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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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Han H, Mendez KJW, Perrin N, Cudjoe J, Taylor G, Baker D, Murphy‐Stone J, Sharps P. Community-based health literacy focused intervention for cervical cancer control among Black women living with human immunodeficiency virus: A randomized pilot trial. Health Expect 2022; 26:172-182. [PMID: 36444391 PMCID: PMC9854322 DOI: 10.1111/hex.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health literacy plays an essential role in how individuals process health information to make decisions about health behaviours including cancer screening. Research is scarce to address health literacy as a strategy to improve cancer screening participation among women living with human immunodeficiency virus (HIV), particularly Black women who, despite the heavy burden of cervical cancer, report consistently low screening rates. AIM To assess the feasibility, acceptability and preliminary efficacy of a health literacy-focused intervention called CHECC-uP-Community-based, HEalth literacy focused intervention for Cervical Cancer control-among women living with HIV. METHODS We conducted a community-based, single-blinded randomized pilot trial. A total of 123 eligible women were enrolled and randomized to one of two conditions, control (i.e., cervical cancer brochure) or intervention (cervical cancer brochure plus 30-60 min health literacy-focused education followed by monthly phone counselling and navigation assistance for 6 months). Study assessments were done at baseline, 3 and 6 months. The final analysis sample included 58 women who completed all data points and whose Papanicolaou (Pap) test status was confirmed by medical records. RESULTS All intervention participants who completed the programme would recommend the CHECC-uP to other women living with HIV. However, adherence in the experimental conditions was low (49.6% attrition rate including 20 women who dropped out before the intervention began) due, in large part, to phone disconnection. Those who had received the intervention had a significantly higher Pap test rate compared to women in the control group at 6 months (50% vs. 21.9%, p = .025). Participation in the intervention programme was associated with improved health literacy and other psychosocial outcomes at 3 months but the trend was attenuated at 6 months. CONCLUSIONS The CHECC-uP was highly acceptable and led to improved Pap testing rates among Black women living with HIV. Future research should consider addressing social determinants of health such as phone connectivity as part of designing a retention plan targeting low-income Black women living with HIV. IMPLICATIONS The findings should be incorporated into a future intervention framework to fulfil the unmet needs of Black women living with HIV to facilitate their decision-making about Pap test screening. PATIENT OR PUBLIC CONTRIBUTION Nineteen community members including women living with HIV along with HIV advocates and care providers participated in four focus groups to develop cervical cancer screening decision-relevant information and the health literacy intervention. Additionally, a community advisory board was involved to provide guidance in the general design and conduct of the study.
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Affiliation(s)
- Hae‐Ra Han
- The Johns Hopkins University School of NursingBaltimoreMarylandUSA,The Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA,Center for Community ProgramsInnovation, and ScholarshipBaltimoreMarylandUSA
| | | | - Nancy Perrin
- The Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Joycelyn Cudjoe
- United States Government Accountability OfficeDistrict of ColumbiaWashingtonUSA
| | - Gregory Taylor
- University of Maryland School of MedicineBaltimoreMarylandUSA
| | - Dorcas Baker
- Older Women Embracing Life (OWEL)BaltimoreMarylandUSA
| | | | - Phyllis Sharps
- The Johns Hopkins University School of NursingBaltimoreMarylandUSA
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Ciceron AC, Jeon MJ, Monroe AK, Clausen ME, Magnus M, Le D. HPV knowledge, screening barriers and facilitators, and sources of health information among women living with HIV: perspectives from the DC community during the COVID-19 pandemic. BMC Womens Health 2022; 22:110. [PMID: 35397535 PMCID: PMC8994173 DOI: 10.1186/s12905-022-01689-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background High-risk human papillomavirus (HPV) causes 99% of cervical cancer cases. Despite available prevention methods through the HPV vaccine and two screening modalities, women continue to die from cervical cancer worldwide. Cervical cancer is preventable, yet affects a great number of women living with HIV (WLH). Low screening rates among WLH further exacerbate their already high risk of developing cervical cancer due to immunosuppression. This study explores WLH’s current cervical cancer knowledge, screening barriers and facilitators, and sources of health information.
Methods Focus group discussions were conducted with 39 WLH aged 21 years old or older, who resided in the Washington-Baltimore Metropolitan Area. Emergent themes were classified and organized into overarching domains and assembled with representative quotations. Results The women had limited knowledge of HPV and the cervical cancer screening guidelines for WLH. Coronavirus 2019 (COVID-19) pandemic has amplified screening barriers due to decreased accessibility to usual medical appointment and cervical cancer screenings. Screening facilitators included knowing someone diagnosed with cervical cancer and provider recommendations. WLH indicated that they obtained health information through in-person education (providers, peer groups) and written literature. Due to the pandemic, they also had to increasingly rely on remote and technology-based communication channels such as the internet, social media, television, radio, email, and short message service (SMS) text messaging. Conclusions Future health interventions need to explore the possibility of sharing messages and increasing cervical cancer and HPV knowledge of WLH through the use of SMS and other technology-based channels.
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Affiliation(s)
- Annie Coriolan Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA
| | - Min Jeong Jeon
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA
| | - Anne Kress Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 5th Floor, Washington, DC, 20052, USA
| | - Michelle Elise Clausen
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 5th Floor, Washington, DC, 20052, USA
| | - Daisy Le
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA. .,Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 3rd Floor, Washington, DC, 20052, USA. .,George Washington University Cancer Center (GW Cancer Center), The George Washington University, 800 22nd Street NW, Suite 7000C (Science and Engineering Hall), Washington, DC, 20052, USA.
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Cervical Cancer Prevention and High-Risk HPV Self-Sampling Awareness and Acceptability among Women Living with HIV: A Qualitative Investigation from the Patients’ and Providers’ Perspectives. Curr Oncol 2022; 29:516-533. [PMID: 35200547 PMCID: PMC8870184 DOI: 10.3390/curroncol29020047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Routine cervical cancer screening is important for women living with HIV (WLH) due to the greater incidence and persistence of high-risk HPV (HR-HPV) infection. HR-HPV self-sampling has been proposed to overcome barriers to in-office cervical cancer screening in underserved populations. However, little is known about baseline knowledge of HR-HPV and the acceptability of HR-HPV self-sampling among WLH. This paper describes WLH’s experiences and needs regarding cervical cancer screening, specifically HR-HPV self-sampling, and seeks to reconcile their experiences with the views of their providers. In total, 10 providers and 39 WLH participated in semi-structured interviews and group discussions, respectively. Knowledge of cervical cancer and HR-HPV was generally limited among WLH; when present, it was often due to personal experience of or proximity to someone affected by cervical cancer. Most WLH were not familiar with HR-HPV self-sampling but, despite some of the providers’ skepticism, expressed their willingness to participate in a mail-based HR-HPV self-sampling intervention and highlighted convenience, ease of use, and affordability as facilitators to the uptake of HR-HPV self-sampling. The experiences identified can be used to guide patient-centered communication aimed at improving cervical cancer knowledge and to inform interventions, such as HR-HPV self-sampling, designed to increase cervical cancer screening among under-screened WLH.
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Wang R, Lee K, Gaydos CA, Anderson JR, Keller J, Coleman JS. Performance of Primary Self-Collected Human Papillomavirus Testing Among Women Living With Human Immunodeficiency Virus in the United States. Obstet Gynecol 2021; 137:342-344. [PMID: 33416287 DOI: 10.1097/aog.0000000000004238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Runzhi Wang
- Department of Gynecology and Obstetrics, and the Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and the Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Pierz AJ, Ajeh R, Fuhngwa N, Nasah J, Dzudie A, Nkeng R, Anastos KM, Castle PE, Adedimeji A. Acceptability of Self-Sampling for Cervical Cancer Screening Among Women Living With HIV and HIV-Negative Women in Limbé, Cameroon. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 2:561202. [PMID: 36304705 PMCID: PMC9580706 DOI: 10.3389/frph.2020.561202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: Like many countries in Sub-Saharan Africa, Cameroon has a high burden of cervical cancer and low availability and uptake of screening. Self-collection has the potential to increase the uptake of cervical cancer screening among Cameroon women. This paper explores patient and community insights surrounding self-collection among women living with HIV and HIV[-] women as well as the barriers and facilitators to obtaining and utilizing self-collected specimens in cervical cancer screening programs. Materials and methods: We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews during data collection that took place from May to August 2018. A two-stage sampling strategy was used to select 80 women who participated in six focus group discussions and eight in-depth interviews. We utilized the socio-ecological framework to guide data analysis. Results: All participants indicated that self-sampling was an acceptable method of specimen collection and should be offered as an option for cervical cancer screening in Cameroon. Whereas, most women, regardless of HIV status, preferred the option for self-collection, barriers were identified, such as lack of education about self-collection procedure, being uncomfortable, embarrassed or in pain from the procedure, fear of consequences, perceived competence about ability to self-collect and privacy and confidentiality. We also found that HIV-related stigma was a major concern for HIV[-] women that could prevent them from accessing cervical cancer screening integrated within HIV treatment settings. Conclusions: To promote self-collection for cervical cancer screening, educational interventions with both patients and providers are necessary to increase knowledge of and overall willingness to utilize self-collection. Further research is recommended to examine the role of stigma for HIV[-] women in screening locations associated with HIV treatment.
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Affiliation(s)
- Amanda J. Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
- *Correspondence: Amanda J. Pierz
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Norbert Fuhngwa
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Limbe Regional Hospital, Limbé, Cameroon
| | - Judith Nasah
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Limbe Regional Hospital, Limbé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Relindis Nkeng
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Kathryn M. Anastos
- Departments of Medicine, Epidemiology and Population Health, and Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
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7
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Yeh PT, Kennedy CE, de Vuyst H, Narasimhan M. Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001351. [PMID: 31179035 PMCID: PMC6529022 DOI: 10.1136/bmjgh-2018-001351] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Human papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic review and meta-analysis of HPV self-sampling among adult women on cervical (pre-)cancer screening uptake, screening frequency, social harms/adverse events and linkage to clinical assessment/treatment. Methods The included studies compared women using cervical cancer screening services with HPV self-sampling with women using standard of care, measured at least one outcome, and were published in a peer-reviewed journal. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CNIAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase through October 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR). Results 33 studies in 34 articles with 369 017 total participants met the inclusion criteria: 29 RCTs and 4 observational studies. All studies examined HPV self-sampling; comparison groups were standard of care (eg, Pap smear, visual inspection with acetic acid, clinician-collected HPV testing). 93% of participants were from high-income countries. All 33 studies measured cervical cancer screening uptake. Meta-analysis found greater screening uptake among HPV self-sampling participants compared with control (RR: 2.13, 95% CI 1.89 to 2.40). Effect size varied by HPV test kit dissemination method, whether mailed directly to home (RR: 2.27, 95% CI 1.89 to 2.71), offered door-to-door (RR: 2.37, 95% CI 1.12 to 5.03) or requested on demand (RR: 1.28, 95% CI 0.90 to 1.82). Meta-analysis showed no statistically significant difference in linkage to clinical assessment/treatment between arms (RR: 1.12, 95% CI 0.80 to 1.57). No studies measured screening frequency or social harms/adverse events. Conclusion A growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment. Systematic review registration number PROSPERO CRD42018114871.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hugo de Vuyst
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France.,Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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8
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Wong JPH, Vahabi M, Miholjcic J, Tan V, Owino M, Li ATW, Poon MKL. Knowledge of HPV/cervical cancer and acceptability of HPV self-sampling among women living with HIV: A scoping review. ACTA ACUST UNITED AC 2018; 25:e73-e82. [PMID: 29507498 DOI: 10.3747/co.25.3855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer rates are disproportionately high among women living with the human immunodeficiency virus (wlhiv). Cervical cancer is preventable through hpv screening, regular Pap tests, and early cancer detection. Evidence indicates that hpv and cervical cancer screening are suboptimal among wlhiv, who face a myriad of access barriers. Considering that screening is an effective first-line defense to cervical cancer, we conducted a scoping review with the aim of gaining a better understanding about: (1) the knowledge and perceptions of hpv and cervical cancer screening among wlhiv; and (2) the acceptability of self-sampling for hpv among wlhiv. We searched five electronic databases for peer-reviewed articles that were published in English within the last ten years, reported on studies with hiv-positive women who were aged 16 or older, and satisfied the topics of the review. A total of 621 articles were found. After accounting for duplicates and unmet criteria, 17 articles and 1 abstract, reporting on studies in the United States and Africa, were included in this review. The review highlighted that most wlhiv had inadequate knowledge of hpv transmission and cervical cancer prevention, which influenced their perceptions of risk and susceptibility. Screening barriers included misconceptions about Pap tests, fear of diagnosis of serious illness, perceived pain, embarrassment, bodily modesty, and limited access to female health care providers. This review also affirms that self-sampling is an acceptable and promising screening option for wlhiv. Implications for policy, research, and practice are discussed.
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Affiliation(s)
- J P H Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - J Miholjcic
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - V Tan
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - M Owino
- Committee for Accessible aids Treatment, Toronto, ON
| | - A T W Li
- Committee for Accessible aids Treatment, Toronto, ON.,Regent Park Community Health Centre, Toronto, ON
| | - M K L Poon
- School of Social Work, York University, Toronto, ON
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Smith JS, Des Marais AC, Deal AM, Richman AR, Perez-Heydrich C, Yen-Lieberman B, Barclay L, Belinson J, Rinas A, Brewer NT. Mailed Human Papillomavirus Self-Collection With Papanicolaou Test Referral for Infrequently Screened Women in the United States. Sex Transm Dis 2018; 45:42-48. [PMID: 28876298 PMCID: PMC5846187 DOI: 10.1097/olq.0000000000000681] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Testing for high-risk human papillomavirus (HPV) infection using mailed, self-collected samples is a promising approach to increase screening in women who do not attend clinic screening at recommended intervals. METHODS To assess this intervention among high-risk women in the United States, 429 women without a Papanicolaou (Pap) test in 4 or more years (overdue by US guidelines) were recruited from the general population. Participants aged 30 to 65 years were mailed a kit to self-collect a cervicovaginal sample at home, return the sample by mail, and receive HPV results by telephone, with referral to follow-up cytological Pap testing at a local clinic. Cervicovaginal self-samples were collected with a Viba brush, stored in Scope mouthwash, and tested by Hybrid Capture 2. Data were collected in 2010 to 2011 and analyzed in 2017. RESULTS Two-thirds (64%) of participants returned a self-collected sample, of whom 15% tested HPV DNA positive. Human papillomavirus self-test-positive women reported higher rates of follow-up Pap tests (82%) than did those with self-test negative results (51%). No demographic differences were found in self-test return rate or HPV positivity. High acceptability was reported in participant surveys: most women (81%) had "mostly positive" overall thoughts about the self-test, and most reported being comfortable receiving the kit in the mail (99%), returning their self-collected sample by mail (82%), and receiving their test results by telephone (97%). CONCLUSIONS Conducting HPV self-testing through population-based recruitment, mailed kit delivery and return by mail, and results delivery by telephone has the potential to reach a broad segment of US underscreened women.
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Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L, Simon MA, Murphy RL, Jordan N. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One 2017; 12:e0183924. [PMID: 28873092 PMCID: PMC5584806 DOI: 10.1371/journal.pone.0183924] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally. Objectives The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer. Methods We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot. Results Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk. Conclusion Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women’s participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.
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Affiliation(s)
- Jonah Musa
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- * E-mail: , ,
| | - Chad J. Achenbach
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Linda C. O’Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Charlesnika T. Evans
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, United States of America
| | - Megan McHugh
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Lifang Hou
- Division of Cancer Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Robert L. Murphy
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Neil Jordan
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Psychiatry & Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
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Anderson C, Breithaupt L, Des Marais A, Rastas C, Richman A, Barclay L, Brewer NT, Smith JS. Acceptability and ease of use of mailed HPV self-collection among infrequently screened women in North Carolina. Sex Transm Infect 2017; 94:131-137. [PMID: 28866635 DOI: 10.1136/sextrans-2017-053235] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/14/2017] [Accepted: 07/30/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing has the potential to make cervical cancer screening more accessible to underscreened women. We evaluated the acceptability and ease of use of home-based HPV self-collection within a diverse population of low-income, infrequently screened women. METHODS Participants were low-income women from North Carolina who had not received Pap testing in 4 or more years. Eligible women received a self-collection kit containing instructions and a brush for home-based sample collection. A total of 227 women returned a self-collected sample by mail and completed a questionnaire to assess their experiences with HPV self-collection. We described acceptability measures and used logistic regression to identify predictors of overall positive thoughts about the self-collection experience. RESULTS Nearly all women were willing to perform HPV self-collection again (98%) and were comfortable receiving the self-collection kit in the mail (99%). Overall, 81% of participants reported positive thoughts about home-based self-collection. Women with at least some college education and those who were divorced, separated or widowed were more likely to report overall positive thoughts. Aspects of self-collection that participants most commonly reported liking included convenience (53%), ease of use (32%) and privacy (23%). The most frequently reported difficulties included uncertainty that the self-collection was done correctly (16%) and difficulty inserting the self-collection brush (16%). CONCLUSIONS Home-based self-collection for HPV was a highly acceptable screening method among low-income, underscreened women and holds the promise to increase access to cervical cancer screening in this high-risk population.
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Affiliation(s)
- Chelsea Anderson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lindsay Breithaupt
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrea Des Marais
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charlotte Rastas
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alice Richman
- College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
| | - Lynn Barclay
- American Sexual Health Association, Chapel Hill, North Carolina, USA
| | - Noel T Brewer
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV. J Low Genit Tract Dis 2017; 20:e63. [PMID: 27556424 DOI: 10.1097/lgt.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Human Papillomavirus DNA Self-Testing to Promote Cervical Cancer Screening Practices Among WLHIV: Revisiting the Evidence. J Low Genit Tract Dis 2017; 20:e62-3. [PMID: 27428606 DOI: 10.1097/lgt.0000000000000236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Viviano M, DeBeaudrap P, Tebeu PM, Fouogue JT, Vassilakos P, Petignat P. A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa. Int J Womens Health 2017; 9:69-79. [PMID: 28203108 PMCID: PMC5298303 DOI: 10.2147/ijwh.s103868] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cervical cancer (CC) is a leading cause of cancer-related death and a major public health issue in sub-Saharan Africa. This heavy burden parallels that of the human immunodeficiency virus (HIV) infection, which increases the risk of developing CC. Despite the progressive reduction of HIV prevalence in the past decade, the CC incidence and mortality rates in sub-Saharan Africa remain high. The heterogeneity of the distribution of the two diseases in the African continent, together with the different availability of human and material resources, stands in the way of finding an appropriate screening strategy. The lack of high-quality evidence on the prevention of CC for HIV-positive women, which is necessary for the implementation of efficient screening and treatment strategies, results in the absence of a clearly defined program, which is responsible for the low screening uptake and high mortality rates in sub-Saharan Africa. By taking advantage of the HIV-positive women's frequent access to health facilities, one way to increase the CC screening coverage rates would be by providing integrated HIV and screening services within the same infrastructure. With the increasing availability of cost-effective methods, screening is becoming more and more available to women who have limited access to health care. Moreover, the introduction of point-of-care technologies for human papillomavirus testing and the subsequent implementation of screen-and-treat strategies, by reducing the number of clinical appointments and, in the long term, the loss to follow-up rates, open up new opportunities for all women, regardless of their HIV status. The purpose of this review is to provide an insight into the different screening practices for CC in order to help define one that is adapted to the resources and necessities of HIV-positive women living in middle-to-low income countries.
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Affiliation(s)
- Manuela Viviano
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre DeBeaudrap
- Centre Population et Développement - UMR 196, Institute of Research for the Development, University of Paris-Descartes, Paris, France
| | - Pierre-Marie Tebeu
- Faculty of Medicine and Biomedical Sciences and Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon, Africa
| | - Jovanny T Fouogue
- Faculty of Medicine and Biomedical Sciences and Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon, Africa
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
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