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Gosse RA, Msengi EA, Chona EZ, Ambikile JS. Experiences of caring for women with cervical cancer: A qualitative study among male partners in Dar es Salaam, Tanzania. Health Expect 2024; 27:e14038. [PMID: 38561909 PMCID: PMC10985225 DOI: 10.1111/hex.14038] [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: 09/30/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND More than three-fourths of cervical cancer cases occur in low- and middle-income countries, with sub-Saharan Africa (SSA) accounting for approximately 25% of global mortality. The significant rise in the prevalence of cervical cancer in SSA amplifies the burden on caregivers, contributing to elevated rates of mental illness, particularly among spouses who provide care. Men who assume the role of caregivers for their partners with cervical cancer encounter unique challenges and substantial adjustments across multiple facets of life, impacting both their own quality of life and that of their partners. Despite this, there is a notable lack of extensive research on the experiences of male partners in caregiving roles, particularly within SSA countries like Tanzania. Therefore, this study aimed to explore the experiences of male partners providing care for women with cervical cancer in Dar es Salaam, Tanzania. METHODS An exploratory qualitative study was undertaken to explore the experiences of 13 male partners, selected purposively and guided by the principle of saturation. Data gathering employed in-depth interviews utilizing a semistructured interview guide, with subsequent analysis conducted via a thematic analysis approach. RESULTS Five themes and 13 subthemes were generated, encompassing psychosocial distress, attitudes towards cervical cancer, unity in the provision of care, economic burden, and altered sexual relationships. Participants reported experiencing emotional distress, shifts in social responsibilities, financial challenges, and unfulfilled sexual needs. Moreover, they expressed the need for social, psychological, financial, and sexual and reproductive support. CONCLUSION This study underscores the numerous challenges encountered by male partners caring for women with cervical cancer, encompassing emotional distress, financial strain, and shifts in social and sexual dynamics. The identified themes and subthemes highlight the intricate interplay of these difficulties and stress the necessity for holistic support systems addressing the social, psychological, financial, and sexual aspects of male partners' experiences. The findings emphasize the importance of designing and implementing comprehensive support programmes tailored to the diverse needs of male partners, ultimately enhancing their quality of life and overall well-being. PATIENT OR PUBLIC CONTRIBUTION Before the study, the nursing manager assisted in selecting three male partners randomly. These partners were involved in the design of the participants' information sheet, the evaluation of the interview schedule and rooms, and the dissemination of information about the study's purpose to the target population. Their valuable input contributed to improving the participant information sheet, refining data collection procedures and addressing ethical considerations. However, these individuals were not considered study participants. Throughout the study, in-charge nurses in the hospital were informed about the study's goals and helped organize appointments with participants and manage the interview schedule.
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Affiliation(s)
- Rashid A. Gosse
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Emanueli Amosi Msengi
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Emmanuel Z. Chona
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Joel S. Ambikile
- Department of Clinical NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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2
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Di Salvo I, Mnzava D, Nicoletti GJ, Senkoro E, Ndege RC, Huang DJ, Makunja NT, Kassiga GI, Kaufmann AM, Weisser M, Kind AB. Upscaling cervical cancer screening and treatment for women living with HIV at a rural referral hospital in Tanzania: protocol of a before-and-after study exploring HPV testing and novel diagnostics. BMC Health Serv Res 2023; 23:234. [PMID: 36894985 PMCID: PMC9998252 DOI: 10.1186/s12913-023-09113-3] [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: 08/28/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is nearly always caused by persistent human papillomavirus (HPV) infection. It is the most common cancer among women living with HIV (WLWH) and is the leading cause of cancer-related death in women in East Africa, with 10,241 new cases reported in Tanzania in 2020. In 2019, the World Health Organization (WHO) presented a global strategy for the elimination of CC as a public health problem, proposing targets to meet by 2030 for HPV vaccine coverage (90% of all 15-year-old girls), CC screening (70% of all women once at 35 and again at 45 years of age) and treatment delivery, to be scaled at national and subnational levels with a context-sensitive approach. This study aims to evaluate the upscaling of screening and treatment services at a rural referral hospital in Tanzania in order to address the second and third WHO targets. METHODS This is an implementation study with a before-and-after design performed at St. Francis Referral Hospital (SFRH) in Ifakara (south-central Tanzania). CC screening and treatment services are integrated within the local HIV Care and Treatment Center (CTC). The standard of care, consisting of visualization of the cervix with acetic acid (VIA) and cryotherapy has been up-scaled with self-sampled HPV testing and also involved the introduction of mobile colposcopy, thermal ablation and loop electrosurgical excision procedure (LEEP). Participants are WLWH aged 18 to 65 years. Outcome measures included the percentage of women screened, HPV prevalence and genotype, and adherence to screening, treatment and follow-up plan. Additionally, we will explore the performance of novel diagnostic tests (QG-MPH®, Prevo-Check® and PT Monitor®), which share the features of being manageable and inexpensive, and thus a potential tool for effective triage in HPV high-prevalence cohorts. DISCUSSION The study will provide relevant information about HPV prevalence and persistence, as well as reproductive and lifestyle indicators in a CC high-risk cohort of WLWH and about upscaling screening and treatment services at the level of a rural referral hospital in Tanzania. Furthermore, it will provide exploratory data on novel assays. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05256862, date of registration 25/02/2022. Retrospectively registered.
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Affiliation(s)
- Ivana Di Salvo
- Colposcopy Unit, Department of Gynaecology and Gynaecologic Oncology, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Chronic Disease Clinic, Department for Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania.,Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Dorcas Mnzava
- Chronic Disease Clinic, Department for Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Giovanni Jacopo Nicoletti
- Chronic Disease Clinic, Department for Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania.,Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Chronic Disease Clinic, Department for Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania.,Saint Francis Referral Hospital, Ifakara, Tanzania
| | - Robert C Ndege
- Chronic Disease Clinic, Department for Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania.,Saint Francis Referral Hospital, Ifakara, Tanzania
| | - Dorothy J Huang
- Colposcopy Unit, Department of Gynaecology and Gynaecologic Oncology, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Nathalia Tobias Makunja
- Saint Francis Referral Hospital, Ifakara, Tanzania.,Department of Obstetrics and Gynecology, St. Francis Referral District Hospital, Ifakara, Tanzania
| | - George I Kassiga
- Saint Francis Referral Hospital, Ifakara, Tanzania.,Department of Obstetrics and Gynecology, St. Francis Referral District Hospital, Ifakara, Tanzania
| | - Andreas M Kaufmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gynaecology, HPV Laboratory, Berlin, Germany
| | - Maja Weisser
- Chronic Disease Clinic, Department for Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania.,University of Basel, Basel, Switzerland.,Department of Infectious Diseases & Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - André B Kind
- Colposcopy Unit, Department of Gynaecology and Gynaecologic Oncology, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland. .,University of Basel, Basel, Switzerland.
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3
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Kahesa C, Thomsen LT, Linde DS, Mchome B, Katanga J, Swai P, Manongi R, Kjaerem M, Iftner T, Waldstrøm M, Mwaiselage J, Rasch V, Kjaer SK. Comparison of human papillomavirus-based cervical cancer screening strategies in Tanzania among women with and without HIV. Int J Cancer 2023; 152:686-696. [PMID: 36093587 PMCID: PMC10087897 DOI: 10.1002/ijc.34283] [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: 08/03/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
Cervical cancer is the most common female cancer in Eastern Africa, and the World Health Organization (WHO) recommends human papillomavirus (HPV)-based screening as a key element to eliminate the disease. In this cross-sectional study from Tanzania, we compared nine HPV-based cervical cancer screening strategies, including HPV testing at standard cut-off; HPV testing at increased viral load cut-offs; HPV testing with partial/extended genotyping, and HPV testing with visual inspection with acetic acid (VIA). We pooled data collected during 2008 to 2009 and 2015 to 2017 from 6851 women aged 25 to 65. Cervical cytology samples were HPV tested with Hybrid Capture 2, and HPV positive samples were genotyped with INNO-LiPA Extra II. Human immunodeficiency virus (HIV) testing and VIA were done according to local standards. We calculated sensitivity, specificity, positive and negative predictive value of screening strategies, with high-grade cytological lesions as reference, separately for women with and without HIV. HPV testing at standard cut-off (1.0 relative light units [RLU]) had highest sensitivity (HIV+: 97.8%; HIV-: 91.5%), but moderate specificity (HIV+: 68.1%; HIV-: 85.7%). Increasing the cut-off for HPV positivity to higher viral loads (5.0/10.0 RLU) increased specificity (HIV+: 74.2%-76.5%; HIV-: 89.5%-91.2%), with modest sensitivity reductions (HIV+: 91.3%-95.7%; HIV-: 83.5%-87.8%). Limiting test positivity to HPV types 16/18/31/33/35/45/52/58 improved specificity while maintaining high sensitivity (HIV+: 90.2%; HIV-: 81.1%). Triage with VIA and/or partial genotyping for HPV16/18 or HPV16/18/45 had low sensitivities (≤65%). In conclusion, HPV testing alone, or HPV testing with extended genotyping or increased viral load cut-offs, may improve cervical cancer screening in Sub-Saharan Africa.
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Affiliation(s)
- Crispin Kahesa
- Department of Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ditte S Linde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Johnson Katanga
- Department of Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania.,Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Patricia Swai
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Rachel Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Myassa Kjaerem
- Department of Medical Affairs and Scientific Communication, AJ Vaccines A/S, Copenhagen, Denmark
| | - Thomas Iftner
- Institute of Medical Virology, University Hospital of Tübingen, Tübingen, Germany
| | - Marianne Waldstrøm
- Department of Pathology, Vejle Hospital, Region of Southern Denmark, Vejle, Denmark
| | - Julius Mwaiselage
- Department of Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania.,Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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4
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Swai P, Mgongo M, Leyaro BJ, Mwaiselage J, Mchome BL, Kjaer SK, Rasch V, Manongi R, Msuya SE. Knowledge on human papilloma virus and experience of getting positive results: a qualitative study among women in Kilimanjaro, Tanzania. BMC Womens Health 2023; 23:61. [PMID: 36774477 PMCID: PMC9921604 DOI: 10.1186/s12905-023-02192-8] [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: 11/13/2021] [Accepted: 01/24/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Human papilloma virus (HPV) is a sexually transmitted infection causing more than 80% of cervical cancers. WHO recommends using of sensitive screening methods like HPV-testing to timely prevent future morbidity and mortality from cervical cancer. Pilot studies have shown that HPV-testing is feasible and can be scaled in developing country like Tanzania. However, there is limited information on women understanding, reactions and psychological challenges following diagnosis of high risk HPV (HR-HPV). This study explored the knowledge of women on HPV and their experience after HPV positive results in Kilimanjaro, Tanzania. METHODS The study was part of a larger study that assessed incidence and persistence of HR-HPV among women aged 18 years and above in Kilimanjaro. This was a cross sectional study conducted in Moshi municipal council among women who had HR-HPV positive results at enrollment. In-depth interviews were conducted with 13 randomly selected women who were attending for follow-up after enrollment. Interviews were conducted at the health facility and Atlas.ti.8 was used to analyze the data using thematic framework analysis. RESULTS Women had knowledge on HPV infection but they had different reactions following receiving positive HPV results. Reaction toward the positive HPV results had two extremes; some women had psychological effect (hopeless, death sentence, having cancer, being shocked, failure to disclose and psychosexual effects) while others women explained positive results is good as they are identified earlier, will be followed up and it has made them plan to continue with cervical cancer screening in future. CONCLUSION Women had knowledge on HPV, but positive results lead to negative and positive experiences by women. Clinicians and programs need to develop interventions and good strategies to minimize the psychological and social burden of testing positive for HPV.
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Affiliation(s)
- Patricia Swai
- grid.412898.e0000 0004 0648 0439Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,Department of Obstetrics and Gynaecology, KCMC Hospital, Moshi, Tanzania
| | - Melina Mgongo
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
| | - Beatrice J. Leyaro
- grid.412898.e0000 0004 0648 0439Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | | | - Bariki L. Mchome
- grid.412898.e0000 0004 0648 0439Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,Department of Obstetrics and Gynaecology, KCMC Hospital, Moshi, Tanzania
| | - Susanne K. Kjaer
- grid.4973.90000 0004 0646 7373Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Rasch
- grid.7143.10000 0004 0512 5013Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rachel Manongi
- grid.412898.e0000 0004 0648 0439Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sia E. Msuya
- grid.412898.e0000 0004 0648 0439Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,grid.412898.e0000 0004 0648 0439Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,grid.415218.b0000 0004 0648 072XDepartment of Community Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
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5
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Kakotkin VV, Semina EV, Zadorkina TG, Agapov MA. Prevention Strategies and Early Diagnosis of Cervical Cancer: Current State and Prospects. Diagnostics (Basel) 2023; 13:diagnostics13040610. [PMID: 36832098 PMCID: PMC9955852 DOI: 10.3390/diagnostics13040610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Cervical cancer ranks third among all new cancer cases and causes of cancer deaths in females. The paper provides an overview of cervical cancer prevention strategies employed in different regions, with incidence and mortality rates ranging from high to low. It assesses the effectiveness of approaches proposed by national healthcare systems by analysing data published in the National Library of Medicine (Pubmed) since 2018 featuring the following keywords: "cervical cancer prevention", "cervical cancer screening", "barriers to cervical cancer prevention", "premalignant cervical lesions" and "current strategies". WHO's 90-70-90 global strategy for cervical cancer prevention and early screening has proven effective in different countries in both mathematical models and clinical practice. The data analysis carried out within this study identified promising approaches to cervical cancer screening and prevention, which can further enhance the effectiveness of the existing WHO strategy and national healthcare systems. One such approach is the application of AI technologies for detecting precancerous cervical lesions and choosing treatment strategies. As such studies show, the use of AI can not only increase detection accuracy but also ease the burden on primary care.
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Affiliation(s)
- Viktor V. Kakotkin
- Scientific and Educational Cluster MEDBIO, Immanuel Kant Baltic Federal University, A. Nevskogo St., 14, 236041 Kaliningrad, Russia
| | - Ekaterina V. Semina
- Scientific and Educational Cluster MEDBIO, Immanuel Kant Baltic Federal University, A. Nevskogo St., 14, 236041 Kaliningrad, Russia
| | - Tatiana G. Zadorkina
- Kaliningrad Regional Centre for Specialised Medical Care, Barnaulskaia Street, 6, 236006 Kaliningrad, Russia
| | - Mikhail A. Agapov
- Scientific and Educational Cluster MEDBIO, Immanuel Kant Baltic Federal University, A. Nevskogo St., 14, 236041 Kaliningrad, Russia
- Correspondence: ; Tel.: +7-(4012)-59-55-95
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Saldaña-Rodríguez P, Bahena-Román M, Delgado-Romero K, Madrid-Marina V, Torres-Poveda K. Prevalence and Risk Factors for High-Risk Human Papillomavirus Infection and Cervical Disorders: Baseline Findings From an Human Papillomavirus Cohort Study. Cancer Control 2023; 30:10732748231202925. [PMID: 37751562 PMCID: PMC10524074 DOI: 10.1177/10732748231202925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/23/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A persistent infection by high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical neoplasms; however, most studies have focused on risk factors associated with HPV-16 and HPV-18 only. OBJECTIVES We assessed the association of risk factors with the prevalence of HPV-16, HPV-18, and non-16/18 HR-HPV infection and with the occurrence of cervical lesions in the baseline of a cohort study of HPV persistence in a Mexican population. METHODS Cross-sectional study within the baseline of a 5-year dynamic cohort study of HR-HPV persistence in women with an abnormal cytology study result from 2015 to 2021. HPV DNA was detected using the Anyplex II HPV 28 kit. Data on lifestyle, sociodemographic, and reproductive factors were assessed using bivariate and multivariate analyses to determine the association of risk factors with HR-HPV infection status and histopathologic diagnosis. RESULTS A total of 373 women were included in the study. The overall prevalence of HR-HPV infection was 69.97%. The most prevalent HR-HPV genotypes, including single and multiple infections, were HPV-53 (13.4%), HPV-16 (11.8%), HPV-58 (10.9%), HPV-31 (10.9%), and HPV-66 (10.7%). We found 90 multiple HR-HPV infection patterns, all of them with α-6 and -9 species. Significant associations of multiple HPV-16 and non-16/18 HR-HPV infections were found with marital status, number of lifetime sexual partners, and smoking history. The most prevalent genotype in CIN1 and CIN2 patients was HPV-16. No association was found between biological plausibility risk factors and cervical lesions. CONCLUSIONS The risk factors for non-16/18 HR-HPV multiple infections are no different than those linked to HPV-16 multiple infections.
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Affiliation(s)
- Paula Saldaña-Rodríguez
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Margarita Bahena-Román
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Karina Delgado-Romero
- Centro de Atención para la Salud de la Mujer (CAPASAM) (Center for Women's Health), Health Services of the State of Morelos, Cuernavaca, Mexico
| | - Vicente Madrid-Marina
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Kirvis Torres-Poveda
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Consejo Nacional de Humanidades Ciencias y Tecnologías (CONAHCYT), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Løkke KF, Rasch V, Mwaiselage J, Gammeltoft T, Linde DS. Acceptability of text messages and knowledge change for cervical cancer screening: a Tanzanian mixed methods study. BMJ Open 2022; 12:e058450. [PMID: 36123109 PMCID: PMC9486230 DOI: 10.1136/bmjopen-2021-058450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the acceptability of a text message intervention and evaluate if text messages could increase knowledge of cervical cancer and screening. DESIGN This study was a substudy of a randomised controlled trial that used a mixed methods research design combining a quantitative questionnaire dataset and qualitative interview data. A before and after assessment was made of questionnaire responses. Acceptability was measured on a 6-point Likert scale and knowledge was measured through 16 binary true/false knowledge questions concerning cervical cancer and screening. Qualitative data were coded using a combined inductive-deductive approach. SETTING Ocean Road Cancer Institute in Dar es Salaam as well as Kilimanjaro Christian Medical Center and Mawenzi Regional hospital in the Kilimanjaro Region in Tanzania. PARTICIPANTS Human papillomavirus (HPV) positive women who had been randomised to the intervention group and received educative and reminder messages. Qualitative interviews were conducted with a subgroup of women in the intervention group. INTERVENTIONS 15 one-way educative and reminder text messages. RESULTS A total of 115 women in the intervention group responded to both the baseline and follow-up questionnaire. Overall, women found it highly acceptable to receive text messages, and there was a trend towards acceptability rising between baseline and follow-up (mean: 0.22; 95% CI 0.00 to 0.44; p=0.05; t-statics=1.96). A significant increase in acceptability was found among the lowest educated and those who had not previously been screened. The qualitative interviews showed that the underlying reasons for the high acceptability rate were that the women felt someone cared for them and that the text messages were for their own benefits. The text messages did not improve the women's knowledge on cervical cancer and screening. CONCLUSIONS Educative and reminder text messages are highly acceptable among HPV-positive Tanzanian women; however, they do not increase the women's knowledge of cervical cancer and screening. TRIAL REGISTRATION NUMBER clingov (NCT02509702).
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Affiliation(s)
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Julius Mwaiselage
- Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Tine Gammeltoft
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Søndergaard Linde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Syddanmark, Denmark
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8
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Adebamowo SN, Befano B, Cheung LC, Rodriguez AC, Demarco M, Rydzak G, Chen X, Porras C, Herrero R, Kim JJ, Castle PE, Wentzensen N, Kreimer AR, Schiffman M, Campos NG. Different human papillomavirus types share early natural history transitions in immunocompetent women. Int J Cancer 2022; 151:920-929. [PMID: 35603904 PMCID: PMC9329241 DOI: 10.1002/ijc.34128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/07/2022]
Abstract
Necessary stages of cervical carcinogenesis include acquisition of a carcinogenic human papillomavirus (HPV) type, persistence associated with the development of precancerous lesions, and invasion. Using prospective data from immunocompetent women in the Guanacaste HPV Natural History Study (NHS), the ASCUS-LSIL Triage Study (ALTS) and the Costa Rica HPV Vaccine Trial (CVT), we compared the early natural history of HPV types to inform transition probabilities for health decision models. We excluded women with evidence of high-grade cervical abnormalities at any point during follow-up and restricted the analysis to incident infections in all women and prevalent infections in young women (aged <30 years). We used survival approaches accounting for interval-censoring to estimate the time to clearance distribution for 20 529 HPV infections (64% were incident and 51% were carcinogenic). Time to clearance was similar across HPV types and risk classes (HPV16, HPV18/45, HPV31/33/35/52/58, HPV 39/51/56/59 and noncarcinogenic HPV types); and by age group (18-29, 30-44 and 45-54 years), among carcinogenic and noncarcinogenic infections. Similar time to clearance across HPV types suggests that relative prevalence can predict relative incidence. We confirmed that there was a uniform linear association between incident and prevalent infections for all HPV types within each study cohort. In the absence of progression to precancer, we observed similar time to clearance for incident infections across HPV types and risk classes. A singular clearance function for incident HPV infections has important implications for the refinement of microsimulation models used to evaluate the cost-effectiveness of novel prevention technologies.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center; University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Maria Demarco
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Greg Rydzak
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Jane J. Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicole G. Campos
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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9
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HIV Prevalence among Injury Patients Compared to Other High-Risk Groups in Tanzania. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sixty-eight percent of persons infected with HIV live in Africa, but as few as 67% of those know their infection status. The emergency department (ED) might be a critical access point to HIV testing. This study sought to measure and compare HIV prevalence in an ED injury population with other clinical and nonclinical populations across Tanzania. Adults (≥18 years) presenting to Kilimanjaro Christian Medical Center ED with acute injury of any severity were enrolled in a trauma registry. A systematic review and meta-analysis was conducted to compare HIV prevalence in the trauma registry with other population groups. Further, 759 injury patients were enrolled in the registry; 78.6% were men and 68.2% consented to HIV counseling and testing. The HIV prevalence was 5.02% (tested), 6.25% (self-report), and 5.31% (both). The systematic review identified 79 eligible studies reporting HIV prevalence (tested) in 33 clinical and 12 nonclinical population groups. Notable groups included ED injury patients (3.53%, 95% CI), multiple injury patients (10.67%, 95% CI), and people who inject drugs (17.43%, 95% CI). These findings suggest that ED injury patients might be at higher HIV risk compared to the general population, and the ED is a potential avenue to increasing HIV testing among young adults, particularly men.
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Swai P, Rasch V, Linde DS, Mchome B, Manongi R, Wu CS, Waldstrom M, Iftner T, Mwaiselage J, Kjaer SK. Persistence and risk factors of high-risk human papillomavirus infection among HIV positive and HIV negative tanzanian women: a cohort study. Infect Agent Cancer 2022; 17:26. [PMID: 35690838 PMCID: PMC9188099 DOI: 10.1186/s13027-022-00442-2] [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: 03/13/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background High-risk (HR) human papillomavirus (HPV) persistence is the most important risk factor for cervical cancer. We have assessed the type-specific HR HPV persistence among HIV positive and HIV negative Tanzanian women and factors associated with HR HPV persistence. Methods In a cohort study including 4080 Tanzanian women, 3074 attended follow-up examination (up to 32 months after enrollment). Cervical samples were obtained for liquid-based cytology and HPV DNA testing using Hybrid Capture 2 and Inno-Lipa Extra II. Information on lifestyle factors was collected through a personal interview. The probability of HR HPV persistence at a given time point since enrollment was estimated non-parametrically using the EMICM algorithm.
Results Among the 462 women HR HPV positive at enrollment, 158 had at least one identical type detected at follow-up. The probability of persistence at 18 months after enrollment was 34.2 (95% CI 29.0–39.4). Stratifying by HIV status, the persistence probability was 42.9% (95% CI 33.5–51.9) among HIV positive, and 28.0% (95% CI 22.1–34.2) among HIV negative. Overall, HR HPV persistence was most common for HPV58, 35, 16, 31, and 52. Among HIV positive women it was HPV45, and HPV16, followed by HPV58 and HPV18, and among HIV negative women it was HPV31, HPV33 and HPV58. Risk factors associated with persistence of HR HPV were older age, longer interval between enrollment and follow-up, binge drinking, and HIV status. Conclusions HR HPV persistence was common in Tanzania, and most common among HIV positive women. Overall, persistence was most frequent for HPV 58, 35, 16, 31 and 52. The nonavalent HPV vaccine should be considered.
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Affiliation(s)
- Patricia Swai
- Kilimanjaro Christian Medical Centre, 3060, Moshi, Tanzania.
| | - Vibeke Rasch
- University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ditte S Linde
- University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Bariki Mchome
- Kilimanjaro Christian Medical Centre, 3060, Moshi, Tanzania
| | - Rachel Manongi
- Kilimanjaro Christian Medical Centre, 3060, Moshi, Tanzania
| | - Chun Sen Wu
- University of Southern Denmark, Odense, Denmark
| | | | - Thomas Iftner
- Institute of Medical Virology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Susanne K Kjaer
- Danish Cancer Society Research Center, Unit of Virus, Lifestyle and Genes, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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11
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Zuberi Z, Mremi A, Chilongola JO, Semango G, Sauli E. Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania. PLoS One 2021; 16:e0259096. [PMID: 34705880 PMCID: PMC8550370 DOI: 10.1371/journal.pone.0259096] [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: 02/15/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Biomarkers yield important information for early diagnosis of cervical cancer. However, they are rarely applied for prognosis of cervical cancer in Tanzania, where visual inspection assay with acetic acid or Lugol’s iodine and Pap test are being used as the standard screening/ diagnostic methods. Methods This was a retrospective hospital-based cross-sectional study that was conducted to assess cyclin-dependent kinase inhibitor (p16) and topoisomerase II-alpha (TOP2A) proteins expression among women seeking cervical cancer care at Kilimanjaro Christian Medical Centre, Tanzania between May 1, 2017 and May 10, 2018. Immunohistochemistry technique was used to detect the expressions of p16 and TOP2A proteins from the retrieved formalin-fixed and paraffin-embedded (FFPE) cervical biopsies. Results A total of 145 patients, with a mean age of 52.1 ± 12.9 years, were included in this study. Upon immunohistochemistry staining, 103 (71.0%) and 90 (62.1%) were p16 and TOP2A positive respectively. There was a strong association between histopathological class and p16/TOP2A expression levels (Fisher’s exact test, p<0.001). Moreover, there was a strong positive correlation between p16/TOP2A and cancerous cervical lesions (Spearman’s rank correlation coefficients = 0.833 and 0.687, p = 0.006 and 0.005, respectively). The age-adjusted odds ratio for predicting cervical cancer lesions were independently significant for p16/TOP2A biomarkers in FFPE cervical tissues [p16: OR = 1.142 (95% CI: 1.059–1.232, p<0.001) and TOP2A: OR = 1.046 (95% CI: 1.008–1.085, p = 0.015)]. Importantly, the diagnostic performance of p16 was higher than that of TOP2A in the diagnosis of cancerous lesions from non-cancerous cervical lesions (sensitivity: 97.2% versus 77.6%, accuracy: 92.8% versus 87.8%, respectively). Conclusion Our study has highlighted that over-expression of TOP2A is related to the grade of cervical intraepithelial neoplasia but does not predict prognosis in cervical cancer. Similarly, expression of p16 is related to degree of histological dysplasia and malignancy, suggesting its prognostic and predictive value in the management of cervical cancers. Further bigger studies are needed to validate their applications in the early diagnosis of cervical cancer.
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Affiliation(s)
- Zavuga Zuberi
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania
- * E-mail:
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jaffu O. Chilongola
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - George Semango
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Elingarami Sauli
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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12
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Mchome B, Linde DS, Manongi R, Waldstroem M, Lftner T, Wu C, Mwaisalage J, Rasch V, Kjaer SK. Incident detection of human papillomavirus - a prospective follow-up study among Tanzanian women with a focus on HIV status. Int J Infect Dis 2021; 110:165-170. [PMID: 34252573 DOI: 10.1016/j.ijid.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The causative role of human papillomavirus (HPV) in cervical carcinogenesis is well established; however, prospective studies examining high-risk(HR)-HPV acquisition among adult women in HIV-prevalent settings are limited. METHODS We conducted a prospective study among women (25-60 years) attending cervical cancer screening in Tanzania. Cervical specimens obtained at enrolment and follow-up were tested for HPV. Participants were interviewed on lifestyle and tested for HIV. RESULTS Among 3805 eligible women, 3074 (80.8%) attended follow-up (median time between the 2 examinations, 17.3 months); 307 had missing HPV results at enrolment or follow-up, leaving 2767 study participants. Among 2253 women initially HR-HPV negative, 184 acquired HR-HPV-incidence: 54.5 per 1000 person-years (95% CI:47.1-62.9); among HIV-positive women 75.2 per 1000 person-years (95% CI:54.5-103.7), HIV-negative 50.9 per 1000 person-years (95% CI:43.3-60.0). HPV52 and HPV16 were the most frequently acquired types. In multivariable regression analysis, HIV positivity, low CD4 count, younger age, and multiple sexual partners were associated with increased odds of HPV acquisition. CONCLUSION HPV acquisition was higher among HIV-positive than HIV-negative women, especially women with low CD4 counts. Improvement of immune status among HIV-positives may decrease HPV acquisition. Nonavalent HPV vaccination should be considered given the pattern of HR-HPV types acquired.
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Affiliation(s)
- Bariki Mchome
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical University College, Kilimanjaro, United republic of Tanzania.
| | - Ditte S Linde
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Rachel Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, United republic of Tanzania
| | | | - Thomas Lftner
- Department of Experimental Virology, Tubingen University, Tubingen, Germany
| | - Chunsen Wu
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julius Mwaisalage
- Department of Cancer Prevention Services, Ocean Road Cancer Institute, Dar-es-Salaam, United Republic of Tanzania
| | - Vibeke Rasch
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susanne K Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Denmark
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