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Agyare Gyane F, Modey E, Maya E, Bonney EY, Abaidoo-Myles A, Paintsil E, Torpey K. Prevalence and risk factors associated with high-risk human papillomavirus infection among women living with HIV (WLWH) at a tertiary health facility in Accra, Ghana. PLoS One 2024; 19:e0303535. [PMID: 38814956 PMCID: PMC11139324 DOI: 10.1371/journal.pone.0303535] [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: 10/05/2023] [Accepted: 04/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Women living with HIV (WLWH) have high risk of developing cervical cancer. High- risk Human papillomavirus (hrHPV) is the single most important cause of cervical cancer. Vaccination for and early detection of pre-malignant cervical changes, through cervical cancer screening contributes to prevention of cervical cancer. This study sought to determine the prevalence of HPV among WLWH, genotypes present and the risk factors associated with cervical cancer development. METHODS AND FINDINGS An analytical cross-sectional study of 250 sexually active women aged 18 years and above, attending HIV clinic at a tertiary health facility in Accra. Demographic data collection and risk factor assessments were done using interviewer-administered questionnaire, and patient records. Cervical swabs were collected and tested for HPV using real-time PCR assays. Genotype analysis was performed on 92 samples. Descriptive statistics and logistic regression analysis were used to establish associations between hrHPV and risk factors among WLWH. Approximately 60% of study participants tested positive for HPV. The prevalence of hr-HPV among WLH was 44.4%. Factors identified to be protective of hrHPV were employment (AOR = 0.19, 95% CI = 0.06, 0.56, p = 0.003) and highly active antiretroviral therapy (HAART) Tenofovir-Lamivudine-Ritonavir-Lopinavir (TLRL) (AOR = 0.30, 95% CI = 0.09, 0.95, p = 0.04). Women with HIV diagnosis within 6 to10 years (AOR = 4.89, 95% CI = 1.05, 22.70, p = 0.043) and diagnosis >10 years (AOR = 8.25, 95% CI = 1.24, 54.84, p = 0.029) had higher odds of hrHPV. Approximately 25% of samples analysed tested positive for hr-HPV group 1 (genotypes 16, 18, 31, 33, 35, 39, 45,51, 52, 56, 58, 69) and 46.8% for multiple HPV genotypes. CONCLUSION A high prevalence of genotypes that include high risk genotypes 16 and 18 and multiple HPV infections was found among WLWH. Almost half of the women screened had high-risk HPV and were prone to cervical cancer without their knowledge. Regular HPV screening is recommended for high-risk patient groups.
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Affiliation(s)
| | - Emefa Modey
- School of Public Health, University of Ghana, Accra, Ghana
| | - Ernest Maya
- School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Elijah Paintsil
- Yale School of Medicine, New Haven, CT, United States of America
| | - Kwasi Torpey
- School of Public Health, University of Ghana, Accra, Ghana
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Olakunde BO, Itanyi IU, Olawepo JO, Liu L, Bembir C, Idemili-Aronu N, Lasebikan NN, Onyeka TC, Dim CC, Chigbu CO, Ezeanolue EE, Aarons GA. Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria. Implement Sci 2024; 19:25. [PMID: 38468266 PMCID: PMC10926605 DOI: 10.1186/s13012-024-01349-9] [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: 12/30/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS gov/ct2/show/study/NCT06128304.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lin Liu
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chinenye Bembir
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Sociology and Anthropology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Nwamaka N Lasebikan
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cyril C Dim
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike O Chigbu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- HealthySunrise Foundation, Las Vegas, NV, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093-0812, USA.
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
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Dangal G, Dhital R, Dwa YP, Poudel S, Pariyar J, Subedi K. Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002832. [PMID: 38236836 PMCID: PMC10796028 DOI: 10.1371/journal.pgph.0002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (β) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (β = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (β = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (β = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.
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Affiliation(s)
- Ganesh Dangal
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Kathmandu Model Hospital, Kathmandu, Nepal
| | | | - Yam Prasad Dwa
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Sandesh Poudel
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
| | - Jitendra Pariyar
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Civil Service Hospital of Nepal, Kathmandu, Nepal
| | - Kirtipal Subedi
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
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Ouedraogo RA, Kande A, Nadembega WMC, Ouermi D, Zohoncon TM, Djigma FW, Ouedraogo CMRN, Lompo OM, Simpore J. Distribution of high- and low-risk human papillomavirus genotypes and their prophylactic vaccination coverage among West African women: systematic review. J Egypt Natl Canc Inst 2023; 35:39. [PMID: 38060078 DOI: 10.1186/s43046-023-00196-x] [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: 09/11/2023] [Accepted: 10/28/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION The second most deadly gynecological cancer worldwide, cervical cancer is steadily on the rise in sub-Saharan Africa, while vaccination programs are struggling to get off the ground. This systematic review's aim was to assess the prevalence and distribution of high- and low-risk HPV genotypes in West African women. METHODS Original studies were retrieved from PubMed/Medline, Embase, Scopus, Google Scholar, and Science Direct. In these studies, Human papillomavirus (HPV) DNA was assessed in cervical samples by polymerase chain reaction (PCR), Hybrid capture, and sequencing. The quality of the articles was assessed and the results were extracted and reviewed. RESULTS Thirty-nine studies from 10 West African countries were included for the systematic review including 30 for the pooled analysis. From an overall of 17358 participants, 5126 of whom were infected with at least one HPV genotype, the systematic review showed a prevalence varying from 8.9% to 81.8% in the general population. In contrast, the pooled prevalence of infection was 28.6% (n = 3890; 95% CI 27.85-29.38), and HPV-52 (13.3%), HPV-56 (9.3%), and HPV-35 (8.2) were the most frequent. Quadrivalent and nonavalent vaccines covered 18.2% and 55.8% of identified genotypes respectively. CONCLUSION Faced with this growing public health challenge in West Africa, it would be necessary for all its countries to have reliable data on HPV infection and to introduce the nonavalent vaccine. A study of the genotypic distribution of HPV in high-grade precancerous lesions and cervical cancer would be very useful in West Africa.
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Affiliation(s)
- Rogomenoma Alice Ouedraogo
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso.
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso.
- Université Nazi BONI, P.O Box 1091, Bobo-Dioulasso 01, Burkina Faso.
| | - Ali Kande
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Wendyam Marie Christelle Nadembega
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Djeneba Ouermi
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Théodora Mahoukèdè Zohoncon
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
- Université Saint Thomas d'Aquin, P.O. Box 10212, Ouagadougou 06, Burkina Faso
| | - Florencia Wendkuuni Djigma
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Charlemagne Marie Ragnag-Newende Ouedraogo
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Université Joseph KI-ZERBO, UFR SDS, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Olga Mélanie Lompo
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Université Joseph KI-ZERBO, UFR SDS, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre Hospitalier Universitaire Yalgado Ouedraogo (CHU/YO), P.O. Box 7022, Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Université Joseph KI-ZERBO, Laboratoire de Biologie Moléculaire et de Génétique, P.O. Box 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
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Bag S, Pezzotti S, Das Mahanta D, Schulke S, Schwaab G, Havenith M. From Local Hydration Motifs in Aqueous Acetic Acid Solutions to Macroscopic Mixing Thermodynamics: A Quantitative Connection from THz-Calorimetry. J Phys Chem B 2023; 127:9204-9210. [PMID: 37843511 DOI: 10.1021/acs.jpcb.3c06328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
We report the results of THz measurements (30-440 cm-1) of aqueous acetic acid solutions over the full mixing range (XAcAc = 0-1). We recorded spectroscopic observables as a function of the acetic acid concentration in the frequency range of the intermolecular stretch at 150 cm-1 and of the librational modes at 350-440 cm-1. This allowed us to unravel changes in hydrophobic and hydrophilic hydration motifs, respectively. By means of a novel THz-calorimetry approach, we quantitatively correlated these changes in local hydration motifs to excess mixing entropy and enthalpy. We find that ΔHmix is determined by both hydrophobic and hydrophilic solvation contributions. In contrast, ΔSmix is governed by hydrophobic cavity formation. Our results further suggest that acetic acid-water mixtures are systems at the edge of phase separation due to endothermic contributions from both hydrophilic and hydrophobic solvation in a large portion of the miscibility range. Our work establishes a quantitative relationship between the balance of local hydrophobic and hydrophilic solvation motifs and the macroscopic mixing thermodynamic properties.
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Affiliation(s)
- Sampad Bag
- Lehrstuhl für Physikalische Chemie II, Ruhr-Universität Bochum, Bochum 44780, Germany
| | - Simone Pezzotti
- Lehrstuhl für Physikalische Chemie II, Ruhr-Universität Bochum, Bochum 44780, Germany
| | - Debasish Das Mahanta
- Department of Physics, Gandhi Institute of Technology and Management (GITAM), Bengaluru, Karnataka 561203, India
| | - Simon Schulke
- Lehrstuhl für Physikalische Chemie II, Ruhr-Universität Bochum, Bochum 44780, Germany
| | - Gerhard Schwaab
- Lehrstuhl für Physikalische Chemie II, Ruhr-Universität Bochum, Bochum 44780, Germany
| | - Martina Havenith
- Lehrstuhl für Physikalische Chemie II, Ruhr-Universität Bochum, Bochum 44780, Germany
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Kabukye JK, Namugga J, Mpamani CJ, Katumba A, Nakatumba-Nabende J, Nabuuma H, Musoke SS, Nankya E, Soomre E, Nakisige C, Orem J. Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda: Qualitative Study of Stakeholders' Perceptions. J Med Internet Res 2023; 25:e45132. [PMID: 37782541 PMCID: PMC10580134 DOI: 10.2196/45132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/03/2023] [Accepted: 07/27/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. OBJECTIVE This study aimed to describe stakeholders' perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. METHODS We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. RESULTS In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. CONCLUSIONS This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Jane Namugga
- Uganda Cancer Institute, Kampala, Uganda
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | | | - Andrew Katumba
- Department of Electrical Engineering, Makerere University, Kampala, Uganda
| | | | - Hanifa Nabuuma
- Department of Electrical Engineering, Makerere University, Kampala, Uganda
| | - Stephen Senkomago Musoke
- Global Programs for Research and Training, University of California San Francisco, Kampala, Uganda
| | | | - Edna Soomre
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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7
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Baena A, Mesher D, Salgado Y, Martínez S, Villalba GR, Amarilla ML, Salgado B, Flores B, Bellido‐Fuentes Y, Álvarez‐Larraondo M, Valls J, Lora O, Virreira‐Prout G, Figueroa J, Turcios E, Soilán AM, Ortega M, Celis M, González M, Venegas G, Terán C, Ferrera A, Mendoza L, Kasamatsu E, Murillo R, Wiesner C, Broutet N, Luciani S, Herrero R, Almonte M. Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study. Int J Cancer 2023; 152:1581-1592. [PMID: 36451311 PMCID: PMC10107773 DOI: 10.1002/ijc.34384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
VIA is recommended for triage of HPV-positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV-positive women was evaluated. Women aged 30-64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study-trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty-two HPV-positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2-89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9-86.6). Overall specificity was 58.6% (95% CI 56.7-60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8-73.5) compared to women <50 (54.3%, 95% CI 52.1-56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9-38.6) compared to women <50 (53.2, 95% CI 51.1-55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%-95.4%, 44.9%-94.4%, 8.2%-65.3%, 0%-98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV-positive women performed by trained providers was high with an important reduction in referral rates. However, scaling-up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision.
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Affiliation(s)
- Armando Baena
- International Agency for Research on CancerLyonFrance
| | - David Mesher
- International Agency for Research on CancerLyonFrance
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV ServiceUK Health Security AgencyLondonUK
| | - Yuli Salgado
- Instituto Nacional de CancerologíaBogotáColombia
| | | | - Griselda Raquel Villalba
- Hospital Materno Infantil de San LorenzoMinisterio de Salud Pública y Bienestar SocialSan LorenzoParaguay
| | | | - Brenda Salgado
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Bettsy Flores
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | | | | | - Joan Valls
- International Agency for Research on CancerLyonFrance
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Oscar Lora
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
| | - Gonzalo Virreira‐Prout
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
- Seguro Social Universitario (SSU)SucreBolivia
| | | | - Elmer Turcios
- Programa Nacional contra el CáncerTegucigalpaHonduras
| | - Ana María Soilán
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Marina Ortega
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | | | | | - Gino Venegas
- Clínica AngloamericanaLimaPeru
- Escuela de Medicina HumanaUniversidad de PiuraLimaPeru
| | - Carolina Terán
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Raúl Murillo
- International Agency for Research on CancerLyonFrance
- Centro Javeriano de OncologíaHospital Universitario San IgnacioBogotáColombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Silvana Luciani
- Pan American Health Organization (PAHO)WashingtonDistrict of ColumbiaUSA
| | - Rolando Herrero
- International Agency for Research on CancerLyonFrance
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)Fundación InciensaGuanacasteCosta Rica
| | - Maribel Almonte
- International Agency for Research on CancerLyonFrance
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
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8
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Qin D, Bai A, Xue P, Seery S, Wang J, Mendez MJG, Li Q, Jiang Y, Qiao Y. Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology. BMC Cancer 2023; 23:187. [PMID: 36823557 PMCID: PMC9951444 DOI: 10.1186/s12885-023-10648-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Colposcopy is an important tool in diagnosing cervical cancer, and the International Federation of Cervical Pathology and Colposcopy (IFCPC) issued the latest version of the guidelines in 2011. This study aims to systematically assess the accuracy of colposcopy in predicting low-grade squamous intraepithelial lesions or worse (LSIL+) / high-grade squamous intraepithelial lesions or worse (HSIL+) under the 2011 IFCPC terminology. METHODS We performed a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for studies about the performance of colposcopy in diagnosing cervical intraepithelial neoplasia under the new IFCPC colposcopy terminology from PubMed, Embase, Web of Science and the Cochrane database. Data were independently extracted by two authors and an overall diagnostic performance index was calculated under two colposcopic thresholds. RESULTS Totally, fifteen articles with 22,764 participants in compliance with the criteria were included in meta-analysis. When colposcopy was used to detect LSIL+, the combined sensitivity and specificity were 0.92 (95% CI 0.88-0.95) and 0.51 (0.43-0.59), respectively. When colposcopy was used to detect HSIL+, the combined sensitivity and specificity were 0.68 (0.58-0.76) and 0.93 (0.88-0.96), respectively. CONCLUSION In accordance with the 2011 IFCPC terminology, the accuracy of colposcopy has improved in terms of both sensitivity and specificity. Colposcopy is now more sensitive with LSIL+ taken as the cut-off value and is more specific to HSIL+. These findings suggest we are avoiding under- or overdiagnosis both of which impact on patients' well-being.
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Affiliation(s)
- Dongxu Qin
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Anying Bai
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Peng Xue
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Samuel Seery
- grid.9835.70000 0000 8190 6402Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4YW UK
| | - Jiaxu Wang
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Maria Jose Gonzalez Mendez
- grid.411971.b0000 0000 9558 1426School of Public Health, Dalian Medical University, Dalian, 116044 Liaoning China
| | - Qing Li
- grid.469593.40000 0004 1777 204XDiagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518028 China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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9
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Kurtay S, Ali KY, Hussein AI. Frequency of cervical premalignant lesions in the gynecologic patients of a tertiary hospital in Mogadishu, Somalia. BMC Womens Health 2022; 22:501. [PMID: 36476212 PMCID: PMC9727848 DOI: 10.1186/s12905-022-02106-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer worldwide and is the most frequently diagnosed cancer in 23 countries and the most common cause of death in 36 countries, mostly from Sub-Saharan African countries. Cervical screening is a key element to reduce the incidence and mortality of cervical cancer. Cancer screening is low in Sub-Saharan Africa. This study aims to provide information about cervical premalignant lesions frequency in Somalia. METHODS The pathology results of cervicovaginal smear samples obtained from patients aged 25-65 years who applied to the gynecology outpatient clinic between October 5 and December 5, 2021 were analyzed retrospectively. SPSS 22.0 was used for the statistical analysis of the data. RESULT Among the 497 results, 63 premalignant lesions were detected. The rate of premalignant lesions (63/497) was found to be 12.3%. The most common premalignant lesion was atypical squamous cells of undetermined significance (ASC-US). CONCLUSION In this study, the frequency of cervical premalignant lesions in Somalia was found to be higher than in the literature. Vaccination, screening, and early diagnosis are the most important components in the fight against cervical cancer. Access to vaccination, screening, and early diagnosis, which are the most important components in the fight against cervical cancer in Somalia, will be possible with the cooperation of the national health system and international organizations.
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Affiliation(s)
- Sabri Kurtay
- Somali Mogadişu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Banadır Somalia
| | - Khadija Yusuf Ali
- Somali Mogadişu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Banadır Somalia
| | - Ahmed Issak Hussein
- Somali Mogadişu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Banadır Somalia
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Fokom Domgue J, Pande M, Yu R, Manjuh F, Welty E, Welty T, Elit L, Lopez-Varon M, Rodriguez J, Baker E, Dangou JM, Basu P, Plante M, Lecuru F, Randall T, Starr E, Kamgno J, Foxhall L, Waxman A, Hawk E, Schmeler K, Shete S. Development, Implementation, and Evaluation of a Distance Learning and Telementoring Program for Cervical Cancer Prevention in Cameroon. JAMA Netw Open 2022; 5:e2240801. [PMID: 36346631 PMCID: PMC9644259 DOI: 10.1001/jamanetworkopen.2022.40801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Although Africa has the highest burden of cervical cancer in the world, educational resources to achieve the 90-70-90 targets set by the World Health Organization in its strategy to eliminate cervical cancer are lacking in the region. OBJECTIVES To adapt, implement, and evaluate the Project Extension for Community Health Care Outcomes (ECHO), an innovative learning tool, to build capacity of clinicians to better incorporate new evidence-based guidelines into cervical cancer control policies and clinical practices. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study assessed knowledge and practices of clinicians and support staff regarding cervical cancer prevention and control and compared them among respondents who had attended Project ECHO sessions (prior ECHO attendees) with those who had not but were planning on attending in the near future (newcomers) as part of the Cameroon Cervical Cancer Prevention Project ECHO. Satisfaction of prior ECHO attendees was also evaluated. Data were analyzed from January to March 2022. MAIN OUTCOMES AND MEASURES Main outcomes were practices and knowledge regarding cervical cancer education and prevention and preinvasive management procedures compared among prior ECHO attendees and newcomers. RESULTS Of the 75 participants (mean [SD] age, 36.4 [10.0] years; 65.7% [95% CI, 54.3%-77.1%] women) enrolled in this study, 41 (54.7%; 95% CI, 43.1%-66.2%) were prior ECHO attendees, and most were clinicians (55 respondents [78.6%; 95% CI, 68.7%-88.4%]). Overall, 50% (95% CI, 37.8%-62.2%) of respondents reported performing cervical cancer screening with visual inspection of the cervix after application of acetic acid (VIA) and/or visual inspection of the cervix after application of Lugol's iodine (VILI), 46.3% (95% CI, 34.0%-58.5%) of respondents reported performing human papillomavirus (HPV) testing, and 30.3% (95% CI, 18.9%-41.7%) of respondents reported performing cervical cytological examination in their practices, Approximately one-fourth of respondents reported performing cryotherapy (25.4% [95% CI, 14.7%-36.1%]), thermal ablation (27.3% [95% CI, 16.2%-38.3%]) or loop electrosurgical excisional procedure (LEEP, 25.0% [95% CI, 14.4%-35.6%]) for treatment of preinvasive disease. The clinical use of many of these screening and treatment tools was significantly higher among prior ECHO attendees compared with newcomers (VIA/VILI: 63.2% [95% CI, 47.4%-78.9%] vs 33.3% [95% CI, 16.0%-50.6%]; P = .03; cryotherapy: 40.5% [95% CI, 24.3%-56.8%] vs 6.7% [95% CI, 0.0%-15.8%]; P = .002; thermal ablation: 43.2% [95% CI, 26.9%-59.6%] vs 6.9% [95% CI, 0.0%-16.4%]; P = .002). Knowledge about cervical cancer education, prevention, and management procedures was satisfactory in 36.1% (95% CI, 23.7%-48.5%) of respondents; this proportion was significantly higher among prior ECHO attendees (53.8% [95% CI, 37.7%-69.9%]) compared with newcomers (4.5% [95% CI, 0.0%-13.5%]; P < .001). Approximately two-thirds of participants (68.8% [95% CI, 51.8%-85.8%]) reported that they had applied knowledge learned in our ECHO sessions to patient care in their practice or adopted best-practice care through their participation in this ECHO program. CONCLUSIONS AND RELEVANCE These findings suggest that the Project ECHO e-learning and telementoring program was associated with improved skills for clinicians and support staff and enhanced quality of care for patients. In the COVID-19 era and beyond, reinforced efforts to strengthen cervical cancer knowledge and best practices through distance learning and collaboration are needed.
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Affiliation(s)
- Joel Fokom Domgue
- University of Texas MD Anderson Cancer Center, Houston
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mala Pande
- University of Texas MD Anderson Cancer Center, Houston
| | - Robert Yu
- University of Texas MD Anderson Cancer Center, Houston
| | - Florence Manjuh
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Laurie Elit
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | | | | | - Ellen Baker
- University of Texas MD Anderson Cancer Center, Houston
| | - Jean-Marie Dangou
- African Regional Office of the World Health Organization, Brazzaville, Congo
| | - Partha Basu
- International Agency for Research on Cancer of the World Health Organization, Lyon, France
| | - Marie Plante
- Division of Gynecologic Oncology, CHU de Quebec, Laval University, Quebec, Canada
| | | | - Thomas Randall
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Lewis Foxhall
- University of Texas MD Anderson Cancer Center, Houston
| | - Alan Waxman
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque
| | - Ernest Hawk
- University of Texas MD Anderson Cancer Center, Houston
| | | | - Sanjay Shete
- University of Texas MD Anderson Cancer Center, Houston
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Mremi A, Mchome B, Mlay J, Schledermann D, Blaakær J, Rasch V. Performance of HPV testing, Pap smear and VIA in women attending cervical cancer screening in Kilimanjaro region, Northern Tanzania: a cross-sectional study nested in a cohort. BMJ Open 2022; 12:e064321. [PMID: 36316070 PMCID: PMC9628663 DOI: 10.1136/bmjopen-2022-064321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE There is a concern about performance of the screening approaches, where information on the quality of novel and affordable screening approaches that will perform well in remote areas is warranted. This lack of information makes it difficult to prioritise resource use in efforts to improve cervical cancer outcomes. We aimed to compare the diagnostic value of human papillomavirus (HPV) testing on self-collected samples, Pap smear and visual inspection of the cervix with acetic acid (VIA) tests for detection of high-grade cervical intraepithelial neoplasia or worse (CIN2+). DESIGN A combined cross-sectional and cohort study. SETTING Three primary healthcare centres in Kilimanjaro region, Tanzania. PARTICIPANTS 1620 women undergoing cervical cancer screening from December 2018 to September 2021. Inclusion criteria were being aged 25-60 years, and no history of premalignant or cervical cancer. Exclusion criteria were overt signs of cancer and previous hysterectomy. INTERVENTIONS Participants underwent HPV self-sampling with Evalyn Brush and Care HPV kit assay was used to determine prevalence of high-risk HPV infection. Women with positive HPV test were together with a random sample of HPV negative women scheduled for follow-up where VIA was performed, and Pap smear and cervical biopsies obtained. RESULTS Of 1620 women enrolled, 229 (14.1%) were HPV positive and 222 of these attended follow-up together with 290 (20.8%) women with negative HPV test. On VIA, 17.6% were positive. On Pap smear, 8.0% were classified as high-grade squamous intraepithelial lesion. The sensitivity and specificity, respectively, of the various tests, compared with histopathology for the detection of CIN2+ were: HPV test 62.5%, 59.3%; Pap smear 82.8%, 82.1% and; VIA 48.4%, 56.8%. When combined, the sensitivity and specificity for HPV and Pap smear were 90.6%, 70.6% while HPV and VIA were 65.6% and 75.5% for the detection of CIN2+. CONCLUSIONS The performance of care HPV testing on self-collected samples opens the possibility of increasing coverage and early detection in resource-constrained settings.
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Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Joseph Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | | | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Odense University Hospital, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Clinical Research, Odense University Hospital, Odense, Denmark
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12
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Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol 2022; 140:470-476. [PMID: 35926207 PMCID: PMC9377370 DOI: 10.1097/aog.0000000000004904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess concordance and acceptability of a modified menstrual pad compared with a clinician-collected high-risk human papillomavirus (HPV) sample. METHODS This was a prospective observational study. Women presenting for either cervical cancer screening or with a history of high-risk HPV positivity were eligible. Three samples were requested from participants: 1) clinician-collected cervical specimens; 2) self-collected vaginal swabs; and 3) a modified menstrual pad, which was taken home for use during the next menstruation. All samples were processed using the Cobas HPV test. Menstrual pad dried blood spots were eluted, then similarly processed. RESULTS Of 153 women enrolled in the study, 106 provided menstrual pad samples and clinician-collected cervical specimens for high-risk HPV analysis. For samples in which the interval between the clinician-collected specimen and the menstrual pad sample was less than 2 months, the concordance was 94% (95% CI 83-98). For women who tested positive for high-risk HPV who presented for general screening and those with more than cervical intraepithelial neoplasia 2, menstrual pad and clinician-collected specimen agreement was 100% (95% CI 32.5-100). Among participants, 22.9% expressed discomfort with the self-collected vaginal swabs and opted out of collection. Overall, 94.0% of participants preferred the menstrual pad over clinician-collected sampling. Twelve patients were found to be positive for HPV on the menstrual pad sample but negative on the clinician-collected specimen. CONCLUSION Among women who tested positive for HPV, the menstrual pad showed highly concordant results compared with clinician-collected sampling. This collection approach shows promise for integration into cervical cancer prevention programs.
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Khumalo PG, Carey M, Mackenzie L, Ampofo AG, Sanson-Fisher R. Trends in cervical cancer screening research in sub-Saharan Africa: A bibliometric analysis of publications from 2001 to 2020. J Cancer Policy 2022; 34:100356. [PMID: 35995396 DOI: 10.1016/j.jcpo.2022.100356] [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: 11/22/2021] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Sub-Saharan Africa has the highest incidence of cervical cancer globally. However, compared to developed countries, the region has lower uptake of cervical cancer screening. Research contribution and progress in the field of cervical cancer in the region has not been well investigated. This bibliometric review aimed to address this information gap by examining changes in research volume and type over a 20 year time frame. Medline, Embase, PsycINFO, CINAHL, and Cochrane Library were searched to identify peer-reviewed publications about cervical cancer screening in sub-Saharan Africa. Changes (from 2001 to 2020) in the (i) total publications, (ii) number and proportion of data-based publications relative to non-data-based publications, and descriptive relative to intervention publications, and (iii) the number and proportion of publications meeting the EPOC design criteria relative to those not meeting the EPOC design criteria were assessed using a generalised linear Poisson model, a generalised binomial model and the Pearson Chi-squared test respectively. A two-year increase in time was associated with an estimated 32 % increase in the total number of publications. While no measurement studies were recorded, the bulk of data-based publications (89 %) were descriptive studies. Relative to descriptive publications, a 1 % increase in the proportion of intervention publications was observed over time. Only a small proportion (28 %) of intervention studies met the EPOC design criteria. Our findings suggest that researchers and funders in the region should invest more effort and money in measurement and rigorous intervention research to inform outcome measures and cervical cancer screening policy and practice, respectively.
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Affiliation(s)
- Phinda G Khumalo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Mariko Carey
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Ama G Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
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Hämmerli P, Moukam AD, Wisniak A, Sormani J, Vassilakos P, Kenfack B, Petignat P, Schmidt NC. "My motivation was to save": a qualitative study exploring factors influencing motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Reprod Health 2022; 19:133. [PMID: 35668427 PMCID: PMC9167909 DOI: 10.1186/s12978-022-01420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is a major public health issue among women in Cameroon and uptake of screening programs remains a challenge in many low- and middle-income countries. Community healthcare workers can play an important role in promoting cervical cancer services. This study aimed to explore factors affecting the motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Methods A qualitative approach including 11 in-depth individual interviews with community healthcare workers was used. The interviews were audio-recorded, transcribed and coded using thematic analysis assisted by ATLAS.ti software. Results Four women and seven men aged between 21 and 77 years old were interviewed. Community healthcare workers had high motivation. Factors affecting motivation were divided into individual and environmental level, based on a theoretical framework. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Conclusions Key interventions to improve motivation among community healthcare workers include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport. Trial registration: Geneva Cantonal Ethics Committee on Human Research (No. 2017-01110) and the Cameroonian National Ethics Committee for Human Health Research (No. 2018/07/1083/CE/CNERSH/SP). Cervical cancer is the second leading cause of cancer-related death among women in Cameroon. This is mainly due to the absence of routine cervical cancer screening programs and the lack of treatment. However, even in case of availability of cervical cancer screening programs, barriers exist. Therefore, community healthcare workers have been involved successfully to increase the screening coverage. As retention of these actors remains a challenge, the main objective of this study was to identify key factors affecting their motivation aiming to suggest interventions to address motivational factors. 11 qualitative interviews with individual community healthcare workers were conducted at a cervical cancer screening program in Dschang, Cameroon. Motivation was generally high and affecting factors were divided into the individual and the environmental level. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Ongoing collaboration with community healthcare workers is beneficial for cervical cancer screening programs, and key interventions should therefore include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport.
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Affiliation(s)
| | - Alida Datchoua Moukam
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jessica Sormani
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva School of Health Sciences, HESSO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Christine Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. .,Faculty of Social Science, Catholic University of Applied Science, Preysingstr. 95, 81667, Munich, Germany.
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Karisani N, Aminimoghaddam S, Kashanian M, Baradaran HR, Moradi Y. Diagnostic accuracy for alternative cervical cancer screening strategies: A systematic review and meta-analysis. Health Care Women Int 2022; 45:323-362. [PMID: 35084291 DOI: 10.1080/07399332.2021.1998059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/21/2021] [Indexed: 12/26/2022]
Abstract
We performed a systematic review and meta-analysis to evaluate the accuracy of screening cervical cancer tests as alternative standalone methods. The combined estimates of sensitivity of visual inspection with acetic acid, visual inspection with lugol's iodine, conventional pap smear, liquid-based cytology, High risk HPV testing by clinician, High risk HPV testing by self- sampling, cervicography were 64%, 80%, 55%, 70%, 70% and 67% respectively; the combine values of specificity of these screening strategies were 88%, 88%, 96%, 59%, 94%, and 95% respectively. Our findings draw attention to an attractive opinion to facilitate the collection of specimens for DNA HPV by patients in settings where they don't have access to a regular screening programs.
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Affiliation(s)
- Narmin Karisani
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Soheila Aminimoghaddam
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Maryam Kashanian
- Gynecologist Oncologist, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Association of HIV status and treatment characteristics with VIA screening outcomes in Malawi: A retrospective analysis. PLoS One 2022; 17:e0262904. [PMID: 35077501 PMCID: PMC8789172 DOI: 10.1371/journal.pone.0262904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Although evidence from high-resource settings indicates that women with HIV are at higher risk of acquiring high-risk HPV and developing cervical cancer, data from cervical cancer “screen and treat” programs using visual inspection with acetic acid (VIA) in lower-income countries have found mixed evidence about the association between HIV status and screening outcomes. Moreover, there is limited evidence regarding the effect of HIV-related characteristics (e.g., viral suppression, treatment factors) on screening outcomes in these high HIV burden settings.
Methods
This study aimed to evaluate the relationship between HIV status, HIV treatment, and viral suppression with cervical cancer screening outcomes. Data from a “screen and treat” program based at a large, free antiretroviral therapy (ART) clinic in Lilongwe, Malawi was retrospectively analyzed to determine rates of abnormal VIA results and suspected cancer, and coverage of same-day treatment. Multivariate logistic regression assessed associations between screening outcomes and HIV status, and among women living with HIV, viremia, ART treatment duration and BMI.
Results
Of 1405 women receiving first-time VIA screening between 2017–2019, 13 (0.9%) had suspected cancer and 68 (4.8%) had pre-cancerous lesions, of whom 50 (73.5%) received same-day lesion treatment. There was no significant association found between HIV status and screening outcomes. Among HIV+ women, abnormal VIA was positively associated with viral load ≥ 1000 copies/mL (aOR 3.02, 95% CI: 1.22, 7.49) and negatively associated with ART treatment duration (aOR 0.88 per additional year, 95% CI: 0.80, 0.98).
Conclusion
In this population of women living with HIV with high rates of ART coverage and viral suppression, HIV status was not significantly associated with abnormal cervical cancer screening results. We hypothesize that ART treatment and viral suppression may mitigate the elevated risk of cervical cancer for women living with HIV, and we encourage further study on this relationship in high HIV burden settings.
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Terasawa T, Hosono S, Sasaki S, Hoshi K, Hamashima Y, Katayama T, Hamashima C. Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis. Sci Rep 2022; 12:94. [PMID: 34997127 PMCID: PMC8741996 DOI: 10.1038/s41598-021-04201-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/17/2021] [Indexed: 02/01/2023] Open
Abstract
To compare all available accuracy data on screening strategies for identifying cervical intraepithelial neoplasia grade ≥ 2 in healthy asymptomatic women, we performed a systematic review and network meta-analysis. MEDLINE and EMBASE were searched up to October 2020 for paired-design studies of cytology and testing for high-risk genotypes of human papillomavirus (hrHPV). The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, random-effects network meta-analysis of test accuracy, and GRADE rating. Twenty-seven prospective studies (185,269 subjects) were included. The combination of cytology (atypical squamous cells of undetermined significance or higher grades) and hrHPV testing (excepting genotyping for HPV 16 or 18 [HPV16/18]) with the either-positive criterion (OR rule) was the most sensitive/least specific, whereas the same combination with the both-positive criterion (AND rule) was the most specific/least sensitive. Compared with standalone cytology, non-HPV16/18 hrHPV assays were more sensitive/less specific. Two algorithms proposed for primary cytological testing or primary hrHPV testing were ranked in the middle as more sensitive/less specific than standalone cytology and the AND rule combinations but more specific/less sensitive than standalone hrHPV testing and the OR rule combination. Further research is needed to assess these results in population-relevant outcomes at the program level.
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Affiliation(s)
- Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
| | - Satoyo Hosono
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tokyo, Japan
| | - Seiju Sasaki
- Center for Preventive Medicine, St. Luke's International Hospital Affiliated Clinic, Tokyo, Japan
| | - Keika Hoshi
- Center for Public Health Informatics, National Institute of Public Health, Wako, Japan
| | - Yuri Hamashima
- Department of Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Takafumi Katayama
- Department of Statistics and Computer Science, College of Nursing Art and Science, University of Hyogo, Hyogo, Japan
| | - Chisato Hamashima
- Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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18
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Tao JM, Wei W, Ma XY, Huo YX, Hu MD, Li XF, Chen X. Diagnostic accuracy of anthropometric indices for discriminating elevated blood pressure in pediatric population: a systematic review and a meta-analysis. BMC Pediatr 2022; 22:19. [PMID: 34983442 PMCID: PMC8725266 DOI: 10.1186/s12887-021-03062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is more likely to increase the chance of many adult health problems. Numerous studies have shown obese children to be more prone to elevated blood pressure (BP) and hypertension. It is important to identify an obesity anthropometric index with good discriminatory power for them in pediatric population. METHODS MEDLINE/PubMed, Web of Science, and Cochrane databases were retrieved comprehensively for eligible studies on childhood obesity and hypertension/elevated BP through June 2021. The systematic review and meta-analysis of studies used receiver operating characteristics (ROC) curves for evaluating the discriminatory power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in distinguishing children with elevated BP and hypertension. RESULTS 21 cross-sectional studies involving 177,943 children and 3-19 years of age were included in our study. Meta-analysis showed that the pooled area under the reporting receiver-operating characteristic curves (AUC) and 95% confidence intervals (CIs) for BMI, WC, and WHtR to detect hypertension of boys were 0.68 (0.64, 0.72), 0.69 (0.64, 0.74), 0.67 (0.63, 0.71), for elevated BP, the pooled AUCs and 95% CIs were 0.67 (0.61, 0.73), 0.65 (0.58, 0.73), 0.65 (0.61, 0.71). The pooled AUCs and 95% CIs for BMI, WC and WHtR of predicting hypertension were 0.70 (0.66, 0.75), 0.69 (0.64, 0.75), 0.67 (0.63, 0.72) in girls, the pooled AUCs and 95% CIs of predicting elevated BP were 0.63 (0.61, 0.65), 0.62 (0.60, 0.65), 0.62 (0.60, 0.64) respectively. There was no anthropometric index was statistically superior in identifying hypertension and elevated BP, however, the accuracy of BMI predicting hypertension was significantly higher than elevated BP in girls (P < 0.05). The subgroup analysis for the comparison of BMI, WC and WHtR was performed, no significant difference in predicting hypertension and elevated BP in pediatric population. CONCLUSIONS This systematic review showed that no anthropometric index was superior in identifying hypertension and elevated BP in pediatric population. While compared with predicting elevated BP, all the indicators showed superiority in predicting hypertension in children, the difference was especially obvious in girls. A better anthropometric index should be explored to predict children's early blood pressure abnormalities.
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Affiliation(s)
- Jun-Min Tao
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Wei Wei
- Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital, Dalian Medical University, Dalian, 116033, China
| | - Xiao-Yang Ma
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Ying-Xiang Huo
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Meng-Die Hu
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Xiao-Feng Li
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Xin Chen
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China.
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Allanson ER, Phoolcharoen N, Salcedo MP, Fellman B, Schmeler KM. Accuracy of Smartphone Images of the Cervix After Acetic Acid Application for Diagnosing Cervical Intraepithelial Neoplasia Grade 2 or Greater in Women With Positive Cervical Screening: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2021; 7:1711-1721. [PMID: 34936374 PMCID: PMC8710337 DOI: 10.1200/go.21.00168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Smartphones are used in cervical screening for visual inspection after acetic acid or Lugol's iodine (VIA/VILI) application to capture and share images to improve the sensitivity and interobserver variability of VIA/VILI. We undertook a systematic review and meta-analysis assessing the diagnostic accuracy of smartphone images of the cervix at the time of VIA/VILI (termed S-VIA) in the detection of precancerous lesions in women undergoing cervical screening. METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies from January 1, 2010, to June 30, 2020, were assessed. MEDLINE/PubMed, Embase, CINAHL, Cochrane, and LILACS were searched. Cohort and cross-sectional studies were considered. S-VIA was compared with the reference standard of histopathology. We excluded studies where additional technology was added to the smartphone including artificial intelligence, enhanced visual assessment, and other algorithms to automatically diagnose precancerous lesions. The primary outcome was the accuracy of S-VIA for the diagnosis of cervical intraepithelial neoplasia grade 2 or greater (CIN 2+). Data were extracted, and we plotted the sensitivity, specificity, negative predictive value, and positive predictive value of S-VIA using forest plots. This study was prospectively registered with The International Prospective Register of Systematic Reviews:CRD42020204024. RESULTS Six thousand three studies were screened, 71 full texts assessed, and eight studies met criteria for inclusion, with six included in the final meta-analysis. The sensitivity of S-VIA for the diagnosis of CIN 2+ was 74.56% (95% CI, 70.16 to 78.95; I2 61.30%), specificity was 61.75% (95% CI, 56.35 to 67.15; I2 95.00%), negative predictive value was 93.71% (95% CI, 92.81 to 94.61; I2 0%), and positive predictive value was 26.97% (95% CI, 24.13 to 29.81; I2 61.3%). CONCLUSION Our results suggest that S-VIA has accuracy in the detection of CIN 2+ and may provide additional support to health care providers delivering care in low-resource settings.
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Affiliation(s)
- Emma R Allanson
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Mila P Salcedo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Obstetrics and Gynecology Department, Federal University of Health Sciences of Porto Alegre/Santa Casa Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Champin D, Ramírez-Soto MC, Vargas-Herrera J. Use of Smartphones for the Detection of Uterine Cervical Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13236047. [PMID: 34885157 PMCID: PMC8656777 DOI: 10.3390/cancers13236047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Little is known regarding the usefulness of the smartphone in the detection of uterine cervical lesions or uterine cervical cancer. Therefore, we evaluated the usefulness of the smartphone in the detection of uterine cervical lesions and measured its diagnostic accuracy by comparing its findings with histological findings. We conducted a systematic review to identify studies on the usefulness of the smartphone in detecting uterine cervical lesions indexed in SCOPUS, MEDLINE/PubMed, Cochrane, OVID, Web of Science, and SciELO until November 2020. The risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A total of 16 studies that evaluated the usefulness of the smartphone in the detection of uterine cervical lesions based on the images clicked after visual inspection with acetic acid (VIA), Lugol's iodine (VILI), or VIA/VILI combination were included in the study. Five studies estimated diagnostic sensitivity and specificity, nine described diagnostic concordance, and five described the usefulness of mobile technology. Among the five first studies, the sensitivity ranged between 66.7% (95% confidence interval (CI); 30.0-90.3%) and 94.1% (95% CI; 81.6-98.3%), and the specificity ranged between 24.0% (95% CI; 9.0-45.0%) and 85.7% (95% CI; 76.7-91.6%). The risk of bias was low (20%), and the applicability was high. In conclusion, the smartphone images clicked after a VIA were found to be more sensitive than those following the VILI method or the VIA/VILI combination and naked-eye techniques in detecting uterine cervical lesions. Thus, a smartphone may be useful in the detection of uterine cervical lesions; however, its sensitivity and specificity are still limited.
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Affiliation(s)
- Denisse Champin
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Peru, Lima 15046, Peru;
| | - Max Carlos Ramírez-Soto
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Peru, Lima 15046, Peru;
- Correspondence: or
| | - Javier Vargas-Herrera
- Departamento de Telemedicina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima 15001, Peru;
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21
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Li YT, Lee WL, Wang PH. Is it possible to increase detection rate of esophageal precancer or cancer lesions in the high-risk population? J Chin Med Assoc 2021; 84:1075-1077. [PMID: 34654018 DOI: 10.1097/jcma.0000000000000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan, ROC
| | - Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
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22
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Awolude OA, Oyerinde SO, Ayeni AO, Adewole IF. Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria. Pan Afr Med J 2021; 40:48. [PMID: 34795828 PMCID: PMC8571938 DOI: 10.11604/pamj.2021.40.48.28628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept. Methods in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. Results same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. Conclusion triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.
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Affiliation(s)
- Olutosin Alaba Awolude
- Obstetrics and Gynaecology Department, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | | | | | - Isaac Folorunso Adewole
- Obstetrics and Gynaecology Department, College of Medicine, University of Ibadan, Ibadan, Nigeria
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23
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Debrah O, Agyemang-Yeboah F, Donkoh ET, Asmah RH. Prevalence of vaccine and non-vaccine human papillomavirus types among women in Accra and Kumasi, Ghana: a cross-sectional study. BMC Womens Health 2021; 21:372. [PMID: 34702246 PMCID: PMC8549380 DOI: 10.1186/s12905-021-01511-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) infection is the main etiological factor for pre-invasive and invasive cervical cancer. HPV type-specific vaccination is being widely recommended to control the burden of disease, but the genotype-specific distribution of HPV may vary in different countries. The aim of the study was to determine the prevalence and distribution of HPV genotypes among women attending reproductive health services in Ghana, their associated risk factors, and to assess the potential coverage of identified HPV genotypes by three licensed vaccines among these women. METHOD Women presenting for reproductive health services in two regional hospitals in Accra and Kumasi from October 2014 to March 2015 were conveniently recruited into the study (n = 317). HPV-DNA detection and genotype identification were carried out by a nested multiplex PCR assay that combines degenerate E6/E7 consensus primers and type-specific primers for the detection and typing of eighteen HPV genotypes. Cytology was performed to screen women for cervical cancer lesions. Risk factors for HPV infection were analyzed by logistic regression. Statistical significance was accepted for p < 0.05. RESULTS The age of study participants ranged from 21 to 76 years. Among women positive for HPV, 35.0% were infected with high-risk HPV, 14.5% with probable high-risk HPV, and 17.0% with low-risk HPV. The prevalence of HPV 16/18 was 8.2%, HPV 6/11/16/18 was 9.1% and HPV 6/11/16/18/31/33/45/52/58 was 28.4%. The most prevalent among HR-HPV were types 52 (18.3%) and 58 (8.8%). HPV positivity may be associated with educational background (p < 0.001), age at first pregnancy (p = 0.028), and age at coitarche (p = 0.016). CONCLUSIONS Our study revealed a high prevalence of HR-HPV infection among women. The high prevalence of HR HPV indicates that multivalent vaccines will be useful for controlling HPV burden in general population contexts. The distribution of HPVs in this population suggests that of the three currently available vaccines the nonavalent vaccine, which protects against seven HPV types in addition to HPV 16 and 18, has the highest coverage of HPV infections among Ghanaian women. Healthcare officials planning to reduce the transmission of HPV and cervical cancer must consider the coverage of the nonavalent vaccine as an advantage.
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Affiliation(s)
- Oksana Debrah
- Institutional Care Division, Ghana Health Service Headquarters, Stadium Post Office, Post Office Box SD 329, Accra, Ghana. .,Department of Science Laboratory Technology, Accra Technical University, Accra, Ghana.
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Timmy Donkoh
- Department of Basic and Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
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24
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Gomes MLDS, Vieira NFC, Sousa DMDN, Moura NDS, Rodrigues IR, Rodrigues DP, Silva BGS, Oriá MOB. Health outcomes in women attending with clinical guideline PROGYNE to a primary care center for cervical cancer prevention. J Obstet Gynaecol Res 2021; 47:4371-4380. [PMID: 34505333 DOI: 10.1111/jog.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 12/24/2022]
Abstract
AIM The objective of the current study was to analyze the health outcomes of women attending with a clinical guideline to consultations for cervical cancer (CC) prevention in a primary care center. METHODS A cross-sectional design was used, and data were collected from March to July 2016 with a sample of 87 women in Fortaleza, Brazil. RESULTS The following correlations were found: previous history of sexually transmitted infection (p = 0.025), women who used oral contraceptives (p = 0.035), and undergo the Papanicolaou test annually; having black skin color (p = 0.031) and attending to the first gynecological consultation; being single (p = 0.031), family history of cancer (p < 0.001), and undergoing the first Papanicolaou test within the first 3 years of sexual activity; age up to 30 years and positive colposcopy (p = 0.027); and being single and positive colposcopy (p = 0.021). CC was characterized by the presence of intraepithelial lesion detected on colposcopy (gold standard). Receiver operating characteristic curves were used to evaluate the diagnostic accuracy of visual inspection with Lugol's iodine, digital cervicography, and Papanicolaou test. The area under the curve values were as follows: digital cervicography: 0.558, p = 0.509; Lugol's iodine: 0.491, p = 0.919; and Papanicolaou test: 0.697, p = 0.024. CONCLUSION Colposcopy in primary care provided a faster diagnosis of pre-cancerous lesions. Understanding the health outcomes of women who underwent consultations for CC prevention, as well as the screening and diagnosis methods used, is essential to the service and national health system of the less developed countries.
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25
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Uzoaru F, Nwaozuru U, Ong JJ, Obi F, Obiezu-Umeh C, Tucker JD, Shato T, Mason SL, Carter V, Manu S, BeLue R, Ezechi O, Iwelunmor J. Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review. Implement Sci Commun 2021; 2:73. [PMID: 34225820 PMCID: PMC8259076 DOI: 10.1186/s43058-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-based interventions (CBIs) are interventions aimed at improving the well-being of people in a community. CBIs for HIV testing seek to increase the availability of testing services to populations that have been identified as at high risk by reaching them in homes, schools, or community centers. However, evidence for a detailed cost analysis of these community-based interventions in sub-Saharan Africa (SSA) is limited. We conducted a systematic review of the cost analysis of HIV testing interventions in SSA. METHODS Keyword search was conducted on SCOPUS, CINAHL, MEDLINE, PsycINFO, Web of Science, and Global Health databases. Three categories of key terms used were cost (implementation cost OR cost-effectiveness OR cost analysis OR cost-benefit OR marginal cost), intervention (HIV testing), and region (sub-Saharan Africa OR sub-Saharan Africa OR SSA). CBI studies were included if they primarily focused on HIV testing, was implemented in SSA, and used micro-costing or ingredients approach. RESULTS We identified 1533 citations. After screening, ten studies were included in the review: five from East Africa and five from Southern Africa. Two studies conducted cost-effectiveness analysis, and one study was a cost-utility analysis. The remainder seven studies were cost analyses. Four intervention types were identified: HIV self-testing (HIVST), home-based, mobile, and Provider Initiated Testing and Counseling. Commonly costed resources included personnel (n = 9), materials and equipment (n = 6), and training (n = 5). Cost outcomes reported included total intervention cost (n = 9), cost per HIV test (n = 9), cost per diagnosis (n = 5), and cost per linkage to care (n = 3). Overall, interventions were implemented at a higher cost than controls, with the largest cost difference with HIVST compared to facility-based testing. CONCLUSION To better inform policy, there is an urgent need to evaluate the costs associated with implementing CBIs in SSA. It is important for cost reports to be detailed, uniform, and informed by economic evaluation guidelines. This approach minimizes biases that may lead decision-makers to underestimate the resources required to scale up, sustain, or reproduce successful interventions in other settings. In an evolving field of implementation research, this review contributes to current resources on implementation cost studies.
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Affiliation(s)
- Florida Uzoaru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA.
| | - Ucheoma Nwaozuru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Jason J Ong
- Department of Clinical Research and Development, London School of Hygiene and Tropical Medicine, United Kingdom Central Clinical School, Monash University, Melbourne, Australia
| | - Felix Obi
- Health Policy Research Group, University of Nigeria, Nsukka, Nigeria
| | - Chisom Obiezu-Umeh
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thembekile Shato
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Stacey L Mason
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Victoria Carter
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Sunita Manu
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Rhonda BeLue
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
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Shin MB, Liu G, Mugo N, Garcia PJ, Rao DW, Bayer CJ, Eckert LO, Pinder LF, Wasserheit JN, Barnabas RV. A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities. Front Public Health 2021; 9:670032. [PMID: 34277540 PMCID: PMC8281011 DOI: 10.3389/fpubh.2021.670032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
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Affiliation(s)
- Michelle B. Shin
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Gui Liu
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patricia J. Garcia
- Department of Global Health, University of Washington, Seattle, WA, United States
- School of Public Health, Cayetano Heredia University, Lima, Peru
| | - Darcy W. Rao
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Cara J. Bayer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Linda O. Eckert
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Leeya F. Pinder
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Judith N. Wasserheit
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Namale G, Mayanja Y, Kamacooko O, Bagiire D, Ssali A, Seeley J, Newton R, Kamali A. Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Infect Agent Cancer 2021; 16:31. [PMID: 33975633 PMCID: PMC8114699 DOI: 10.1186/s13027-021-00373-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/01/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although cervical cancer is preventable, most women in sub-Saharan Africa (SSA) do not receive routine screening and few treatment options exist. Female Sex Workers (FSWs) are among the Ugandan female population at highest risk of acquiring sexually transmitted infections (STIs) including HIV and human papilloma viruses (HPV), the cause of cervical cancer. We report one-year experiences of visual inspection with acetic acid (VIA) positivity among FSWs in the early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. METHODS Between June 2014 and July 2015, we enrolled FSWs into a cross-sectional study at a research clinic. The women were screened using the VIA method (application of 3-5 % acetic acid to the cervix). All VIA positive women were referred to a tertiary hospital for colposcopy, biopsy, and immediate treatment (if indicated) at the same visit according to national guidelines. Data on socio-demographic, sexual behaviour, sexual reproductive health and clinical characteristics were collected. We used logistic regression to identify factors associated with VIA positivity. RESULTS Of 842 women assessed for eligibility, 719 (85 %) of median age 30 (IQR 26, 35) were screened, and 40 (6 %) women were VIA positive. Of the 24 histology specimens analysed, 6 showed inflammation, only 1 showed cervical intraepithelial neoplasia (CIN) 1, 13 women showed CIN2/3, while 4 women already had invasive cervical cancer. The overall prevalence of HIV was 43 %, of whom only 35 % were receiving ART. In the age-adjusted analysis, VIA positivity was more likely among women who reported having > 100 life-time partners (aOR = 3.34, 95 %CI: 1.38-8.12), and HIV positive women (aOR = 4.55; 95 %CI: 2.12-9.84). CONCLUSIONS We found a relatively low proportion of VIA positivity in this population. The experience from our program implies that the VIA results are poorly reproducible even among a category of trained professional health workers. VIA positivity was more likely among women with a high number of sexual partners and HIV infection. Interventions for improving cervical cancer screening should be recommended as part of HIV care for FSWs to reduce the disease burden in this population.
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Affiliation(s)
- Gertrude Namale
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.
| | - Yunia Mayanja
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Onesmus Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Daniel Bagiire
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Agnes Ssali
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,University of York, York, United Kingdom
| | - Anatoli Kamali
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
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Devine A, Vahanian A, Sawadogo B, Zan S, Bocoum FY, Kelly H, Gilham C, Nagot N, Ong JJ, Legood R, Meda N, Miners A, Mayaud P. Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study. PLoS One 2021; 16:e0248832. [PMID: 33765011 PMCID: PMC7993811 DOI: 10.1371/journal.pone.0248832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. METHODS The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol's iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). RESULTS The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31-41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0. CONCLUSION Depending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases.
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Affiliation(s)
- Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Alice Vahanian
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bernard Sawadogo
- Centre de Recherche Internationale pour la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Souleymane Zan
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Fadima Yaya Bocoum
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilham
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicolas Nagot
- Pathogenesis and control of chronic infections, INSERM, Etablissement Francais du Sang, University of Montpellier, Montpellier, France
| | - Jason J. Ong
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosa Legood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicolas Meda
- Centre de Recherche Internationale pour la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Alec Miners
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philippe Mayaud
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ba DM, Ssentongo P, Musa J, Agbese E, Diakite B, Traore CB, Wang S, Maiga M. Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study. Cancer Epidemiol 2021; 72:101930. [PMID: 33756434 DOI: 10.1016/j.canep.2021.101930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, with an estimate of 570,000 new cases and about 311,000 deaths annually. Low-resource countries, including those in sub-Saharan Africa, have the highest-burden with an estimate of 84 % of all cervical cancers. This study examines the prevalence and socio-demographic-economic factors associated with cervical cancer screening in sub-Saharan Africa. METHODS A weighted population-based cross-sectional study using Demographic and Health Surveys data. We used available data on cervical cancer screening between 2011 and 2018 from the Demographic and Health Surveys for five sub-Saharan African countries (Benin, Ivory Coast, Kenya, Namibia, and Zimbabwe). The study population included women of childbearing age, 21-49 years (n = 28,976). We fit a multivariable Poisson regression model to identify independent factors associated with cervical cancer screening. RESULTS The overall weighted prevalence of cervical cancer screening was 19.0 % (95 % CI: 18.5 %-19.5 %) ranging from 0.7 % in Benin to 45.9 % in Namibia. Independent determinants of cervical cancer screening were: older age (40-49 years) adjusted prevalence ratio (aPR) = 1.77 (95 % CI: 1.64, 1.90) compared with younger age (21-29 years), secondary/higher education (aPR = 1.51, 95 CI: 1.28-1.79) compared with no education, health insurance (aPR = 1.53, 95 % CI: 1.44-1.61) compared with no insurance, and highest socioeconomic status (aPR = 1.39, 95 % CI: 1.26-1.52) compared with lowest. CONCLUSION The prevalence of cervical cancer screening is substantially low in sub-Saharan Africa countries and shows a high degree of between-country variation. Interventions aimed at increasing the uptake of cervical cancer screening in sub-Saharan Africa are critically needed.
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Affiliation(s)
- Djibril M Ba
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States.
| | - Paddy Ssentongo
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Nigeria; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
| | - Edeanya Agbese
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Brehima Diakite
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Cheick Bougadari Traore
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Steve Wang
- Mobile Imaging Innovations, Inc., Evanston, IL, United States
| | - Mamoudou Maiga
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali; Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
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30
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Taghavi K, Moono M, Mwanahamuntu M, Basu P, Limacher A, Tembo T, Kapesa H, Hamusonde K, Asangbeh S, Sznitman R, Low N, Manasyan A, Bohlius J. Screening test accuracy to improve detection of precancerous lesions of the cervix in women living with HIV: a study protocol. BMJ Open 2020; 10:e037955. [PMID: 33371015 PMCID: PMC7751198 DOI: 10.1136/bmjopen-2020-037955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The simplest and cheapest method for cervical cancer screening is visual inspection after application of acetic acid (VIA). However, this method has limitations for correctly identifying precancerous cervical lesions (sensitivity) and women free from these lesions (specificity). We will assess alternative screening methods that could improve sensitivity and specificity in women living with humanimmunodeficiency virus (WLHIV) in Southern Africa. METHODS AND ANALYSIS We will conduct a paired, prospective, screening test accuracy study among consecutive, eligible women aged 18-65 years receiving treatment for HIV/AIDS at Kanyama Hospital, Lusaka, Zambia. We will assess a portable magnification device (Gynocular, Gynius Plus AB, Sweden) based on the Swede score assessment of the cervix, test for high-risk subtypes of human papillomavirus (HR-HPV, GeneXpert, Cepheid, USA) and VIA. All study participants will receive all three tests and the reference standard at baseline and at six-month follow-up. The reference standard is histological assessment of two to four biopsies of the transformation zone. The primary histological endpoint is cervical intraepithelial neoplasia grade two and above (CIN2+). Women who are VIA-positive or have histologically confirmed CIN2+ lesions will be treated as per national guidelines. We plan to enrol 450 women. Primary outcome measures for test accuracy include sensitivity and specificity of each stand-alone test. In the secondary analyses, we will evaluate the combination of tests. Pre-planned additional studies include use of cervigrams to test an automated visual assessment tool using image pattern recognition, cost-analysis and associations with trichomoniasis. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Zambia Biomedical Research Ethics Committee, Zambian National Health Regulatory Authority, Zambia Medicines Regulatory Authority, Swissethics and the International Agency for Research on Cancer Ethics Committee. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03931083; Pre-results.
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Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Misinzo Moono
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mulindi Mwanahamuntu
- Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia
- Women and Newborn health, Levy Mwanawasa Medical University Hospital, Lusaka, Zambia
| | - Partha Basu
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | | | - Taniya Tembo
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Herbert Kapesa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Kalongo Hamusonde
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Serra Asangbeh
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Julia Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Rahatgaonkar V, Uchale P, Oka G. Comparative Study of Smart Scope® Visual Screening Test with Naked Eye Visual Screening and Pap Test. Asian Pac J Cancer Prev 2020; 21:3509-3515. [PMID: 33369446 PMCID: PMC8046303 DOI: 10.31557/apjcp.2020.21.12.3509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Cervical cancer is a major contributor to mortality and morbidity in women. Naked eye visual screening (NE test) and Pap test are commonly used for cervical cancer screening. Both tests have inherent limitations like low sensitivity (Pap test) and subjectivity in interpretation, lack of permanent record and overestimation (NE test). Here, Smart Scope® visual screening test (SS test) was compared with NE and Pap tests. Smart Scope® is a small, hand-held device that captures cervical images attached to a tablet to store data. Objective: To compare SS test with Pap and NE tests. Study Design: This prospective observational study was conducted at a tertiary care hospital in India, over 16 months. A total of 509 women in the age group of 25 to 65 years were included in the study as per the inclusion criteria. All the participants underwent Pap test, NE test and SS test. Screen positives on any one test were advised colposcopy and biopsy. Results: Out of 154 screen-positive women, 49 visited for follow-up colposcopy-guided biopsy. Nine incidental biopsies of screen-negative women were included in the data. Thus, statistical analysis was carried out based on 58 available histopathology results. Out of 58 biopsies, 8 were normal, 30 were benign lesions, 18 were precancerous and 2 were cancerous lesions. SS test was found to have a sensitivity and NPV of 100% each, PPV of 45.4% and a specificity of 36.8%. Sensitivity and specificity of NE test was 90% and 39.5% respectively, PPV was 43.9% and NPV was 88.2%. Pap smear had a sensitivity of 25% and specificity of 84.2%, PPV of 45.5% and NPV of 68.08%. Conclusion: SS test has great potential to be a primary screening test in low-resource settings due to its better sensitivity and NPV as compared to NE and Pap tests.
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Affiliation(s)
- Veena Rahatgaonkar
- Department of Gynecology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Pooja Uchale
- Department of Research, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Gauri Oka
- Department of Research, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
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Hemida RA, van Doorn HC, Massuger LF. Collaboration Benefits All. JCO Glob Oncol 2020; 6:56-58. [PMID: 32031439 PMCID: PMC6998033 DOI: 10.1200/jgo.19.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Reda A. Hemida
- Department of Obstetrics and Gynaecology, Mansoura University, Mansoura, Egypt
| | - Helena C. van Doorn
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Leon F.A.G. Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Asgary R, Staderini N, Mthethwa-Hleta S, Lopez Saavedra PA, Garcia Abrego L, Rusch B, Marie Luce T, Rusike Pasipamire L, Ndlangamandla M, Beideck E, Kerschberger B. Evaluating smartphone strategies for reliability, reproducibility, and quality of VIA for cervical cancer screening in the Shiselweni region of Eswatini: A cohort study. PLoS Med 2020; 17:e1003378. [PMID: 33211691 PMCID: PMC7676712 DOI: 10.1371/journal.pmed.1003378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/08/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cervical cancer is among the most common preventable cancers with the highest morbidity and mortality. The World Health Organization (WHO) recommends visual inspection of the cervix with acetic acid (VIA) as cervical cancer screening strategy in resource-poor settings. However, there are barriers to the sustainability of VIA programs including declining providers' VIA competence without mentorship and quality assurances and challenges of integration into primary healthcare. This study seeks to evaluate the impact of smartphone-based strategies in improving reliability, reproducibility, and quality of VIA in humanitarian settings. METHODS AND FINDINGS We implemented smartphone-based VIA that included standard VIA training, adapted refresher, and 6-month mHealth mentorship, sequentially, in the rural Shiselweni region of Eswatini. A remote expert reviewer provided diagnostic and management feedback on patients' cervical images, which were reviewed weekly by nurses. Program's outcomes, VIA image agreement rates, and Kappa statistic were compared before, during, and after training. From September 1, 2016 to December 31, 2018, 4,247 patients underwent screening; 247 were reviewed weekly by a VIA diagnostic expert. Of the 247, 128 (49%) were HIV-positive; mean age was 30.80 years (standard deviation [SD]: 7.74 years). Initial VIA positivity of 16% (436/2,637) after standard training gradually increased to 25.1% (293/1,168), dropped to an average of 9.7% (143/1,469) with a lowest of 7% (20/284) after refresher in 2017 (p = 0.001), increased again to an average of 9.6% (240/2,488) with a highest of 17% (17/100) before the start of mentorship, and dropped to an average of 8.3% (134/1,610) in 2018 with an average of 6.3% (37/591) after the start of mentorship (p = 0.019). Overall, 88% were eligible for and 68% received cryotherapy the same day: 10 cases were clinically suspicious for cancer; however, only 5 of those cases were confirmed using punch biopsy. Agreement rates with the expert reviewer for positive and negative cases were 100% (95% confidence interval [CI]: 79.4% to 100%) and 95.7% (95% CI: 92.2% to 97.9%), respectively, with negative predictive value (NPV) (100%), positive predictive value (PPV) (63.5%), and area under the curve of receiver operating characteristics (AUC ROC) (0.978). Kappa statistic was 0.74 (95% CI; 0.58 to 0.89); 0.64 and 0.79 at 3 and 6 months, respectively. In logistic regression, HIV and age were associated with VIA positivity (adjusted Odds Ratio [aOR]: 3.53, 95% CI: 1.10 to 11.29; p = 0.033 and aOR: 1.06, 95% CI: 1.0004 to 1.13; p = 0.048, respectively). We were unable to incorporate a control arm due to logistical constraints in routine humanitarian settings. CONCLUSIONS Our findings suggest that smartphone mentorship provided experiential learning to improve nurses' competencies and VIA reliability and reproducibility, reduced false positive, and introduced peer-to-peer education and quality control services. Local collaboration; extending services to remote populations; decreasing unnecessary burden to screened women, providers, and tertiary centers; and capacity building through low-tech high-yield screening are promising strategies for scale-up of VIA programs.
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Affiliation(s)
- Ramin Asgary
- Medecins Sans Frontieres, Geneva, Switzerland
- George Washington University, Washington, District of Columbia, United States of America
- Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | | | | | | | | | | | | | | | | | - Elena Beideck
- Weill Cornell Medical College, New York, New York, United States of America
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Magdi R, Elshafeey F, Elshebiny M, Kamel M, Abuelnaga Y, Ghonim M, Nabhan A. A systematic review and meta-analysis of diagnostic accuracy of HPV tests for the screening of cervical cancer in low-resource settings. Int J Gynaecol Obstet 2020; 152:12-18. [PMID: 33124048 DOI: 10.1002/ijgo.13455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/04/2020] [Accepted: 10/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND HPV tests for the screening of cervical cancer in low-income countries (LICs) might improve early detection and preventive efforts. OBJECTIVES To determine the diagnostic accuracy of HPV tests for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in LICs. SEARCH STRATEGY The Cochrane Library, MEDLINE, and CINAHL databases were searched on June 1, 2020. References of relevant studies were hand-searched. SELECTION CRITERIA Diagnostic test accuracy studies were included if women had an HPV test for cervical cancer screening, followed by verification with colposcopy and colposcopy-directed biopsy. The primary target was CIN2+. DATA COLLECTION AND ANALYSIS Two authors independently screened studies, extracted data, and assessed methodological quality. Bivariate diagnostic random-effects meta-analysis was used. MAIN RESULTS Eleven studies including 82 556 women were eligible, most of which were at low risk of bias. The pooled diagnostic odds ratio of hybrid capture test of samples collected from the cervix by healthcare providers for detecting CIN2+ and CIN3+ was 42.0 (95% confidence interval [CI] 20.7-76.3) and 97.1 (95% CI 35.3-215.0), respectively. CONCLUSIONS Evidence indicates that hybrid capture tests can be used for screening of cervical cancer in LICs. Future studies are warranted for self-sampling and for low-cost HPV tests.
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Affiliation(s)
- Rana Magdi
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | | | | | - Menna Kamel
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | | | - Mohanad Ghonim
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Ashraf Nabhan
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt.,Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
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35
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Lemp JM, De Neve JW, Bussmann H, Chen S, Manne-Goehler J, Theilmann M, Marcus ME, Ebert C, Probst C, Tsabedze-Sibanyoni L, Sturua L, Kibachio JM, Moghaddam SS, Martins JS, Houinato D, Houehanou C, Gurung MS, Gathecha G, Farzadfar F, Dryden-Peterson S, Davies JI, Atun R, Vollmer S, Bärnighausen T, Geldsetzer P. Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries. JAMA 2020; 324:1532-1542. [PMID: 33079153 PMCID: PMC7576410 DOI: 10.1001/jama.2020.16244] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
Importance The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. Objective To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Design, Setting, and Participants Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. Exposures World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Main Outcomes and Measures Self-report of having ever had a screening test for cervical cancer. Results Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. Conclusions and Relevance In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.
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Affiliation(s)
- Julia M. Lemp
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Hermann Bussmann
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michaela Theilmann
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Maja-Emilia Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Cara Ebert
- RWI–Leibniz Institute for Economic Research, Essen (Berlin office), Germany
| | - Charlotte Probst
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | | | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Joseph M. Kibachio
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
- Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Joao S. Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa’e, Rua Jacinto Candido, Dili, Timor-Leste
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Mongal S. Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Dryden-Peterson
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Justine I. Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, University of Witwatersrand School of Public Health, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population at the Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Global Health and Social Medicine at the Harvard Medical School, Boston, Massachusetts
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of Global Health and Population at the Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Africa Health Research Institute, Somkhele, South Africa
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
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Orang’o EO, Were E, Rode O, Muthoka K, Byczkowski M, Sartor H, Vanden Broeck D, Schmidt D, Reuschenbach M, von Knebel Doeberitz M, Bussmann H. Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16 INK4a/Ki-67 dual stain cytology in Western Kenya. Infect Agent Cancer 2020; 15:57. [PMID: 33024449 PMCID: PMC7531147 DOI: 10.1186/s13027-020-00323-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology. METHODS We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology. RESULTS In 701 of a total of 800 women aged 18-64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5-4.3), 1.9 (95%CI 0.89-4.4) and 3.4 (95%CI 1.07-10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2-38). CONCLUSIONS Primary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied.
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Affiliation(s)
- Elkanah Omenge Orang’o
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Edwin Were
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Oliver Rode
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kapten Muthoka
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Heike Sartor
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Davy Vanden Broeck
- International Centre of Reproductive Health, Ghent University, Ghent, Belgium
- National Reference Centre for HPV, Brussels, Belgium
- Laboratory of Molecular Pathology, AML, Antwerp, Belgium
| | - Dietmar Schmidt
- MVZ of Histology, Cytology and Molecular Diagnostics, Department of Cytopathology, Trier, Germany
| | - Miriam Reuschenbach
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Hermann Bussmann
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
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Mchome B, Swai P, Wu C, Katanga J, Kahesa C, Manongi R, Mwaiselage JD, Kjaer S, Rasch V, Linde DS. Comprehensive Cervical Cancer Prevention in Tanzania (CONCEPT) study: Cohort profile. BMJ Open 2020; 10:e038531. [PMID: 32948569 PMCID: PMC7511617 DOI: 10.1136/bmjopen-2020-038531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Cervical cancer is a major cause of death among women in Eastern Africa, and the distribution of human papillomavirus (HPV) according to HIV status is inadequately characterised in this region. In order to guide future cervical cancer preventive strategies that involve HPV testing, the Comprehensive Cervical Cancer Prevention in Tanzania (CONCEPT) study was established in 2015. The CONCEPT cohort aims to investigate the natural history of HPV and determine acquisition and persistence patterns of high-risk (HR) HPV among HIV-positive and HIV-negative women. Further, the influence of lifestyle and sexual/reproductive factors will be investigated. The main objective of this article is to describe how the CONCEPT cohort was established. PARTICIPANTS Women aged 25-60 years were enrolled from cervical cancer screening clinics in Dar-es-Salaam and Moshi, Tanzania. Data were collected at baseline, at 14 months (first follow-up) and at 28 months (second follow-up). Biological samples included two cervical swabs for careHPV DNA testing, cytology, Hybrid Capture 2, genotyping and blood samples for HIV. Visual inspection with acetic acid was performed, and sociodemographic, lifestyle and sexual/reproductive characteristics were collected through a standardised questionnaire. FINDINGS TO DATE 4043 women were included in the cohort from August 2015 to May 2017. At baseline, 696 (17.1%) women were HR HPV positive, and among these, 31.6% were HIV positive; 139 women (3.4%) had high-grade squamous intraepithelial lesions. 3074 women (81%) attended the first follow-up. The majority attended after receiving a phone call reminder (35%) or from home via self-samples (41%). At first follow-up, 438 (14.4%) were HR HPV positive and 30.4% of these were HIV positive. FUTURE PLANS A second follow-up is underway (17 December 2018-October 2020). We plan to integrate our data with a previous cross-sectional HPV study from Tanzania to increase the power of our findings. Researchers interested in collaborating are welcomed, either by extracting data or jointly requesting further investigation from the cohort.
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Affiliation(s)
- Bariki Mchome
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Patricia Swai
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Chunsen Wu
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - Johnson Katanga
- Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Crispin Kahesa
- Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Rachel Manongi
- Department of Public Health, Kilimanjaro Chrstian Medical College, Moshi, Tanzania
| | - Julius D Mwaiselage
- Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Susanne Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - Ditte Søndergaard Linde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
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Corrado G, Mazzara C, Certelli C, Nsubuga JB, Zanetto F, Schurfeld K, Dell'Antonio G, Orti CD, Savarese A, Andriani MT. Screening for cervical cancer in Africa: A proposal of a different combination of VIA test and cervical smear in Uganda. Int J Gynaecol Obstet 2020; 152:68-71. [PMID: 32812648 DOI: 10.1002/ijgo.13350] [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: 01/25/2020] [Revised: 05/29/2020] [Accepted: 08/17/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the efficacy of visual inspection with acetic acid (VIA) screening combined with a cervical smear in Uganda. METHODS Nine screening campaigns were held in Uganda between January 2011 and October 2019. In the last three campaigns, a new approach was used: the cervical smear was performed before the VIA test and, in case of a positive VIA test, the slide was sent for examination. The data collected were divided into two groups: the first six campaigns and the last three campaigns. RESULTS During the study period, 10 520 women were screened, of whom 911 had a positive VIA test. The VIA test showed 84.2% false positives. In the first group, the VIA test was positive in 516 women, of whom 93% were referred for further examinations. In the second group, the VIA test was positive in 395 women, but the cervical smear was positive in only 65 women. Thus, only 16.5% women were referred for further examinations. CONCLUSION Combining cervical smear, VIA test, and slide analysis in positive VIA tests may allow women who need treatment to be selected more effectively, while waiting for other more expensive solutions to become more affordable for this setting.
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Affiliation(s)
- Giacomo Corrado
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Di Roma, Roma, Italy
| | - Calogero Mazzara
- Department of Pediatrics, IPSI - Istituto Pediatrico della Svizzera Italiana, Lugano, Switzerland
| | - Camilla Certelli
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Di Roma, Roma, Italy
| | - John B Nsubuga
- Department of Obstetrics and Gynecology, St. Kizito Hospital, Matany, Uganda
| | - Francesca Zanetto
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, Erba, Italy
| | - Karin Schurfeld
- Department of Human Pathology and Oncology, Policlinico Le Scotte, Siena, Italy
| | | | | | - Antonella Savarese
- Department of Oncology, Regina Elena National Cancer Institute, Rome, Italy
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Mensah K, Assoumou N, Duchesne V, Pourette D, DeBeaudrap P, Dumont A. Acceptability of HPV screening among HIV-infected women attending an HIV-dedicated clinic in Abidjan, Côte d'Ivoire. BMC Womens Health 2020; 20:155. [PMID: 32723350 PMCID: PMC7385896 DOI: 10.1186/s12905-020-01021-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cervical cancer incidence is high among women living with HIV due to high-risk HPV persistence in the cervix. In low-income countries, cervical cancer screening is based on visual inspection with acetic acid. Implementing human papilloma virus (HPV) screening through self-sampling could increase women's participation and screening performance. Our study aims to assess the preintervention acceptability of HPV screening among HIV-infected women in Abidjan, Côte d'Ivoire. METHODS Applying the Health Belief Model theoretical framework, we collected qualitative data through in-depth interviews with 21 HIV-infected women treated in an HIV-dedicated clinic. Maximum variation sampling was used to achieve a diverse sample of women in terms of level of health literacy. Interviews were recorded and transcribed with the participants' consent. Data analysis was performed using NVivo 12. RESULTS Screening acceptability relies on cervical cancer representations among women. Barriers were the fear of diagnosis and the associated stigma disregard for HIV-associated health conditions, poor knowledge of screening and insufficient resources for treatment. Fees removal, higher levels of knowledge about cervical cancer and of the role of HIV status in cancer were found to facilitate screening. Healthcare providers are obstacle removers by their trusting relationship with women and help navigating through the healthcare system. Self-confidence in self-sampling is low. CONCLUSIONS Free access to cervical screening, communication strategies increasing cervical cancer knowledge and healthcare provider involvement will foster HPV screening. Knowledge gathered through this research is crucial for designing adequate HPV-based screening interventions for women living with HIV in this setting.
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Affiliation(s)
- Keitly Mensah
- Institut Recherche et Développement, Université de Paris, Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, 75006, Paris, France.
| | - Nelly Assoumou
- Programme PAC-CI, Site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Véronique Duchesne
- Institut Recherche et Développement, Université de Paris, Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, 75006, Paris, France
| | - Dolorès Pourette
- Institut Recherche et Développement, Université de Paris, Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, 75006, Paris, France
| | - Pierre DeBeaudrap
- Institut Recherche et Développement, Université de Paris, Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, 75006, Paris, France
| | - Alexandre Dumont
- Institut Recherche et Développement, Université de Paris, Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, 75006, Paris, France
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Fokom Domgue J, Futuh B, Ngalla C, Kakute P, Manjuh F, Manga S, Nulah K, Welty E, Schmeler K, Welty T. Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa. Int J Cancer 2019; 147:128-138. [PMID: 31633801 DOI: 10.1002/ijc.32746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Joel Fokom Domgue
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer Center Houston TX
- Department of Obstetrics and GynecologyFaculty of Medicine and Biomedical Sciences, University of Yaoundé Yaoundé Cameroon
| | - Beatrice Futuh
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Calvin Ngalla
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Peter Kakute
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Florence Manjuh
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Simon Manga
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer Center Houston TX
| | - Thomas Welty
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
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Abstract
Supplemental Digital Content is available in the text To determine the performance of molecular screening strategies for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in comparison with cytology screening in women living with HIV.
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Rahman R, Clark MD, Collins Z, Traore F, Dioukhane EM, Thiam H, Ndiaye Y, De Jesus EL, Danfakha N, Peters KE, Komarek T, Linn AM, Linn PE, Wallner KE, Charles M, Hasnain M, Peterson CE, Dykens JA. Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review. Glob Health Action 2019; 12:1587894. [PMID: 30938248 PMCID: PMC6450494 DOI: 10.1080/16549716.2019.1587894] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low- and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges. Objective: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque’s Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership’s approach to shaping Senegal’s regional cervical cancer screening policy. Methods: The systematic review search strategy comprised two complementary sub-searches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance. Results: Our findings identified specific demand-side (clients and community) and supply-side (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand- and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature. Conclusions: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.
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Affiliation(s)
- R Rahman
- a University of Toledo College of Medicine and Life Sciences , Toledo , OH , USA
| | - M D Clark
- b Library of the Health Sciences , University Library, University of Illinois at Chicago , Chicago , IL , USA.,c Department of Medical Education, College of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - Z Collins
- d Department of Family Medicine, Institute for Health Research and Policy , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - F Traore
- e Region medical de Kedougou , Bureau de la santé de la reproduction, prevention transmission mere enfant du VIH-SIDA , Kedougou , Senegal
| | | | - H Thiam
- g Region medical de Kedougou , Bureau régional de la formation, de la supervision et de la recherche , Kedougou , Senegal
| | - Y Ndiaye
- h Département de Recherche , Sénégal Ministère de la Santé et l'Action Sociale , Dakar , Sénégal
| | - E L De Jesus
- i School of Public Health (SPH) , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | | | - K E Peters
- k School of Public Health, Division of Community Health Sciences, Illinois Prevention Research Center, Institute for Health Research and Policy , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - T Komarek
- l Uniformed Services University , Bethesda , MD , USA
| | - A M Linn
- m School of Public Health, Center for Communications Programs , Johns Hopkins University , Baltimore , MD , USA
| | - P E Linn
- n Logistics Management Institute , Tysons , VA , USA
| | - K E Wallner
- o Elizabeth Glaser Pediatric AIDS Foundation , Washington , DC , USA
| | - M Charles
- p Department of Internal Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - M Hasnain
- q Department of Family Medicine , University of Illinois at Chicago College of Medicine , Chicago , IL , USA
| | - C E Peterson
- r School of Public Health, Division of Epidemiology & Biostatistics, UI Cancer Center , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - J A Dykens
- s Department of Family Medicine, Center for Global Health, Institute for Health Research and Policy, Cancer Center , University of Illinois at Chicago (UIC) , Chicago , IL , USA
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Asgary R, Cole H, Adongo P, Nwameme A, Maya E, Adu-Amankwah A, Barnett H, Adanu R. Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana: mHealth and cervical cancer screening. BMJ Open 2019; 9:e030528. [PMID: 31315879 PMCID: PMC6661590 DOI: 10.1136/bmjopen-2019-030528] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography. DESIGN In 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2). SETTING Community health centres (CHCs) in Accra, Ghana. RESULTS The 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective. CONCLUSIONS Our findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries.
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Affiliation(s)
- Ramin Asgary
- Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
- Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Helen Cole
- Environmental Science and Technology, Autonomous University of Barcelona Barcelona Catalunya Spain, Barcelona, Spain
| | - Philip Adongo
- Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Ada Nwameme
- Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Ernest Maya
- Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
- Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Amanda Adu-Amankwah
- Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Hannah Barnett
- Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Richard Adanu
- Dean, University of Ghana School of Public Health, Accra, Ghana
- Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
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Paluku JL, Carter TE, Lee M, Bartels SA. Massive single visit cervical pre-cancer and cancer screening in eastern Democratic Republic of Congo. BMC Womens Health 2019; 19:43. [PMID: 30832697 PMCID: PMC6399865 DOI: 10.1186/s12905-019-0737-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the Democratic Republic of Congo (DRC), practical and affordable strategies for cervical cancer screening are needed to detect and treat pre-cancerous and cancerous lesions in a timely fashion. This study presents the results of mass cervical cancer screenings in eastern DRC using a "screen and treat" approach. METHODS In two mass cervical cancer screening campaigns, patients underwent a combination of visual inspection of the cervix with acetic acid, visual inspection of the cervix with Lugol iodine solution, and colposcopy with or without loop electrosurgical excision procedure. Cervical biopsy samples were taken for histology analysis. Marital status, age, history of abnormal bleeding, and number of pregnancies were recorded for each patient and association analyses were performed. RESULTS Of the 644 women who received cervical pre-cancer and cancer screening, 48 had suspicious pre-cancer and cancer lesions that were biopsied (7.45%). On histology analysis cervical intraepithelial neoplasia (CIN) was identified in 15 (2.33%), squamous cell carcinoma (SCC) was identified in 6 (0.93%) and non-neoplastic cervicitis was identified in 11 (1.71%). Abnormal bleeding was significantly associated with CIN/SCC but no significant association was observed for prior pregnancy, patients' home region, or age. CONCLUSION Forty-eight women with suspicious pre-cancerous or cancerous lesions were successfully identified using the "screen and treat" approach in eastern DRC, suggesting that this approach is feasible for reducing cervical cancer morbidity and mortality. However, community awareness would be necessary, providers would have to be properly trained, referral and follow up mechanisms would have to be put in place, and equipment / supplies would have to be secured if the "screen and treat" approach is to be successful on a wider scale. There is ongoing need for HPV vaccination in DRC as a primary prevention strategy against cervical cancer.
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Affiliation(s)
| | - Tamar E Carter
- Bioinformatics and Genomics Department, University of North Carolina, Charlotte, USA
- Department of Biology, Baylor University, Waco, TX, USA
| | | | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
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Linde DS, Rasch V, Mwaiselage JD, Gammeltoft TM. Competing needs: a qualitative study of cervical cancer screening attendance among HPV-positive women in Tanzania. BMJ Open 2019; 9:e024011. [PMID: 30819704 PMCID: PMC6398757 DOI: 10.1136/bmjopen-2018-024011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to understand causes of attendance and non-attendance to a follow-up cervical cancer screening among human papillomavirus (HPV)-positive women. DESIGN Semistructured, individual interviews with HPV-positive women and cervical cancer screening nurses. The interview guide and initial data analysis were guided by existing health behaviour theories. However, as the theories limited the potential of the data material, a grounded theory framework guided the final data analysis. SETTING Interviews were conducted in Dar es Salaam, Tanzania, at Ocean Road Cancer Institute (ORCI) or in the homes of screening clients. PARTICIPANTS 15 interviews were conducted with women who had tested HPV-positive during a patient-initiated screening and been appointed for a follow-up screening 14 months later. Nine women had not attended the follow-up appointment, four had delayed attendance and two had attended on the scheduled date. Further, individual interviews were conducted with the two nurses working at ORCI's screening clinic. RESULTS Perceived benefits for attending a patient-initiated screening include treatment of gynaecological symptoms and prevention of disease. The key perceived benefit of a health provider-initiated follow-up screening is prevention, which is challenged by the circumstance that it is seen by women as having merely potential benefit and therefore can be postponed when competing needs are present. Perceived challenges for screening attendance include emotional costs, in the form of fear of the disease, fear of the gynaecological examination as well as direct and indirect economic costs, such as transportation costs, lost income and waiting time. CONCLUSION Cervical cancer screening is one among many tasks that women living in a low-income setting must attend to. Since health provider-initiated follow-up screening is seen as having only potential benefit, attendance can be postponed when competing needs exist. TRIAL REGISTRATION NUMBER NCT02509702.
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Affiliation(s)
- Ditte Søndergaard Linde
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julius D Mwaiselage
- Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Tine M Gammeltoft
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
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Ng’ang’a A, Nyangasi M, Nkonge NG, Gathitu E, Kibachio J, Gichangi P, Wamai RG, Kyobutungi C. Predictors of cervical cancer screening among Kenyan women: results of a nested case-control study in a nationally representative survey. BMC Public Health 2018; 18:1221. [PMID: 30400916 PMCID: PMC6219012 DOI: 10.1186/s12889-018-6054-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cervical cancer is a major public health concern in Kenya. It is the leading cause of cancer morbidity and mortality among women. Although screening is an effective prevention method, uptake is low among eligible women. Little is known about predictors of cervical cancer screening uptake. This study explored relationship between uptake of cervical cancer screening, socio-demographic, behavioral and biological risk factors. METHODS Nested case-control study within STEPS survey, a population-based cross-sectional household survey conducted between April and June 2015.Cases were women who had undergone cervical cancer screening and controls were unscreened women. Study participants were women eligible for cervical cancer screening (30-49 years). Variables included socio-demographic; behavioral risk factors such as physical activity, tobacco and alcohol use diet and biological factors like diabetes and hypertension. Outcome of interest was cervical cancer screening. Data analysis was done using STATA version 14. Logistic regression model was used to assess relationship between cervical cancer screening and socio-demographic, behavioral and biological risk factors. RESULTS Of 1180 women interviewed, 16.4% (n = 194) had been screened for cervical cancer. Of unscreened women (n = 986), 67.9% were aware of cervical cancer screening. Higher screening rates were observed in more educated women (25.2%), highest income quintile (29.6%) and living in urban areas (23%) than in women with no formal education (3.2%), poorest (3.6%) and living in rural areas (13.8%). Younger women (35-39) and those with low High-density lipoprotein (HDL) were less likely to be screened [OR = 0.56; 95% CI = (0.34, 0.93); p-value = 0.025] and [OR = 0.51; 95% CI = (0.29, 0.91); p = value 0.023] respectively. Self-employed women, those in the fourth wealth quintile, binge drinkers, high sugar consumption and insufficient physical activity were more likely to be screened [OR 2.55 (1.12, 5.81) p value 0.026], [OR 3.56 (1.37, 9.28) p value 0.009], [OR 5.94 (1.52, 23.15) p value 0.010], [OR 2.99 (1.51, 5.89) p value 0.002] and [OR 2.79 (1.37, 5.68) p value 0.005] respectively. CONCLUSION Uptake of cervical cancer screening is low despite high awareness. Strategies to improve cervical cancer screening in Kenya should be implemented with messages targeting persons with both risky and non-risky lifestyles especially younger women with no formal education living in rural areas.
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Affiliation(s)
- Anne Ng’ang’a
- NCD Division National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- NCD Division National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Nancy G Nkonge
- Division of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | - Eunice Gathitu
- NCD Division National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joseph Kibachio
- Division of Non Communicable Diseases, Ministry of Health, Nairobi, Kenya
- The Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Peter Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard G Wamai
- Department of Cultures, Societies and Global Studies, North Eastern University, Massachusetts, USA
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Kremer WW, Van Zummeren M, Novianti PW, Richter KL, Verlaat W, Snijders PJF, Heideman DAM, Steenbergen RDM, Dreyer G, Meijer CJLM. Detection of hypermethylated genes as markers for cervical screening in women living with HIV. J Int AIDS Soc 2018; 21:e25165. [PMID: 30101434 PMCID: PMC6088247 DOI: 10.1002/jia2.25165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/02/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION To evaluate the performance of hypermethylation analysis of ASCL1, LHX8 and ST6GALNAC5 in physician-taken cervical scrapes for detection of cervical cancer and cervical intraepithelial neoplasia (CIN) grade 3 in women living with HIV (WLHIV) in South Africa. METHODS Samples from a prospective observational cohort study were used for these analyses. Two cohorts were included: a cohort of WLHIV who were invited for cervical screening (n = 321) and a gynaecologic outpatient cohort of women referred for evaluation of abnormal cytology or biopsy proven cervical cancer (n = 108, 60% HIV seropositive). Cervical scrapes collected from all subjects were analysed for hypermethylation of ASCL1, LHX8 and ST6GALNAC5 by multiplex quantitative methylation specific PCR (qMSP). Histology endpoints were available for all study subjects. RESULTS Hypermethylation levels of ASCL1, LHX8 and ST6GALNAC5 increased with severity of cervical disease. The performance for detection of CIN3 or worse (CIN3+ ) as assessed by the area under the receiver operating characteristic (ROC) curves (AUC) was good for ASCL1 and LHX8 (AUC 0.79 and 0.81 respectively), and moderate for ST6GALNAC5 (AUC 0.71). At a threshold corresponding to 75% specificity, CIN3+ sensitivity was 72.1% for ASCL1 and 73.8% for LHX8 and all samples from women with cervical cancer scored positive for these two markers. CONCLUSIONS Hypermethylation analysis of ASCL1 or LHX8 in cervical scrape material of WLHIV detects all cervical carcinomas with an acceptable sensitivity and good specificity for CIN3+ , warranting further exploration of these methylation markers as a stand-alone test for cervical screening in low-resource settings.
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Affiliation(s)
- Wieke W Kremer
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Marjolein Van Zummeren
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Putri W Novianti
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamThe Netherlands
| | - Karin L Richter
- Department of Medical VirologyUniversity of Pretoria and National Health Laboratory ServicesPretoriaSouth Africa
| | - Wina Verlaat
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Peter JF Snijders
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Daniëlle AM Heideman
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Renske DM Steenbergen
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Greta Dreyer
- Department of Obstetrics and GynaecologyUniversity of PretoriaPretoriaSouth Africa
| | - Chris JLM Meijer
- Department of PathologyCancer Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
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PERFORMANCE OF SMARTPHONE-BASED DIGITAL IMAGES FOR CERVICAL CANCER SCREENING IN A LOW-RESOURCE CONTEXT. Int J Technol Assess Health Care 2018; 34:337-342. [PMID: 29921339 DOI: 10.1017/s0266462318000260] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Colposcopes are expensive, heavy, and need specialized technical service, which may outreach the capacity of low-resource settings. Our aim was to assess the performance of smartphone-based digital images for the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS Human papillomavirus (HPV)-positive women recruited through a cervical cancer screening campaign had VIA/VILI assessment (visual inspection after application of acetic acid/lugol's iodine). Cervical digital images were captured with a smartphone camera, randomly coded with no prior selection and distributed on an online database (Google Forms) for evaluation. Healthcare providers were invited to evaluate the images and identify CIN2+. The gold standard was the histopathological diagnosis. The sensitivity and specificity for the detection of CIN2+ was assessed for each reader and reported with the 95 percent confidence interval (Clopper-Pearson method). RESULTS One hundred twenty-five consecutive HPV-positive women were included, with 19 CIN2+ (15.2 percent). Forty-five gynecologists completed the assessment, one-third were considered as experts (>50 colposcopies) and two-thirds as novices (<50 colposcopies). The sensitivity and specificity for CIN 2+ detection was 71.3 percent (67.0-75.7 percent) and 62.4 percent (57.5-67.4 percent), respectively. The performance of novices and experts was similar. The readers assessed 73.1 percent of images as acceptable for diagnostic. CONCLUSION Smartphone-based digital images, with its high portability, have a great potential for the diagnosis of CIN2+ in low-resource context.
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Taghavi K, Banerjee D, Mandal R, Kallner HK, Thorsell M, Friis T, Kocoska-Maras L, Strander B, Singer A, Wikström E. Colposcopy telemedicine: live versus static swede score and accuracy in detecting CIN2+, a cross-sectional pilot study. BMC WOMENS HEALTH 2018; 18:89. [PMID: 29890991 PMCID: PMC6040214 DOI: 10.1186/s12905-018-0569-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/16/2018] [Indexed: 12/04/2022]
Abstract
Background This cross-sectional pilot study evaluates diagnostic accuracy of live colposcopy versus static image Swede-score evaluation for detecting significant precancerous cervical lesions greater than, or equal to grade 2 severity (CIN2+). Methods VIA or HrHPV positive women were examined using a mobile colposcope, in a rural clinic in Kolkata, India. Live versus static Swede-score colposcopy assessments were made independently. All assessments were by gynecologists, junior or expert. Static image assessors were blinded to live scoring, patient information and final histopathology result. Primary outcome was the ability to detect CIN2+ lesions verified by directed biopsies. Diagnostic accuracy was calculated for live versus static Swede-score in detecting CIN2+ lesions, as well as for interclass correlation. Results 495 images from 94 VIA positive women were evaluated in this study. Thirteen women (13.9%) had CIN2+ on biopsy. No significant difference was found in the detection of CIN2+ lesions between live and static assessors (area under curve = 0.69 versus 0.71, p = 0.63). A Swede-score of 4+, had a sensitivity of 76.9% (95% CI 46.2–95.0%) and 84.6% (95% CI 54.6–98.1%), for live- and static-image assessment respectively. The corresponding positive predictive values were found to be 90.9% (95% CI 75.7–98.1%) and 92.6% (95% CI 75.7–99.1%). The interclass correlation was good (kappa statistic = 0.60) for the senior static assessors. Conclusions Swede-score evaluation of static colposcopy images was found to reliably detect CIN2+ lesions in this study. Larger studies are needed to further develop the colposcopy telemedicine concept which may offer reliable guidance in management where direct specialist input is not available. Trial registration Ethical approval of the study was obtained by the Chittaranjan National Cancer Institute (CNCI) Human Research Ethics Committee (4.311/27/2014). The trial was retrospectively registered in the Clinical Trails Registry of India CTRI/2018/03/012470. Electronic supplementary material The online version of this article (10.1186/s12905-018-0569-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Dipanwita Banerjee
- Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Ranajit Mandal
- Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Malin Thorsell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Therese Friis
- Akademiska sjukhuset, Uppsala University Hospital, Uppsala, Sweden
| | | | - Björn Strander
- Department of Clinical Sciences, Sahlgrenska academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Elisabeth Wikström
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Negeri ZF, Shaikh M, Beyene J. Bivariate random-effects meta-analysis models for diagnostic test accuracy studies using arcsine-based transformations. Biom J 2018; 60:827-844. [PMID: 29748967 DOI: 10.1002/bimj.201700101] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 01/30/2018] [Accepted: 02/26/2018] [Indexed: 11/11/2022]
Abstract
Diagnostic or screening tests are widely used in medical fields to classify patients according to their disease status. Several statistical models for meta-analysis of diagnostic test accuracy studies have been developed to synthesize test sensitivity and specificity of a diagnostic test of interest. Because of the correlation between test sensitivity and specificity, modeling the two measures using a bivariate model is recommended. In this paper, we extend the current standard bivariate linear mixed model (LMM) by proposing two variance-stabilizing transformations: the arcsine square root and the Freeman-Tukey double arcsine transformation. We compared the performance of the proposed methods with the standard method through simulations using several performance measures. The simulation results showed that our proposed methods performed better than the standard LMM in terms of bias, root mean square error, and coverage probability in most of the scenarios, even when data were generated assuming the standard LMM. We also illustrated the methods using two real data sets.
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Affiliation(s)
- Zelalem F Negeri
- Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada, L8S 4K1
| | - Mateen Shaikh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada, L8S 4K1
| | - Joseph Beyene
- Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada, L8S 4K1.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada, L8S 4K1
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