RESULTS Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34-49 years. CD4 cell counts fell in the range of 200-500 cells/mm3 in most of the HIV-positive patients (68.75%), but was not found to be statistically significant. CONCLUSION Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200-500 cells/mm3.
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Affiliation(s)
- Kritika Gupta
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Cheryl Sarah Philipose
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India,
| | - Sharada Rai
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - John Ramapuram
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Gagandeep Kaur
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Chaithra Gv
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Deepa Adiga
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
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10
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Fletcher FE, Vidrine DJ, Trejo MB, Molina Y, Sha BE, Floyd BR, Sarhene N, Mator J, Matthews AK. "You Come Back to the Same Ole Shit:" A Qualitative Study of Smoking Cessation Barriers among Women Living with HIV: Implications for Intervention Development. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2019; 12:106-122. [PMID: 32963893 PMCID: PMC7505055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although tobacco use among women living with HIV (WLWH) is decreasing, the prevalence is more than double that of women in the general population and remains an important health behavior to target among WLWH. Few smoking cessation interventions specifically focus on the unique social and medical needs of WLWH. Thus, the investigative team engaged WLWH (N=18) in qualitative focus groups to: 1) understand barriers and facilitators to smoking cessation; and 2) inform intervention structure and content priorities. Participants identified salient reasons for smoking and barriers to smoking cessation, which included coping with multiple life stressors, HIV-related stress, HIV-related stigma and social isolation. Further, WLWH highlighted the importance of long-term smoking cessation support, peer support, mental health content, religion/spirituality, and targeted risk messaging in smoking cessation intervention development. Study findings provide concrete, operational strategies for future use in a theory-based smoking cessation intervention, and underscore the importance of formative research to inform smoking cessation interventions for WLWH.
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Affiliation(s)
| | | | | | - Yamile' Molina
- University of Illinois at Chicago School of Public Health
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11
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Abstract
HIV-infected smokers are at relatively higher risk of cancer than HIV-infected non-smokers. HIV weakens the immune system and renders infected individuals more vulnerable to the carcinogenic effects of smoking. HIV-infected smokers suffer more aggressive forms of cancers than do non-smokers because of the cumulative effects of the virus and cigarette smoke carcinogens. The major types of cancer observed in HIV-infected smokers are lung, head and neck, esophageal, anal, and cervical cancers. In this review, we will discuss the recent advances in cancer outcomes, primarily in terms of cancer incidence, prevalence, and progression in HIV patients who are smokers.
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Affiliation(s)
- Sabina Ranjit
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Room 456, Memphis, TN, 38163, USA
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Room 456, Memphis, TN, 38163, USA
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12
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Mapanga W, Chipato T, Feresu SA. Treatment of cervical cancer in HIV-seropositive women from developing countries: a protocol for a systematic review. Syst Rev 2018; 7:22. [PMID: 29370853 PMCID: PMC5785816 DOI: 10.1186/s13643-018-0686-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/15/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cervical cancer has become the most common cancer affecting women in Africa. Significantly, 85% of these annual deaths occur in the developing world, with the majority being middle-aged women. Research has shown that in sub-Saharan Africa, cervical cancer trends are on the rise in the past two decades because of HIV and this has resulted in an increase in cervical cancer cases among young women. However, little or no information exists that has shown that any of the available treatment methods are more effective than others when it comes to treating cervical cancer in HIV-seropositive women. The aim of this protocol is to offer a plan on how to systematically review cervical cancer treatment methods available for HIV-seropositive women in developing countries. METHODS/DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement was used to develop the protocol for the systematic review which will be reported in accordance with the PRISMA guidelines. A number of databases, Embase, MEDLINE, PubMed, CINAHL and Cochrane Library, will be searched for relevant studies, and citation and reference list tracking will be used to search for additional studies. Prospective and retrospective cohort studies, case-control, randomised controlled trials and cross-sectional studies that were carried out in and for the developing world will be eligible for inclusion. Peer-reviewed studies and grey literature examining cervical cancer treatment modalities in HIV-seropositive women will be included. Descriptive statistics and tables will be used to summarise results, and meta-analysis will be used where appropriate. DISCUSSION The review findings will provide the current picture of the existing treatment methods being used to treat cervical cancer in HIV-seropositive women in developing countries. The findings might be used for the establishment of evidence-based guidelines for treatment of cervical cancer in seropositive women as well as prompt policy-makers and governments to decide and support future research in a way to find a lasting solution. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017054676 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=54676.
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Affiliation(s)
- Witness Mapanga
- School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa. .,, 47 Newstead Road, Harare, Marlborough, Zimbabwe.
| | - Tsungai Chipato
- College of Health Sciences, University of Zimbabwe-University of California, San Francisco Collaborative Research Programme, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Shingairai A Feresu
- School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa
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13
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Bynum SA, Wigfall LT, Brandt HM, Julious CH, Glover SH, Hébert JR. Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care. AIDS Behav 2016; 20:2101-9. [PMID: 26955821 DOI: 10.1007/s10461-016-1345-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cervical cancer prevention/control efforts among women living with HIV/AIDS (WLH) are socially and structurally challenging. Healthcare access and perceived HIV stigma and discrimination are factors that may challenge risk reduction efforts. This study examined socio-structural determinants of cervical cancer screening among women engaged in HIV care. One hundred forty-five WLH seeking health/social services from AIDS Service Organizations in the southeastern US completed a questionnaire assessing factors related to cervical cancer prevention/control. Ninety percent were African American, mean age 46.15 ± 10.65 years. Eighty-one percent had a Pap test <1 year ago. Low healthcare access was positively associated with having a Pap test <1 year ago, (Odds ratio [OR] 3.80; 95 % Confidence interval [CI] 1.34-10.78). About 36 % reported ≥2 Pap tests during the first year after HIV diagnosis. Lower educational attainment was positively associated with having ≥2 Pap tests, OR 3.22; CI 1.08-9.62. Thirty-five percent reported more frequent Pap tests after diagnosis. Lower income was moderately associated with more frequent Pap tests post-diagnosis, OR 2.47; CI .98-6.23. Findings highlight the successes of HIV initiatives targeting socio-economically disadvantaged women and provide evidence that health policy aimed at providing and expanding healthcare access for vulnerable WLH has beneficial health implications.
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Affiliation(s)
- Shalanda A Bynum
- Division of AIDS, Behavioral, and Population Sciences, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA.
| | - Lisa T Wigfall
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Heather M Brandt
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Saundra H Glover
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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14
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Tron L, Lert F, Spire B, Dray-Spira R. Levels and determinants of breast and cervical cancer screening uptake in HIV-infected women compared with the general population in France. HIV Med 2016; 18:181-195. [PMID: 28967199 DOI: 10.1111/hiv.12412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Cancer is a growing concern for HIV-infected people, and screening plays a major role in alleviating the burden it causes. We sought to investigate the levels and determinants of breast cancer screening (BCS) and cervical cancer screening (CCS) in HIV-infected women as compared with the general population. METHODS The Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS)-Vespa2 study was conducted in 2011 in a national representative sample of 3022 HIV-infected hospital out-patients in France. The rates and correlates of BCS and CCS among HIV-infected women were compared with those in the general population using multivariate Poisson regression models. RESULTS The BCS rate during the 2 years preceding the survey interview was 80.7% among HIV-infected women vs. 89.1% in the general population (P = 0.146). The CCS rate during the preceding 3 years was 88.1% among HIV-infected women vs. 83.1% in the general population (P = 0.021). During the preceding year, the CCS rate among HIV-infected women was 76.5%. The barriers to BCS and CCS were a low educational level [BCS: adjusted prevalence rate ratio 0.88; 95% confidence interval (CI) 0.80-0.97; CCS: adjusted prevalence rate ratio 0.91; 95% CI 0.83-0.99], not having supplementary health insurance (CCS: adjusted prevalence rate ratio 0.92; 95% CI 0.86-0.98), an irregular gynaecological follow-up (BCS: adjusted prevalence rate ratio 0.77; 95% CI 0.64-0.92; CCS: adjusted prevalence rate ratio 0.72; 95% CI 0.64-0.81) and a low CD4 count (BCS: adjusted prevalence rate ratio 0.83; 95% CI 0.71-0.97; CCS: adjusted prevalence rate ratio 0.78; 95% CI 0.63-0.98). The disparities in CCS uptake in terms of age, employment and gynaecological follow-up were less pronounced among HIV-infected women than in the general population. CONCLUSIONS BCS and CCS uptake was not lower among HIV-infected women than in the general population, but CCS was suboptimal. Specificities in the profile of barriers to screening emerged.
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Affiliation(s)
- L Tron
- Department of social epidemiology, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS1136), UPMC Univ Paris 06, Sorbonne University, INSERM, Paris, France
| | - F Lert
- Department of Epidemiology of Occupational and Social Determinants of Health, Center for Research in Epidemiology and Population Health, INSERM, U1018, Villejuif, France
| | - B Spire
- Economics and Social Sciences Applied to Health and Analysis of Medical Information (SESSTIM), INSERM, UMR912, Marseille, France.,Aix-Marseille University, UMRS912, IRD, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - R Dray-Spira
- Department of social epidemiology, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS1136), UPMC Univ Paris 06, Sorbonne University, INSERM, Paris, France
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15
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Murphy J, Mark H, Anderson J, Farley J, Allen J. A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV. J Low Genit Tract Dis 2016; 20:139-44. [PMID: 27015260 PMCID: PMC4808515 DOI: 10.1097/lgt.0000000000000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Women living with HIV experience higher risk of cervical cancer, but screening rates in the United States are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervicovaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV. MATERIALS AND METHODS This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women older than 18 years, with HIV infection, attending an HIV clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer. RESULTS A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences in comparing HPV-positive with HPV-negative women nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer. CONCLUSIONS The intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible.
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16
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Abstract
People living with human immunodeficiency virus (HIV) are living longer since the advent of effective combined antiretroviral therapy (cART). While cART substantially decreases the risk of developing some cancers, HIV-infected individuals remain at high risk for Kaposi sarcoma, lymphoma, and several solid tumors. Currently HIV-infected patients represent an aging group, and malignancies have become a leading cause of morbidity and mortality. Tailored cancer-prevention strategies are needed for this population. In this review we describe the etiologic agents and pathogenesis of common malignancies in the setting of HIV, as well as current evidence for cancer prevention strategies and screening programs.
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Affiliation(s)
- Priscila H Goncalves
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jairo M Montezuma-Rusca
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas S Uldrick
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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17
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Dailey Garnes NJ, D'Souza G, Chiao E. Number of Primary Care Visits Associated with Screening for Cervical Dysplasia among Women with HIV Infection in Harris County, Texas, United States of America. HIV ADVANCE RESEARCH AND DEVELOPMENT : OPEN ACCESS 2015; 1:107. [PMID: 27500276 PMCID: PMC4974513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Studies indicate that women with HIV infection in the United States are inadequately screened for cervical dysplasia. However, few of these studies have included women in the southern United States, where HIV incidence is now concentrated. We performed a retrospective chart review of women with HIV infection in two HIV clinics in a large southern metropolitan area. To describe screening rates among women in care, only women with ≥2 primary care clinic visits during 2007 were included. We used log-binomial regression to estimate prevalence ratios and 95% confidence intervals of screening and to identify demographic, behavioral, and care-related factors associated with screening. Only 52% (258/498) of women in our study were screened during the year; only 29% (8/28) of women with ≤50 CD4 cells/mm3. Factors associated with increased screening in unadjusted analyses included increased number of primary care visits (p<0.001), higher CD4 cell count (p<0.001), younger age (p=0.006) and Hispanic compared to non-Hispanic ethnicity (p<0.001). In adjusted analyses, women with ≥4 primary care visits were 21% more likely to be screened than women with <4 visits (adjusted prevalence ratio = 1.21; 95% confidence interval: 1.02-1.44). Women with CD4 cell counts <200 cells/mm3 were less likely to be screened than women with CD4 counts ≥350 cells/mm3 (adjusted prevalence ratio: 0.77; 95% confidence interval: 0.59- 1.00). Rates of screening for cervical dysplasia were lower than those seen in similar care settings in other geographic areas in the United States. The number of HIV primary care visits, which has been associated with retention in care, was associated with screening prevalence. Interventions designed to improve retention in care may improve screening rates for cervical dysplasia as well.
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Affiliation(s)
- Natalie Jm Dailey Garnes
- (Department of Pediatrics,) Baylor College of Medicine, USA; (Department of Medicine,) Baylor College of Medicine, USA; (Department of Medicine,) Baylor College of Medicine, USA
| | - Gypsyamber D'Souza
- (Department of Epidemiology,) Johns Hopkins Bloomberg School of Public Health, USA
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18
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Williams M, Moneyham L, Kempf MC, Chamot E, Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDS 2015; 29:13-9. [PMID: 25514125 DOI: 10.1089/apc.2014.0063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
African American women have disproportionately high prevalence rates of HIV and cervical cancer. HIV-infected women are significantly less likely to obtain recommended cervical cancer screenings than HIV-uninfected women. The purpose of this study was to examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African American in Alabama. The PEN-3 Model and the Health Belief Model were used as theoretical frameworks. In-depth interviews were conducted with twenty HIV-infected African American women to identify perceptions, enablers, and nurturers, perceived susceptibility, perceived severity, and perceived benefits related to cervical cancer and screening. The most common positive perceptions, enablers, and nurturers that contributed to cervical cancer screening included internal motivation and awareness of the importance of HIV-infected women getting Pap tests due to their weakened immune system. Negative perceptions, enablers, and nurturers included lack of knowledge about cervical cancer and screening, and lack of perceived susceptibility to cervical cancer. The results of this study can be used to guide the development of culturally relevant cervical cancer and screening education interventions aimed at increasing cervical cancer screening adherence among HIV-infected African American women.
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Affiliation(s)
- Michelle Williams
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Eric Chamot
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isabel Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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19
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Fletcher FE, Buchberg M, Schover LR, Basen-Engquist K, Kempf MC, Arduino RC, Vidrine DJ. Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic. AIDS Care 2014; 26:1229-35. [PMID: 24635664 DOI: 10.1080/09540121.2014.894617] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significantly elevated rates of cervical cancer and low rates of Papanicolaou (Pap) smear screening have been documented among HIV-infected women. However, little is known about women's perceptions of cervical cancer screening utilization. Hence, this study describes barriers and facilitators related to cervical cancer screening in a sample of HIV-infected women seeking care at an integrated HIV clinic in Houston, Texas. Using an inductive qualitative methodological approach, data were obtained from five focus group discussions with a total of 33, HIV-infected women. The majority of the study sample consisted of women who self-identified as Black (69.7%), and reported heterosexual contact as the mode of HIV acquisition (75.8%). Barriers to cervical cancer screening were described as pain and discomfort associated with receiving Pap smears and subsequent procedures; lack of awareness of cervical cancer as a preventable disease; limited transportation access; and systemic issues as it relates to scheduling gynecological appointments. Facilitators were described as awareness of HIV-infected women's increased risk of cervical cancer and strong provider-patient relationships. To address disparities in cervical cancer screening among low-income HIV-infected women, programs should capitalize on the identified facilitators and alleviate modifiable barriers using multilevel strategies.
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Affiliation(s)
- Faith E Fletcher
- a Division of Community Health Sciences , University of Illinois at Chicago School of Public Health , Chicago , IL , USA
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