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Dearie C, Linhart C, Figueroa C, Saumaka V, Dobbins T, Morrell S, Taylor R. Adult mortality from non-communicable diseases in Fiji's major ethnic groups 2013-17. GLOBAL EPIDEMIOLOGY 2024; 8:100157. [PMID: 39161916 PMCID: PMC11332792 DOI: 10.1016/j.gloepi.2024.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 08/21/2024] Open
Abstract
Background Sustainable Development Goal 3.4.1 (SDG3.4.1) targets a one-third reduction in non-communicable disease (NCD) mortality in ages 30-69-years by 2030 (relative to 2015). Directing interventions to achieve this aim requires reliable estimates of underlying cause of death (UCoD). This may be problematic when both cardiovascular diseases (CVD) and diabetes are present due to a lack of consistency in certification of such deaths. We estimate empirically 2013-17 NCD mortality in Fiji, by sex and ethnicity, from CVD, diabetes, cancer, and chronic lower respiratory diseases (CRD), and aggregated as NCD4. Methods UCoD was determined from Medical Certificates of Cause-of-Death (MCCD) from the Fiji Ministry of Health after pre-processing of mortality data where diabetes and/or hypertension were present in order to generate internationally comparable UCoD. If no potentially fatal complications from diabetes or hypertension accompanied these causes in Part I (direct cause) of the MCCD, these conditions were re-assigned to Part II (contributory cause). The probability of a 30-year-old dying before reaching age 70-years (PoD30-70), by cause, was calculated. Findings The PoD30-70 from NCD4 over 2013-17 differed by sex and ethnicity: in women, it was 36% (95%CI 35-37%) in i-Taukei and 27% (26-28%) in Fijians of Indian descent (FID); in men, it was 41% (40-42%) in both i-Taukei and FID.PoD30-70 from CVD, diabetes, cancer and CRD in women was: 18%, 10%, 13% and 1·0% in i-Taukei; 13%, 10%, 5·6% and 1·1% in FID; in men was: 28%, 8.4%, 7·6% and 2·2% in i-Taukei; 31%, 8.3%, 3.5% and 3·1% in FID. Interpretation To achieve SDG3.4.1 goals in Fiji by 2030, effective population wide and ethnic-specific interventions targeting multiple NCDs are required to reduce PoD30-70 from NCD4: from 36% to 24% in i-Taukei, and 27% to 18% in FID women; and from 41% to 27% in i-Taukei and FID men. Funding Not applicable.
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Affiliation(s)
- Catherine Dearie
- School of Population Health, University of New South Wales, Samuels Building, Botany St, Randwick, NSW 2052, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Carah Figueroa
- School of Health & Social Development, Deakin University, Burwood, Victoria, Australia
| | | | - Timothy Dobbins
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Stephen Morrell
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Sydney, Australia
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Costa T, Bateson D, Woo YL. Enhancing equity in cervical screening - initiatives to increase screening participation. Curr Opin Obstet Gynecol 2024; 36:345-352. [PMID: 39109609 DOI: 10.1097/gco.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW Cervical cancer can be eliminated as a public health problem through a three-pillar approach including high coverage of human papillomavirus (HPV) vaccination and HPV-based cervical screening, and treatment of precancers and invasive cancers. However, access inequities prevent many women and people with a cervix benefitting from these life-saving advances. This review focuses on evidence-based interventions that can improve equity and scale-up of cervical screening. RECENT FINDINGS The transition from conventional cytology to HPV screening provides multiple opportunities to address equity and a multipronged approach can be used to identify priority groups, understand barriers and develop tailored solutions. There are proven financing mechanisms, tools, technologies and screening delivery methods to overcome screening barriers in different settings. This includes self-sampling interventions, point-of-care testing, health service integration, consumer-led co-design processes and digital screening registries. SUMMARY To achieve cervical cancer elimination globally, cervical screening must be delivered in an inclusive, culturally safe and context-appropriate manner. There are multiple tools and strategies that can be implemented to improve participation of never- and under-screened groups, and to enhance equity in cervical screening.
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Affiliation(s)
- Telma Costa
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia
| | - Deborah Bateson
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Black KI, Duro-Aina T, Bateson D. The case for integrating sexual and reproductive health services in Pacific Island countries. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2024-202317. [PMID: 39147568 DOI: 10.1136/bmjsrh-2024-202317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Kirsten I Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Shahbazi E, Moradi A, Mollasalehi H, Mohebbi SR. Unravelling the diagnostic methodologies for SARS-CoV-2; the Indispensable need for developing point-of-care testing. Talanta 2024; 275:126139. [PMID: 38696900 DOI: 10.1016/j.talanta.2024.126139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 05/04/2024]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-caused COVID-19 pandemic that continues to be a global menace and since its emergence in the late 2019, SARS-CoV-2 has been vigorously spreading throughout the globe putting the whole world into a multidimensional calamity. The suitable diagnosis strategies are on the front line of the battle against preventing the spread of infections. Since the clinical manifestation of COVID-19 is shared between various diseases, detection of the unique impacts of the pathogen on the host along with the diagnosis of the virus itself should be addressed. Employing the most suitable approaches to specifically, sensitively and effectively recognize the infected cases may be a real game changer in controlling the outbreak and the crisis management. In that matter, point-of-care assays (POC) appears to be the potential option, due to sensitivity, specificity, affordable, and availability. Here we brief the most recent findings about the virus, its variants, and the conventional methods that have been used for its detection, along with the POC strategies that have been applied to the virus diagnosis and the developing technologies which can accelerate the diagnosis procedure yet maintain its efficiency.
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Affiliation(s)
- Erfan Shahbazi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Asma Moradi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Hamidreza Mollasalehi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran.
| | - Seyed Reza Mohebbi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Haghayegh F, Norouziazad A, Haghani E, Feygin AA, Rahimi RH, Ghavamabadi HA, Sadighbayan D, Madhoun F, Papagelis M, Felfeli T, Salahandish R. Revolutionary Point-of-Care Wearable Diagnostics for Early Disease Detection and Biomarker Discovery through Intelligent Technologies. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400595. [PMID: 38958517 DOI: 10.1002/advs.202400595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/19/2024] [Indexed: 07/04/2024]
Abstract
Early-stage disease detection, particularly in Point-Of-Care (POC) wearable formats, assumes pivotal role in advancing healthcare services and precision-medicine. Public benefits of early detection extend beyond cost-effectively promoting healthcare outcomes, to also include reducing the risk of comorbid diseases. Technological advancements enabling POC biomarker recognition empower discovery of new markers for various health conditions. Integration of POC wearables for biomarker detection with intelligent frameworks represents ground-breaking innovations enabling automation of operations, conducting advanced large-scale data analysis, generating predictive models, and facilitating remote and guided clinical decision-making. These advancements substantially alleviate socioeconomic burdens, creating a paradigm shift in diagnostics, and revolutionizing medical assessments and technology development. This review explores critical topics and recent progress in development of 1) POC systems and wearable solutions for early disease detection and physiological monitoring, as well as 2) discussing current trends in adoption of smart technologies within clinical settings and in developing biological assays, and ultimately 3) exploring utilities of POC systems and smart platforms for biomarker discovery. Additionally, the review explores technology translation from research labs to broader applications. It also addresses associated risks, biases, and challenges of widespread Artificial Intelligence (AI) integration in diagnostics systems, while systematically outlining potential prospects, current challenges, and opportunities.
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Affiliation(s)
- Fatemeh Haghayegh
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Alireza Norouziazad
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Elnaz Haghani
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Ariel Avraham Feygin
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Reza Hamed Rahimi
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Hamidreza Akbari Ghavamabadi
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Deniz Sadighbayan
- Department of Biology, Faculty of Science, York University, Toronto, ON, M3J 1P3, Canada
| | - Faress Madhoun
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Manos Papagelis
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, M5T 3A9, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, M5T 3M6, Canada
| | - Razieh Salahandish
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
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Molano M, Machalek DA, Phillips S, Tan G, Garland SM, Hawkes D, Balgovind P, Haqshenas R, Badman SG, Bolnga J, Gabuzzi J, Kombati Z, Munnull GM, Brotherton JM, Saville M, Kaldor JM, Toliman PJ, Vallely AJ, Murray GL. DNA methylation at individual CpG-sites of EPB41L3, HTERT and FAM19A4 are useful for detection of cervical high-grade squamous intraepithelial lesions (HSIL) or worse: Analysis of individual CpG-sites outperforms averaging. Tumour Virus Res 2024; 18:200288. [PMID: 38960143 PMCID: PMC11278974 DOI: 10.1016/j.tvr.2024.200288] [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: 12/13/2023] [Revised: 06/17/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024] Open
Abstract
Global methylation analysis of gene promoters is promising for detection of high-grade squamous intraepithelial lesions or worse (HSIL+) in high-risk human papillomavirus (hrHPV)-positive women. However, diagnostic performance of methylation data at individual CpG-sites is limited. We explored methylation for predicting HSIL+ in self- and clinician-collected samples from Papua New Guinea. Methylation of EPB41L3 (1-6 CpG-sites), hTERT (1-10 CpG-sites) and FAM19A4 (1-5 CpG-sites) was assessed through pyrosequencing from 44 HPV+ samples (4 cancers, 19 HSIL, 4 low-grade squamous intraepithelial lesions (LSIL), 17 normal). New primers were designed for FAM19A4 directed to the first exon region not explored previously. In clinician-collected samples, methylation at CpG-sites 4 and 5 of EPB41L3 were the best HSIL predictors (AUC >0.83) and CpG-site 4 for cancer (0.925). Combination of EPB41L3 sites 2/4 plus FAM19A4 site 1 were the best HSIL+ markers [100% sensitivity, 63.2% specificity]. Methylation at CpG-site 5 of FAM19A4 was the best HSIL predictor (0.67) in self-collected samples, and CpG-sites 1 and 3 of FAM19A4 for cancer (0.77). Combined, FAM19A4 site 1 plus HPV 16/18 detection yielded sensitivity of 82.6% and specificity of 61.9%. In conclusion, methylation at individual CpG-sites of EPB41L3 and FAM19A4 outperformed global analysis and improved HSIL+ detection, warranting further investigation.
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Affiliation(s)
- Monica Molano
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Samuel Phillips
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Grace Tan
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - Prisha Balgovind
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Reza Haqshenas
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Steve G Badman
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John Bolnga
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, Modilon General Hospital, Madang, Papua New Guinea
| | - Josephine Gabuzzi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, Modilon General Hospital, Madang, Papua New Guinea
| | - Zure Kombati
- Department of Pathology, Mt Hagen Provincial Hospital, WHP 281, Papua New Guinea
| | - Gloria M Munnull
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Obstetrics and Gynaecology, Mt Hagen Provincial Hospital, Mount Hagen, Papua New Guinea
| | - Julia Ml Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Pamela J Toliman
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew J Vallely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Gerald L Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Qin J, Scarinci I, Lu E, Senkomago V, Ngoc Nguyen DT, Abonales L, Soin K, Edilyong J, Reichhardt M, Marfel M, Simms K, Canfell K, Maxwell K, Saraiya M, Palafox N. Building Capacity for Cervical Cancer Prevention in U.S.-Affiliated Pacific Islands: The Pacific Against Cervical Cancer Project. J Womens Health (Larchmt) 2024; 33:839-847. [PMID: 38864276 DOI: 10.1089/jwh.2024.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
The U.S.-affiliated Pacific Islands (USAPI) have higher cervical cancer incidence and mortality rates and lower screening coverage compared with the United States. This is likely because of economic, geographical, health care delivery, and cultural barriers for women living in these resource-constrained, isolated regions. The most recent U.S. and World Health Organization cervical cancer screening guidelines recommended primary human papillomavirus (HPV) testing as one screening option or the preferred screening modality. Primary HPV screening-based strategies offer several advantages over current screening methods in the USAPI. However, adoption of this newer screening modality has been slow in the United States and not yet incorporated into USAPI screening programs. The U.S. Centers for Disease Control and Prevention and partners initiated the Pacific Against Cervical Cancer (PACe) project in 2019 to evaluate the feasibility, acceptability, and cost-effectiveness of primary HPV testing-based strategies in Guam and in Yap, Federated States of Micronesia. This report provides an overview of the PACe project and outlines the approaches we took in implementing primary HPV testing as a new cervical cancer screening strategy (including the option of self-sampling in Yap), encompassing four core components: (1) community engagement and education, (2) medical and laboratory capacity building, (3) health information and system improvement, and (4) modeling and cost-effectiveness analysis. The PACe project provides examples of systematic implementation and resource appropriate technologies to the USAPI, with broader implications for never screened and under-screened populations in the United States and Pacific as they face similar barriers to accessing cervical cancer screening services.
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Affiliation(s)
- Jin Qin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isabel Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Enriquito Lu
- Family Planning and Reproductive Health Unit, Jhpiego, Johns Hopkins University, Baltimore, Maryland, USA
| | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, a joint venture between Cancer Council New South Wales and the University of Sydney, Sydney, Australia
| | - Lesley Abonales
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Komal Soin
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - James Edilyong
- Yap State Department of Health Services, Colonia, Micronesia (the Federated States of)
| | - Martina Reichhardt
- Yap State Department of Health Services, Colonia, Micronesia (the Federated States of)
| | - Maria Marfel
- Yap State Department of Health Services, Colonia, Micronesia (the Federated States of)
| | - Kate Simms
- The Daffodil Centre, a joint venture between Cancer Council New South Wales and the University of Sydney, Sydney, Australia
| | - Karen Canfell
- The Daffodil Centre, a joint venture between Cancer Council New South Wales and the University of Sydney, Sydney, Australia
| | - Kathryn Maxwell
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neal Palafox
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
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Molano M, Machalek DA, Tan G, Garland S, Balgovind P, Haqshenas G, Munnull G, Phillips S, Badman SG, Bolnga J, Cornall AM, Gabuzzi J, Kombati Z, Brotherton J, Saville M, Hawkes D, Kaldor J, Toliman PJ, Vallely AJ, Murray GL. Performance of CADM1, MAL and miR124-2 methylation as triage markers for early detection of cervical cancer in self-collected and clinician-collected samples: an exploratory observational study in Papua New Guinea. BMJ Open 2024; 14:e081282. [PMID: 38904134 PMCID: PMC11191780 DOI: 10.1136/bmjopen-2023-081282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/02/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE WHO recommends human papillomavirus (HPV) testing for cervical screening, with triage of high-risk HPV (hrHPV) positive women. However, there are limitations to effective triage for low-resource, high-burden settings, such as Papua New Guinea. In this exploratory study, we assessed the performance of host methylation as triage tools for predicting high-grade squamous intraepithelial lesions (HSIL) in self-collected and clinician-collected samples. DESIGN Exploratory observational study. SETTING Provincial hospital, same-day cervical screen-and-treat trial, Papua New Guinea. PARTICIPANTS 44 hrHPV+women, with paired self/clinician-collected samples (4 squamous cell carcinomas (SCC), 19 HSIL, 4 low-grade squamous intraepithelial lesions, 17 normal). PRIMARY AND SECONDARY OUTCOME MEASURES Methylation levels of CADM1, MAL and miR124-2 analysed by methylation-specific PCRs against the clinical endpoint of HSIL or SCC (HSIL+) measured using liquid-based-cytology/p16-Ki67 stain. RESULTS In clinician-collected samples, MAL and miR124-2 methylation levels were significantly higher with increasing grade of disease (p=0.0046 and p<0.0015, respectively). miR124-2 was the best predictor of HSIL (area under the curve, AUC 0.819) while MAL of SCC (AUC 0.856). In self-collected samples, MAL best predicted HSIL (AUC 0.595) while miR124-2 SCC (AUC 0.812). Combined miR124-2/MAL methylation yielded sensitivity and specificity for HSIL+ of 90.5% (95% CI 69.6% to 98.8%) and 70% (95% CI 45.7% to 88.1%), respectively, in clinician-collected samples, and 81.8% (95% CI 59.7% to 94.8%) and 47.6% (95% CI 25.7% to 70.2%), respectively, in self-collected samples. miR124-2/MAL plus HPV16/HPV18 improved sensitivity for HSIL+ (95.2%, 95% CI 76.2% to 99.9%) but decreased specificity (55.0%, 95% CI 31.5% to 76.9%). CONCLUSION miR124-2/MAL methylation is a potential triage strategy for the detection of HSIL/SCC in low-income and middle-income country.
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Affiliation(s)
- Monica Molano
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Tan
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - Suzanne Garland
- The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Prisha Balgovind
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gholamreza Haqshenas
- The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gloria Munnull
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Samuel Phillips
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Steven G Badman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - John Bolnga
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- Obstetrics and Gynaecology, Modilon General Hospital, Madang, Papua New Guinea
| | - Alyssa Marie Cornall
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Josephine Gabuzzi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- Obstetrics and Gynaecology, Modilon General Hospital, Madang, Papua New Guinea
| | - Zure Kombati
- Tininga Clinic, Mount Hagen General Hospital, Mount Hagen, Western Highlands Province, Papua New Guinea
| | - Julia Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
- School of Population Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Pamela Josephine Toliman
- Kirby Institute -Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew John Vallely
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Gerald L Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
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Park DH, Haizan I, Ahn MJ, Choi MY, Kim MJ, Choi JH. One-Pot CRISPR-Cas12a-Based Viral DNA Detection via HRP-Enriched Extended ssDNA-Modified Au@Fe 3O 4 Nanoparticles. BIOSENSORS 2024; 14:26. [PMID: 38248403 PMCID: PMC10812942 DOI: 10.3390/bios14010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
In the context of virus outbreaks, the need for early and accurate diagnosis has become increasingly urgent. In addition to being crucial for effective disease control, timely and precise detection of viral infections is also necessary for the implementation of essential public health measures, especially during pandemics. Among these measures, point-of-care testing (POCT) stands out as a powerful approach with the potential to revolutionize the landscape of viral diagnosis. In this study, we developed a one-pot clustered regularly interspaced short palindromic repeats (CRISPR)-Cas12a-based viral DNA detection system tailored for POCT; this method utilizes multi-enzyme-modified Au@Fe3O4 nanoparticles. As an alternative to nucleic acid amplification, our method uses single-stranded DNA elongation to facilitate multi-enzyme modification; this guarantees heightened sensitivity and expedites the diagnostic process. We achieved a satisfactory limit of detection of 0.25 nM, demonstrating the remarkable sensitivity of the method without the need for sophisticated equipment. The incorporation of Au@Fe3O4 magnetic nanoparticles facilitates sample separation, further streamlining the workflow and reinforcing the simplicity of our method. This integrated approach offers a practical solution for sensitive viral DNA detection in POCT scenarios, advancing the field of rapid and accurate diagnostics.
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Affiliation(s)
- Dong Hyeok Park
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
| | - Izzati Haizan
- Department of Bioprocess Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea;
| | - Min Ju Ahn
- Department of Biotechnology, Jeonbuk National University, 79 Gobongro, Iksan-si 54596, Jeollabuk-do, Republic of Korea;
| | - Min Yu Choi
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
| | - Min Jung Kim
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
| | - Jin-Ha Choi
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
- Department of Bioprocess Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea;
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10
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Salcedo MP, Lathrop E, Osman N, Neves A, Rangeiro R, Mariano AAN, Nkundabatware JC, Tivir G, Carrilho C, Monteiro ECS, Burny R, Thomas JP, Carns J, Andrade V, Mavume C, Paulo Mugolo R, Atif H, Hoover H, Chivambo E, Chissano M, Oliveira C, Milan J, Varon ML, Fellman BM, Baker E, Jeronimo J, Castle PE, Richards-Kortum R, Schmeler KM, Lorenzoni C. The Mulher Study: cervical cancer screening with primary HPV testing in Mozambique. Int J Gynecol Cancer 2023; 33:1869-1874. [PMID: 37907263 DOI: 10.1136/ijgc-2023-004958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally. METHODS Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected. RESULTS Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology. CONCLUSION It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.
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Affiliation(s)
- Mila Pontremoli Salcedo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eva Lathrop
- Population Services International, Washington, District of Columbia, USA
| | | | - Andrea Neves
- Hospital Geral e Centro de Saúde José Macamo, Maputo, Mozambique
| | | | | | | | | | | | | | | | - Joseph P Thomas
- Oncology Care & Research IS, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Celda Mavume
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | | | - Hira Atif
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Hannah Hoover
- Population Services International, Washington, District of Columbia, USA
| | | | | | | | - Jessica Milan
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Lopez Varon
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan M Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ellen Baker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Umo I, Kulai M, Umo P, James K, Ikasa R. The direct medical cost of breast cancer management in a provincial hospital of Papua New Guinea: A cost of illness study of consecutive patients from 2017 to 2022. J Cancer Policy 2023; 38:100447. [PMID: 37813161 DOI: 10.1016/j.jcpo.2023.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Breast cancer is a major global health, gender and socioeconomic challenge. In PNG it is the leading cause of female mortality. Understanding direct medical costs related to breast cancer management can direct resource allocation and investment in breast cancer screening, treatment, infastructure and training. METHODS A cost of illness study was conducted amongst patients with breast cancer at Alotau Provincial Hospital from the 12th of January 2017-9 th of August 2022. A bottom up approach of micro costing was applied to estimate the patient and hospital perspectives of direct medical costs. RESULTS The total cost of breast cancer management was K1,624,656.14 (US$471,150.28). 58.5 % (n = 38) of patients with breast cancer did not undergo any form of surgery. Hospital costs accounted for 99.7 % (K1,620,156.14, US$469,845.28) of the total direct medical costs. The average cost per patient was K24,994.71 (US$ 7248.47). The dollar conversion was 1 KINA = 0.29 USD. CONCLUSION Investment in screening, diagnosis and treatment is crucial in addressing the burden of breast cancer in PNG. POLICY SUMMARY Provincial hospitals (in PNG) must invest in and implement the 2015 National Cancer Control Policy strategies that aim to develop hospital based cancer registries, human resources, equip health systems, improve cancer screening, improve diagnostics, research, funding and treatment for breast cancer control.
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Affiliation(s)
- Ian Umo
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea.
| | - Michealynne Kulai
- School of Medicine and Health Science, Divine Word University, Papua New Guinea
| | - Pius Umo
- Pacific International Hospital, Papua New Guinea
| | - Kennedy James
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Rodger Ikasa
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
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12
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Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population. Nat Med 2023; 29:3050-3058. [PMID: 38087115 PMCID: PMC10719104 DOI: 10.1038/s41591-023-02600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix, to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63-67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO's updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years.
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Affiliation(s)
- Kate T Simms
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Adam Keane
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michaela T Hall
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Gigi Lui
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - 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
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Silvia De Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Linda O Eckert
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
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13
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Denny L, Saidu R, Boa R, Mbatani N, Castor D, Moodley J, Kuhn L. Point-of-care testing with Xpert HPV for single-visit, screen-and-treat for cervical cancer prevention: a demonstration study in South Africa. Sci Rep 2023; 13:16182. [PMID: 37758811 PMCID: PMC10533854 DOI: 10.1038/s41598-023-43467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
Human papillomavirus (HPV)-based screen-and-treat (SAT) is recommended but implementation presents operational challenges. We implemented HPV-SAT at a research site in Khayelitsha, South Africa, screening 3062 women aged 30-65 years (44% women living with HIV [WHIV]). All were screened using point-of-care Xpert HPV and almost all received their HPV results on the same day. HPV-positivity occurred in 41.5% of WHIV and 17.4% of women without HIV (WNoH) reducing to 26.2% in WHIV and 10.4% in WNoH applying treatment eligibility criteria based on high viral load in the channels detecting HPV16, 18, 45, 16, 18, 31, 33, 35, 52, 58. Among those eligible for treatment, 91.3% were considered suitable for ablative therapy, and 94.6% underwent thermal ablation on the same day, with no serious adverse events. Twelve months later, 39.0% of WHIV and 65.2% of WNoH treated with ablative therapy were clear of HPV. In women who were HPV-positive but ineligible for treatment, 19.1% and 12.9% had histologically-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) at 12 months. SAT programs need to weigh trade-offs between overtreatment versus delayed or no treatment for women who test positive for HPV. Treatment modalities for precancerous lesions need to be improved.
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Affiliation(s)
- Lynette Denny
- Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department Obstetrics and Gynaecology, South African Medical Research Council, Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rakiya Saidu
- Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department Obstetrics and Gynaecology, South African Medical Research Council, Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rosalind Boa
- Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department Obstetrics and Gynaecology, South African Medical Research Council, Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nomonde Mbatani
- Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department Obstetrics and Gynaecology, South African Medical Research Council, Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Delivette Castor
- Department Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA
- Division of Infectious Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
| | - Jennifer Moodley
- Department Obstetrics and Gynaecology, South African Medical Research Council, Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cancer Research Initiative and School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Louise Kuhn
- Department Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA.
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA.
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14
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Rayner M, Welp A, Stoler MH, Cantrell LA. Cervical Cancer Screening Recommendations: Now and for the Future. Healthcare (Basel) 2023; 11:2273. [PMID: 37628471 PMCID: PMC10454304 DOI: 10.3390/healthcare11162273] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Cervical cancer is the fourth most common cancer worldwide, with over 600,000 new cases annually and approximately 350,000 cancer-related deaths per year. The disease burden is disproportionately distributed, with cancer-related mortality ranging from 5.2 deaths per 100,000 individuals in highly-developed countries, to 12.4 deaths per 100,000 in less-developed countries. This article is a review of the current screening recommendations and potential future recommendations.
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Affiliation(s)
| | | | | | - Leigh A. Cantrell
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA 22908, USA
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15
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Riegler AN, Larsen N, Amerson-Brown MH. Point-of-Care Testing for Sexually Transmitted Infections. Clin Lab Med 2023; 43:189-207. [PMID: 37169442 DOI: 10.1016/j.cll.2023.02.006] [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: 05/13/2023]
Abstract
Point-of-care testing for sexually transmitted infections is essential for controlling transmission and preventing sequelae in high-risk populations. Since the World Health Organization published the ASSURED criteria, point-of-care testing has improved for use in large population screening and rapid testing that prevents loss of clinical follow-up. Recent advancements have been advantageous for low-resource areas allowing testing at a minimal cost without reliable electricity or refrigeration. Point-of-care nucleic acid detection and amplification techniques are recommended, but are often inaccessible in low-resource areas. Future advancements in point-of-care diagnostic testing should focus on improving antibody-based assays, monitoring viral loads, and detecting antimicrobial resistance.
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Affiliation(s)
- Ashleigh N Riegler
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Natalie Larsen
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Megan H Amerson-Brown
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA.
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16
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Perkins RB, Smith DL, Jeronimo J, Campos NG, Gage JC, Hansen N, Rodriguez AC, Cheung LC, Egemen D, Befano B, Novetsky AP, Martins S, Kalpathy-Cramer J, Inturrisi F, Ahmed SR, Marcus J, Wentzensen N, de Sanjose S, Schiffman M. Use of risk-based cervical screening programs in resource-limited settings. Cancer Epidemiol 2023; 84:102369. [PMID: 37105017 DOI: 10.1016/j.canep.2023.102369] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/29/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
Cervical cancer screening and management in the U.S. has adopted a risk-based approach. However, the majority of cervical cancer cases and deaths occur in resource-limited settings, where screening and management are not widely available. We describe a conceptual model that optimizes cervical cancer screening and management in resource-limited settings by utilizing a risk-based approach. The principles of risk-based screening and management in resource limited settings include (1) ensure that the screening method effectively separates low-risk from high-risk patients; (2) directing resources to populations at the highest cancer risk; (3) screen using HPV testing via self-sampling; (4) utilize HPV genotyping to improve risk stratification and better determine who will benefit from treatment, and (5) automated visual evaluation with artificial intelligence may further improve risk stratification. Risk-based screening and management in resource limited settings can optimize prevention by focusing triage and treatment resources on the highest risk patients while minimizing interventions in lower risk patients.
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Affiliation(s)
- Rebecca B Perkins
- Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA.
| | | | | | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Li C Cheung
- National Cancer Institute, Bethesda, MD, USA
| | | | - Brian Befano
- Information Management Services Inc, 3901 Calverton Blvd Suite 200, Calverton, MD, USA
| | - Akiva P Novetsky
- Westchester Medical Center/New York Medical College, Valhalla, NY, USA
| | | | | | | | - Syed Rakin Ahmed
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02129, USA; Harvard Graduate Program in Biophysics, Harvard Medical School, Harvard University, Cambridge, MA 02115, USA; Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 02139,USA
| | - Jenna Marcus
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | | | - Silvia de Sanjose
- National Cancer Institute, Bethesda, MD, USA; ISGlobal, Barcelona, Spain
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17
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Rodriguez NM, Brennan LP, Claure L, Balian LN, Champion VL, Forman MR. Leveraging COVID-era innovation for cervical cancer screening: Clinician awareness and attitudes toward self-sampling and rapid testing for HPV detection. PLoS One 2023; 18:e0282853. [PMID: 36893182 PMCID: PMC9997915 DOI: 10.1371/journal.pone.0282853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023] Open
Abstract
Cervical cancer screening rates are declining in the US, with persistent disparities among vulnerable populations. Strategies to better reach under-screened communities are needed. The COVID pandemic sparked major shifts in healthcare delivery, including the accelerated development and adoption of rapid diagnostic testing, broadened access to remote care, and growing consumer demand for self-testing, which could be leveraged for cervical cancer. Rapid tests for the detection of Human Papillomavirus (HPV) have the potential to improve cervical cancer screening coverage, and if coupled with patient-collected cervicovaginal samples, create an opportunity for self-testing. The objectives of this study were: 1) to examine whether COVID influenced clinician perspectives of rapid testing as a screening modality; and 2) to assess clinician awareness, perceived benefits and limitations, and willingness to adopt point-of-care HPV testing, patient self-sampling, and rapid HPV self-testing with self-collected samples. The methodology adopted consisted of an online cross-sectional survey (n = 224) and in-depth interviews (n = 20) were conducted with clinicians who perform cervical cancer screening in Indiana, ranked in the top ten states for cervical cancer mortality and with marked disparities across socio-demographic groups. The main findings show that about half the clinicians reported that the COVID pandemic had influenced their views on rapid testing as a screening modality both positively (greater public acceptability of rapid testing and impact on patient care) and negatively (concerns regarding accuracy of rapid tests). The majority of clinicians (82%) were willing to adopt rapid HPV testing at the point-of-care, while only 48% were willing to adopt rapid HPV self-testing with self-collected samples. In-depth interviews revealed provider concerns around patients' ability to collect their own sample, report results correctly, and return to the clinic for follow-up and other preventive care. Addressing clinician concerns about self-sampling and rapid HPV testing, such as ensuring that rapid tests include sample adequacy controls, is necessary to mitigate barriers to adoption for cervical cancer screening.
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Affiliation(s)
- Natalia M. Rodriguez
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States of America
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, Indiana, United States of America
- Indiana University Simon Comprehensive Cancer Center, Cancer Prevention and Control Program, Indianapolis, Indiana, United States of America
| | - Luke P. Brennan
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Layla Claure
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Lara N. Balian
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Victoria L. Champion
- Indiana University Simon Comprehensive Cancer Center, Cancer Prevention and Control Program, Indianapolis, Indiana, United States of America
| | - Michele R. Forman
- Formerly at Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States of America
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18
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Nightingale C, Bavor C, Stone E, Rankin NM. Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region. JCO Glob Oncol 2023; 9:e2200329. [PMID: 36749907 PMCID: PMC10166439 DOI: 10.1200/go.22.00329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Claire Nightingale
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Claire Bavor
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emily Stone
- Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Nicole M Rankin
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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Creagh NS, Boyd LAP, Bavor C, Zammit C, Saunders T, Oommen AM, Rankin NM, Brotherton JML, Nightingale CE. Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence. JCO Glob Oncol 2023; 9:e2200297. [PMID: 36724416 PMCID: PMC10166429 DOI: 10.1200/go.22.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Although cervical cancer is a disease of inequity, it can be eliminated as a public health problem through vaccination, screening, and treatment. Human papillomavirus vaginal self-collection cervical screening is a high-performance test that can increase reach of screening. This review describes the different contexts and models of care used to pilot or implement self-collection within the Asia-Pacific, measures the extent that implementation outcome measures are reported and, where available, summarizes key implementation findings. METHODS A scoping review was conducted by searching five databases of the peer-reviewed literature on June 20, 2022. Two researchers assessed eligibility and extracted data independently to the model of care used and the Conceptual Framework for Implementation Outcomes. A mixed-method consolidation of findings (quantitative: count and frequencies; qualitative: content analysis) was undertaken to narratively report findings. RESULTS Fifty-seven articles, comprising 50 unique studies from 11 countries and two special autonomous regions, were included; 82% were conducted in trials. The implementation of self-collection was conducted in low- (2%), lower-middle- (32%), upper-middle- (32%), and high-income (35%) settings, with 10 different delivery models used; 80% delivered through practitioner-supported models with diversity in how samples were processed, and treatment was offered. Acceptability (73%) and appropriateness (64%) measures were most reported, followed by adoption (57%), feasibility (48%), and fidelity (38%). Only 7% of articles reported implementation cost or penetration measures. No articles reported sustainability measures. CONCLUSION The literature confirms that self-collection cervical screening has been implemented within the Asia-Pacific region, with evidence demonstrating that it is acceptable and appropriate from the user's perspective. Well-designed, high-quality implementation trials and real-world evaluations of self-collection that report the breadth of implementation outcomes can support the progression toward the elimination of cervical cancer.
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Affiliation(s)
- Nicola Stephanie Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Ann Patricia Boyd
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Bavor
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tessa Saunders
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anu Mary Oommen
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nicole Marion Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Mary Louise Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Claire Elizabeth Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Dhanasekaran K, Tamang H, Pradhan S, Lhamu R, Hariprasad R. Challenges in setting up a primary human papillomavirus-DNA testing facility in a lower and middle income country: lessons learned from a pilot programme. Ecancermedicalscience 2022; 16:1492. [PMID: 36819827 PMCID: PMC9935055 DOI: 10.3332/ecancer.2022.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Detection of high-risk human papillomavirus (hrHPV) is the most sensitive test for the screening of cervical cancer. Although most high-income countries have adopted this strategy in their screening programme, there are a lot of barriers in low and middle-income countries (LMICs) in setting up this facility for screening. The lessons learned based on this experience can be useful for other LMICs in their first steps to integrate HPV testing into a screening programme. Methods HPV testing using self-sampling was offered to eligible women residing in one district of Sikkim state. To implement the same, a testing laboratory was set up in the district and the challenges faced are listed. Results The cost of testing equipment, sampler and cold storage was beyond the budget capping. Setting up of the HPV testing lab accessible to study sites and referral centre was a difficult decision to make. Training the health care providers in their proficiency in triaging and treatment was challenging. Coordinating with community health workers and beneficiaries for effective screening and establishing referral linkages was not easy, as we expected. The cost of transportation, consumables and contingencies was higher due to the difficult terrain. Conclusion The cost of the equipment and consumables for primary HPV screening can be reduced in bulk purchases through negotiations. Adequate knowledge of the terrain and economic implications of the area of interest is crucial during the budgeting of the programme. Collaborating with the state government, integration with the existing health system and repurposing the available resources are key for success. The barriers faced during implementation are stepping stones for improvement.
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Affiliation(s)
- Kavitha Dhanasekaran
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh 201301, India,https://orcid.org/0000-0002-3756-3419
| | - Harki Tamang
- Department of Health and Welfare, Government of Sikkim, Gangtok, Sikkim 737101, India
| | - Sangeeta Pradhan
- Department of Health and Welfare, Government of Sikkim, Gangtok, Sikkim 737101, India
| | - Rinzing Lhamu
- Department of Health and Welfare, Government of Sikkim, Gangtok, Sikkim 737101, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh 201301, India,https://orcid.org/0000-0003-2032-3432
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Saidu R, Morhason-Bello I. Same-day test and treat for early detection and treatment of cervical cancer in LMICs. THE LANCET GLOBAL HEALTH 2022; 10:e1226-e1227. [DOI: 10.1016/s2214-109x(22)00316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
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