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Lee J, Ismail-Pratt I, Machalek DA, Kumarasamy S, Garland SM. The recovery strategies to support cervical cancer elimination in lower-and middle-income countries (LMICs) following COVID-19 disruptions. Prev Med Rep 2023; 35:102291. [PMID: 37455756 PMCID: PMC10307672 DOI: 10.1016/j.pmedr.2023.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
The COVID-19 pandemic has exacerbated the existing challenges to achieving the WHO target of eliminating cervical cancer as a public health problem by working towards the target of fewer than four cases per 100 000 women. We reviewed the literature to identify potential recovery strategies to support cervical cancer prevention programs in lower-and middle-income countries (LMICs) following COVID-19 disruptions and the extent to which strategies have been implemented. Utilising the WHO health systems framework, we mapped these recovery strategies against the six building blocks to examine their reach across the health system. Most recovery strategies were focused on service delivery, while leadership and governance played a pivotal role in the continuity of cervical cancer prevention programs during the pandemic. Leadership and governance were the drivers for outcomes in the building blocks of health information systems, financing and critical support in operationalising service delivery strategies. In the aftermath of the COVID-19 pandemic with strained health resources and economies, stakeholders would significantly influence the coverage and sustainability of cervical cancer prevention programs. The support from multisectoral stakeholders would accelerate the recovery of cervical cancer prevention programs. To achieve the WHO target by 2030, we call for future studies to understand the barriers and facilitators from the perspectives of stakeholders in order to support the decision-making processes and information required to implement recovery strategies in LMICs.
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Affiliation(s)
| | - Ida Ismail-Pratt
- Asia Pacific HPV Coalition
- The Obstetrics & Gynaecology Centre, Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road, Singapore 329563
| | - Dorothy A Machalek
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville 3052, Victoria, Australia
- The Kirby Institute, University of New South Wales, Kensington 2052, New South Wales, Australia
| | - Suresh Kumarasamy
- Asia Pacific HPV Coalition
- Gleneagles Hospital Penang, 10050 George Town, Pulau Pinang, Malaysia
| | - Suzanne M. Garland
- Asia Pacific HPV Coalition
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville 3052, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia
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Mwenda V, Bor JP, Nyangasi M, Njeru J, Olwande S, Njiri P, Arbyn M, Weyers S, Tummers P, Temmerman M. Integrating human papillomavirus testing as a point-of care service using GeneXpert platforms: Findings and lessons from a Kenyan pilot study (2019-2020). PLoS One 2023; 18:e0286202. [PMID: 37228154 DOI: 10.1371/journal.pone.0286202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization's Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out. METHODS The pilot was implemented from October 2019 to December 2020, in nine health facilities across six counties. We utilized the GeneXpert platform (Cepheid, Sunnyvale, CA, USA), currently used for TB, Viral load testing and early infant diagnosis for HIV, for HPV screening. Visual inspection with acetic acid (VIA) was used for triage of HPV-positive women, as recommended in national guidelines. Quality assurance (QA) was performed by the National Oncology Reference Laboratory (NORL), using the COBAS 4800 platform (Roche Molecular System, Pleasanton, CF, USA). HPV testing was done using either self or clinician-collected samples. We assessed the following screening performance indicators: screening coverage, screen test positivity, triage compliance, triage positivity and treatment compliance. Test agreement between local GeneXpert and central comparator high-risk HPV (hrHPV) testing for a random set of specimens was calculated as overall concordance and kappa value. We conducted a final evaluation and applied the Nominal Group Technique (NGT) to identify implementation challenges and opportunities. KEY FINDINGS The screening coverage of target population was 27.0% (4500/16,666); 52.8% (2376/4500) were between 30-49 years of age. HPV positivity rate was 22.8% (1027/4500). Only 10% (105/1027) of HPV positive cases were triaged with VIA/VILI; 21% (22/105) tested VIA/VILI positive, and 73% (16/22) received treatment (15 received cryotherapy, 1 was referred for biopsy). The median HPV testing turnaround time (TAT) was 24 hours (IQR 2-48 hours). Invalid sample rate was 2.0% (91/4500). Concordance between the Cepheid and COBAS was 86.2% (kappa value = 0.71). Of 1042 healthcare workers, only 5.6% (58/1042) were trained in cervical cancer screening and treatment, and only 69% (40/58) of those trained were stationed at service provision areas. Testing capacity was identifed as the main challenge, while the community strategy was the main opportunity. CONCLUSION HPV testing can be performed on GeneXpert as a near point of care platform. However, triage compliance and testing TAT were major concerns. We recommend strengthening of the screening-triage-treatment cascade and expansion of testing capacity, before adoption of a GeneXpert-based HPV screening among other near point of care platforms in Kenya.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - James Njeru
- Clinton Health Access Initiative, Nairobi, Kenya
| | | | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
| | - Steven Weyers
- Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
| | - Philippe Tummers
- Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Ramshankar V, Ravindran S, Arun K, Albert K, Sri SL, Ramasubramanian L, Satyaseelan B. Impact of HPV molecular testing with partial genotyping as a feasibility study in cervical cancer community screening program in South India. J Med Virol 2023; 95:e28715. [PMID: 37185837 DOI: 10.1002/jmv.28715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
Cervical cancer can be eradicated by 2030 by the implementation of a global strategy involving the vaccination of young girls against human papillomavirus (HPV), screening 70% of women in 30-69 years of age and treating 90% of the women with precancerous lesions. For a country with a large population like India, all the three strategies can be a challenge. There is a need for implementation of a high throughput technology that can be scalable. Cobas 4800, a multiplexed assay based on quantitative polymerase chain reaction technology, identifies HPV 16 and HPV 18 along with the concurrent detection of 12 pooled other high-risk HPV infections. This technology was used to test 10 375 women from the South Indian community for the first time as a feasibility program. Upon testing, high-risk HPV was found in 595 (5.73%) women. A total of 127 women (1.2%) were found to be infected with HPV 16, 36 women (0.34%) with HPV 18 and 382 women (3.68%) with the 12 pooled high-risk HPV and multiple mixed infections were found in 50 women (0.48%). It was observed that there was a high prevalence of high-risk HPV in younger women, 30-40 years of age and a second peak was observed at 46-50 years of age. The second peak had higher mixed infections in the 46-50 years of age and this association was statistically significant. We found that 24/50 (48%) of the multiple mixed high-risk HPV infections were in the age group 46-50 years. The current study is the first attempt from India, on a completely automated platform using Cobas 4800 HPV test in a community screening program. This study shows HPV 16 and HPV 18 infections, when differentiated, can be valuable for risk stratification in community screening program. Women in the perimenopausal age (46-50yrs) showed a higher prevalence of multiple mixed infections, signifying a higher risk.
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Affiliation(s)
| | - Soundharya Ravindran
- Department of Preventive Oncology (Research), Cancer Institute (WIA), Adyar, Chennai, India
| | - Komathi Arun
- Department of Preventive Oncology (Research), Cancer Institute (WIA), Adyar, Chennai, India
| | - Kanchana Albert
- Department of Preventive Oncology (Research), Cancer Institute (WIA), Adyar, Chennai, India
| | - Sakthi Lalitha Sri
- Department of Preventive Oncology (Research), Cancer Institute (WIA), Adyar, Chennai, India
| | - Lalitha Ramasubramanian
- Department of Radiation Oncology, Government Thoothukudi Medical College Hospital, Thoothukudi, India
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Denninghoff V, von Petery F, Fresno C, Galarza M, Torres F, Avagnina A, Fishkel V, Krupitzki H, Fiorillo A, Monge F. Clinical implementation of a cervical cancer screening program via co-testing at a university hospital. PLoS One 2022; 17:e0278476. [PMID: 36454784 PMCID: PMC9714701 DOI: 10.1371/journal.pone.0278476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
The Human Papillomavirus (HPV) test is a crucial technology for cervical cancer prevention because it enables programs to identify women with high-risk HPV infection who are at risk of developing cervical cancer. Current U.S. Preventive Services Task Force recommendations include cervical cancer screening every three years with cervical cytology alone or every five years with either high-risk HPV testing alone or high-risk HPV testing combined with cytology (co-testing). In Argentina, 7,548 new cervical cancer cases are diagnosed each year with 3,932 deaths attributed to this cause. Our study aims to show the clinical implementation of a cervical cancer screening program by concurrent HPV testing and cervical cytology (co-testing); and to evaluate the possible cervical cancer screening scenarios for Latin America, focusing on their performance and average cost. A cervical cancer screening five year program via co-testing algorithm (Hybrid-2-Capture/cytology) was performed on women aged 30-65 years old at a university hospital. Statistical analysis included a multinomial logistic regression, and two cancer screening classification alternatives were tested (cytology-reflex and HPV-reflex). A total of 2,273 women were included, 91.11% of the participants were double-negative, 2.55% double-positive, 5.90% positive-Hybrid-2-Capture-/negative-cytology, and 0.44% negative-Hybrid-2-Capture/positive-cytology. A thorough follow-up was performed in the positive-Hybrid-2-Capture group. Despite our efforts, 21 (10.93%) were lost, mainly because of changes on their health insurance coverage which excluded them from our screening algorithm. Of the 171 women with positive-Hybrid-2-Capture results and follow-up, 68 (39.77%) cleared the virus infection, 64 (37.43%) showed viral persistence, and 39 (22.81%) were adequately treated after detection via colposcopy/biopsy of histological HSIL (High-Grade Squamous Intraepithelial Lesion). The prevalence of high-risk HPV in this population was 192 women (8.45%), with HSIL histology detection rates of 17 per 1,000 screened women. A multinomial logistic regression analysis was performed over the women with positive-Hybrid-2-Capture considering the follow up (clearance, persistence and HSIL) as dependent variable, and the cytology test results (positive- or negative-cytology and Atypical Squamous Cells of Undetermined Significance, ASC-US) as independent variable. The model supported a direct association between cytology test results and follow up: negative-cytology/clearance, ASC-US/persistence, and positive-cytology/HSIL with the following probabilities of occurrence for these pairs 0.5, 0.647 and 0.647, respectively. Cytology could be considered a prognostic-factor in women with a positive-Hybrid-2-Capture. These findings suggest that the introduction of co-testing could diminish the burden of cervical cancer in low-and middle-income-countries, acting as a tool against inequity in healthcare.
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Affiliation(s)
- Valeria Denninghoff
- Molecular-Clinical Laboratory, University of Buenos Aires—National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
- * E-mail: (VD); (CF)
| | - Felicitas von Petery
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Cristóbal Fresno
- Health and Sciences Research Center (CICSA), Health and Sciences Faculty, Anahuac University, Huixquilucan, Estado de México, México
- * E-mail: (VD); (CF)
| | - Mercedes Galarza
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Florencia Torres
- General Acute’s Hospital Dr. I. Pirovano, Buenos Aires, Argentina
| | - Alejandra Avagnina
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Vanina Fishkel
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Hugo Krupitzki
- CEMIC-CONICET Interacting Units, Buenos Aires, Argentina
| | - Angel Fiorillo
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Fernando Monge
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
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Kelly H, Jaafar I, Chung M, Michelow P, Greene S, Strickler H, Xie X, Schiffman M, Broutet N, Mayaud P, Dalal S, Arbyn M, de Sanjosé S. Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among women living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101645. [PMID: 36187721 PMCID: PMC9520209 DOI: 10.1016/j.eclinm.2022.101645] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We systematically reviewed the diagnostic accuracy of cervical cancer screening and triage strategies in women living with HIV (WLHIV). METHODS Cochrane Library, Embase, Global Health and Medline were searched for randomised controlled trials, prospective or cross-sectional studies published from database inception to 15 July 2022 reporting diagnostic accuracy of tests in cervical cancer screening and triage of screen-positive WLHIV. Studies were included if they reported the diagnostic accuracy of any cervical cancer screening or triage strategies for the detection of histologically-confirmed high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among WLHIV. Summary data were extracted from published reports. Authors were contacted for missing data where applicable. Sensitivity and specificity estimates for CIN2/3+ were pooled using models for meta-analysis of diagnostic accuracy data. Study quality was assessed using the QUADAS-2 tool for the quality assessment of diagnostic accuracy studies. PROSPERO registration:CRD42020189031. FINDINGS In 38 studies among 18,737 WLHIV, the majority (n=19) were conducted in sub-Saharan Africa. The pooled prevalence was 12.0% (95%CI:9.8-14.1) for CIN2+ and 6.7% (95%CI:5.0-8.4) for CIN3+. The proportion of screen-positive ranged from 3-31% (visual inspection using acetic acid[VIA]); 2-46% (high-grade squamous intraepithelial lesions, and greater [HSIL+] cytology); 20-64% (high-risk[HR]-HPV DNA). In 14 studies, sensitivity and specificity of VIA were variable limiting the reliability of pooled estimates. In 5 studies where majority had histology-confirmed CIN2+, pooled sensitivity was 56.0% (95%CI:45.4-66.1; I2=65%) for CIN2+ and 65.0% (95%CI:52.9-75.4; I2 =42%) for CIN3+; specificity for <CIN2 was 73.8% (95%CI:59.8-84.2, I2=94%). Cytology was similarly variable (sensitivity of ASCUS+ for CIN2+ range: 58-100%; specificity: 9-96%). In 28 studies, sensitivity of tests targeting 14-HR-HPV types was high (91.6%, 95%CI:88.1-94.1; I2=45% for CIN2+ and 92.5%, 95%CI:88.4-95.2; I2=32%) for CIN3+); but specificity for <CIN2 was low (62.2% (95%CI:57.9-66.4;I2=92%). Restriction to 8-HR-HPV increased specificity (65.8%; Relative specificity[RSpec] vs. 14-HR-HPV=1.17; 95%CI:1.10-1.24) with no significant change in sensitivity (CIN2+:85.5%; Relative Sensitivity[RSens]=0.94, 95%CI: 0.89-1.00; CIN3+:90%; RSens=0.96, 95%CI:0.89-1.03). VIA triage of 14-HR-HPV positive women decreased sensitivity for CIN2+ compared to HPV-DNA test alone (64.4% vs. 91.6%; RSens=0.68, 95%CI:0.62-0.75). INTERPRETATION HPV-DNA based approaches consistently showed superior sensitivity for CIN2+/CIN3+ compared to VIA or cytology. The low specificity of HPV-DNA based methods targeting up to 14-HR-HPV could be improved significantly by restricting to 8-HR-HPV with only minor losses in sensitivity, limiting requirement for triage for which optimal approaches are less clear. FUNDING World Health Organisation; National Cancer Institute; European Union's Horizon 2020 and Marie Skłodowska-Curie Actions programme.
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Affiliation(s)
- Helen Kelly
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Corresponding author at: London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Iman Jaafar
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Michael Chung
- Department of Global Health, University of Washington, Seattle, USA
| | - Pamela Michelow
- Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Greene
- Department of Global Health, University of Washington, Seattle, USA
| | - Howard Strickler
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Xianhong Xie
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Mark Schiffman
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Nathalie Broutet
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Silvia de Sanjosé
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
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Woo YL, Gravitt P, Khor SK, Ng CW, Saville M. Accelerating action on cervical screening in lower- and middle-income countries (LMICs) post COVID-19 era. Prev Med 2021; 144:106294. [PMID: 33678225 PMCID: PMC7931730 DOI: 10.1016/j.ypmed.2020.106294] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
Cervical cancer remains the fourth most common cancer in women, with 85% of deaths occurring in LMICs. Despite the existence of effective vaccine and screening tools, efforts to reduce the burden of cervical cancer must be considered in the context of the social structures within the health systems of LMICs. Compounding this existing challenge is the global COVID-19 pandemic, declared in March 2020. While it is too soon to tell how health systems priorities will change as a result of COVID-19 and its impact on the cervical cancer elimination agenda, there are opportunities to strengthen cervical screening by leveraging on several trends. Many LMICs maximized the strengths of their long established community-based primary care and public health systems with expansion of surveillance systems which incorporated mobile technologies. LMICs can harness the momentum of the measures taken against COVID-19 to consolidate the efforts against cervical cancer. Self-sampling, molecular human papillomavirus (HPV) testing and digital health will shift health systems towards stronger public health and primary care networks and away from expensive hospital-based care investments. While COVID-19 will change health systems priorities in LMICs in ways that may de-prioritize cervical cancer screening, there are significant opportunities for integration into longer-term trends towards universal health coverage, self-care and digital health.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Patti Gravitt
- Department of Epidemiology and Public Health, Division of Preventive Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Swee Kheng Khor
- Blavatnik School of Government, University of Oxford, Oxford, United Kingdom
| | - Chiu Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Marion Saville
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; VCS Foundation, Victoria, Australia
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Gibbs N, Kwon J, Balen J, Dodd PJ. Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review. BMJ Glob Health 2020; 5:e002259. [PMID: 32605934 PMCID: PMC7328817 DOI: 10.1136/bmjgh-2019-002259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies. METHODS We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC). RESULTS A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC. CONCLUSION Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.
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Affiliation(s)
- Naomi Gibbs
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter J Dodd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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