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Mapaona R, Williams V, Musarapasi N, Kibwana S, Maseko T, Chekenyere R, Gumbo S, Mdluli P, Byarugaba H, Galagedera D, Mafukidze A, Hurtado-de-Mendoza A, Adsul P, Bongomin P, Loffredo C, Dlamini X, Bazira D, Ojoo S, Haumba S. Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002760. [PMID: 38625931 PMCID: PMC11020862 DOI: 10.1371/journal.pgph.0002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 04/18/2024]
Abstract
This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system (CMIS). VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n = 14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n = 7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p = 0.096). Screening at mission-owned (AOR 1.40; p = 0.001), NGO-owned (AOR 3.08; p<0.001) and industrial/workplace-owned health facilities (AOR 2.37; p = 0.044) were associated with increased odds of a positive VIA compared to government-owned health facilities. Compared to those aged 25-34, the odds of a positive VIA increased by 1.26 for those in the 35-44 age group (AOR 1.26; p = 0.017). Predictors with lower odds for a positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (AOR 0.76; p = 0.004) and ≥10 years (AOR 0.66; p = 0.002) compared to <5 years; and having an undetectable viral load (AOR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.
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Affiliation(s)
- Rufaro Mapaona
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Rhinos Chekenyere
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sidumo Gumbo
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Phetsile Mdluli
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Dileepa Galagedera
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Christopher Loffredo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Xolisile Dlamini
- National Cancer Control Program, Ministry of Health, Mbabane, Eswatini
| | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
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Anderson JR, Yogeshkumar S, Lu E, Yenokyan G, Thaler K, Mensa M, Chikaraddi S, Lokare L, Gudadinni MR, Antartani R, Donimath K, Patil B, Bidri S, Goudar SS, Derman R, Dalal A. The CryoPop study: Screening for high-grade cervical dysplasia in Karnataka, India. BJOG 2023; 130 Suppl 3:158-167. [PMID: 37932903 PMCID: PMC10659137 DOI: 10.1111/1471-0528.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To describe our experience of screening with visual inspection with acetic acid (VIA) and colposcopy to identify women with high-grade precancerous cervical lesions who were candidates for cryotherapy. Women were screened to determine eligibility for a clinical trial testing the safety and efficacy of a new, simple and inexpensive cryotherapy device (CryoPop®) targeted for use in low and middle-income countries (LMICs). DESIGN Prospective cohort study. SETTING Primary and urban health centres in Belagavi, Hubballi and Vijayapur, India. POPULATION Women in the age-group 30-49 years, premenopausal, with no prior hysterectomy and no known HIV infection were eligible for screening. METHODS Visual inspection with acetic acid was performed on eligible women following informed consent. VIA-positive women were referred for colposcopy and biopsy. Biopsies were read by two pathologists independently, with a third pathologist acting as tie-breaker if needed. MAIN OUTCOME MEASURES The primary outcome measures were the number/proportion of women screening positive by VIA and the number/proportion of those women screening VIA-positive found to have high-grade cervical lesions on biopsy (cervical intraepithelial neoplasia 2/3 [CIN 2/3]). Demographic variables were compared between women who screened VIA-positive and those who screened VIA-negative; a separate comparison of demographic and limited reproductive variables was performed between women who had CIN 2/3 on biopsy and those without CIN 2/3 on biopsy. Chi-square or Fisher's exact tests for categorical data and t-tests or analysis of variance for numeric data were used with all tests two-sided and performed at an alpha 0.05 level of statistical significance. RESULTS A total of 9130 women were screened with VIA between 4 July 2020 and 31 March 2021. The mean age of all women screened was 37 years (standard deviation = 5.6 years) with 6073 of the women (66.5%) in the 30-39 year range. Only 1% of women reported prior cervical cancer screening. A total of 501 women (5.5%) were VIA-positive; of these, 401 women underwent colposcopy. Of those who had colposcopy, 17 (4.2%) had high-grade lesions on biopsy, an additional 164 (40.9%) had low-grade cervical lesions on biopsy or endocervical curettage and one woman (0.2%) was found to have invasive cancer. VIA-positive women were younger and had higher levels of education and income; however, women who were VIA-positive and found to have CIN 2/3 were older, were more likely to be housewives and had higher household income than those without CIN 2/3. CONCLUSION Despite the COVID-19 pandemic, over 9100 women were screened with VIA for precancerous lesions. However, only 17 (4.2%) were found to have biopsy-proven high-grade cervical lesions, underscoring the subjective performance of VIA as a screening method. Given that this is significantly lower than rates reported in the literature, it is possible that the prevalence of high-grade lesions in this population was impacted by screening a younger and more rural population. This study demonstrates that screening is feasible in an organised fashion and can be scaled up rapidly. However, while inexpensive and allowing for same-day treatment, VIA may be too subjective and have insufficient accuracy clearly to identify lesions requiring treatment, particularly in low-prevalence and low-risk populations, calling into question its overall cost-effectiveness.
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Affiliation(s)
- Jean R Anderson
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Enriquito Lu
- Jhpiego, an Affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | - Gayane Yenokyan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katrina Thaler
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Margaret Mensa
- Jhpiego, an Affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Muttappa R Gudadinni
- BLDE (Deemed-to-be-University) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, India
| | | | | | - Basavaraj Patil
- Karnataka Cancer Therapy & Research Institute, Hubballi, India
| | - Shailaja Bidri
- BLDE (Deemed-to-be-University) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, India
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Richard Derman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anita Dalal
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
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Tesfaye B, Tilahun T, Dechasa Heyi W, Oljira R. Associated factors of positive visual inspection of cervix with acetic acid test among women screened for cervical cancer at public health facilities in Woliso town, Southwest Shoa, Ethiopia: A case-control study. SAGE Open Med 2022; 10:20503121221108227. [PMID: 35814309 PMCID: PMC9260562 DOI: 10.1177/20503121221108227] [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: 03/16/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: Screening for precancerous cervical lesions and providing access to effective
treatment can significantly improve the likelihood of survival. To identify
associated factors of positive visual inspection of the cervix with acetic
acid test for precancerous cervical lesions among women screened for
cervical cancer at public health facilities in Woliso Town, Southwest Shoa,
Ethiopia. Methods: A facility-based unmatched case–control study was conducted on 86 cases and
172 controls. Cases were women who had a positive result for the visual
inspection of the cervix with acetic acid test, and controls were women with
a negative result. Data were collected using a pretested structured
questionnaire and organized using SPSS version 20. Descriptive analysis and
logistic regressions were performed. The adjusted odds ratio with a 95%
confidence interval was used, and statistical significance was declared at
p-value <0.05. Results: The study found that women aged 40–44 years (adjusted odds ratio = 4.11, 95%
confidence interval (1.20–14.50)), greater or equal to five deliveries
(adjusted odds ratio = 2.78, 95% confidence interval (1.39–5.56)), age at
first birth less than 20 (adjusted odds ratio = 5.45, 95% confidence
interval (1.41–21.04), age at first sexual intercourse less than 18
(adjusted odds ratio = 4.73, 95%, confidence interval (1.79–12.48)), ever
used condom (adjusted odds ratio = 11.06, 95% confidence interval
(3.93–31.14), having a history of sexually transmitted diseases (adjusted
odds ratio = 4.05, 95% confidence interval (2.15–7.76), having a history of
multiple sexual partners (adjusted odds ratio = 4.81, 95% confidence
interval (1.37–16.90)), and being human immunodeficiency virus positive
(adjusted odds ratio = 3.85, 95% confidence interval (1.68–8.83)) were
associated factors of positive visual inspection with acetic acid test for
precancerous cervical lesions. Conclusion: Given the above-associated factors of positive visual inspection with acetic
acid test for precancerous cervical lesions, the health facilities should
target women with these factors and timely screen them with the application
of acetic acid on the cervix.
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Affiliation(s)
- Bahiru Tesfaye
- Public Health Expert, MEAL Regional Project, Save the Children, Ambo, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Worku Dechasa Heyi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Rut Oljira
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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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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Getinet M, Taye M, Ayinalem A, Gitie M. Precancerous Lesions of the Cervix and Associated Factors among Women of East Gojjam, Northwest Ethiopia, 2020. Cancer Manag Res 2021; 13:9401-9410. [PMID: 35002317 PMCID: PMC8721437 DOI: 10.2147/cmar.s338177] [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: 09/07/2021] [Accepted: 12/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cervical cancer is the commonest cancer of women's reproductive system, and is caused by a progression of precancerous lesions of the cervix. Studies on the prevalence and associated factors of precancerous lesions of the cervix are very limited in Ethiopia, particularly in the study area. OBJECTIVE This study aimed to assess precancerous lesions of the cervix and associated factors among women of East Gojjam, northwest Ethiopia in 2020. METHODS A facility-based cross-sectional study was conducted on 340 cervical cancer-screened women in three hospitals of East Gojjam from February to April 2020. Data were collected by six BSc-qualified nurses who were working in the selected hospitals. EpiData Manager and SPSS 26 were used for data management and analysis. After the data had been clean, descriptive analysis was done and multivariate logistic regression used to identify predictors of precancerous lesions of the cervix. Statistical significance was taken to be P<0.05. RESULTS Of the 340 recruited women, 15.3% (95% CI 11.83%-19.54%) had precancerous cervical lesions. Mean age was 37.11±9.3 years. Age 46-55 (AOR 3.8, 95% CI 1.21-12.47) years, age 56-65 (AOR 12.26, 95% CI 3.18-47.18) years, residing rurally (AOR 2.04, 95% CI 1.12-3.7), prolonged use of oral contraceptive pills (AOR 9.11, 95% CI 1.14-72.8), history of sexual transmitted infection (STI; AOR 3.40, 95% CI 1.32-8.78), HIV-positive status (AOR 4.89, 95% CI 1.54-15.49), and number of lifetime sexual partners (AOR 9.87, 95% CI 1.38-70.4) were important factors associated with precancerous lesions of the cervix. CONCLUSION We found relatively high prevalence of precancerous cervical lesions. Age, rural residence, prolonged use of oral contraceptives, STI, multiple sexual partners, and being HIV-positive were important factors associated with precancerous cervical lesions. Women aged >46 years, with a history of STI, being HIV infected, and with a history of multiple sexual partners should be encouraged to get screened for cervical cancer.
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Affiliation(s)
- Mamaru Getinet
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Molla Taye
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Ayinalem
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Menberesibhat Gitie
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nguyen NTK, Nguyen LT, Le HT, Nguyen BT, Pham NB, Pham PL, Vu LTH. How to integrate screening for cervical cancer into grassroots health services for low income countries: An implementation research. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1729593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ngan T. K. Nguyen
- Department of Epidemiology& Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Linh T. Nguyen
- Department of Epidemiology& Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Hoang T. Le
- Department of Epidemiology& Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Binh T. Nguyen
- Food Safety Management Board, Bac Ninh provincial People’s Committee, Bac Ninh, Vietnam
| | - Nha Ba Pham
- Department of Obstetrics and Gynecology, Bach Mai Hospital, Hanoi, Vietnam
| | - Phuong Lan Pham
- Department of Training, National Hospital for Obstetrics and Gynecology, Hanoi, Vietnam
| | - Lan T. H. Vu
- Department of Epidemiology& Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
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Baena A, De Vuyst H, Mesher D, Kasubi M, Yuma S, Mwaiselage J, Zouiouich S, Mlay P, Kahesa C, Landoulsi S, de la Luz Hernandez M, Lucas E, Herrero R, Almonte M, Broutet N. Reproducibility of a Rapid Human Papillomavirus Test at Different Levels of the Healthcare System in Tanzania: The AISHA Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2261-2268. [PMID: 32856600 DOI: 10.1158/1055-9965.epi-20-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/23/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To inform policy makers in Tanzania if and how best to implement rapid HPV testing, we assessed the interobserver reproducibility of careHPV test at three different levels of the healthcare system in an urban and a rural region of Tanzania. METHODS Women aged 30 to 50 years were screened by careHPV testing in two primary healthcare centers (PHC), two district hospitals (DiH), and two regional hospitals (ReH). Aliquots were retested at regional (ReH) and national referral laboratories (NRL). Reproducibility was evaluated using agreement and kappa index measures. Intralaboratory reproducibility was also evaluated in a set of 10 positive and 10 negative samples. RESULTS Samples from 1,134 women were locally tested and retested at ReH and/or NRL. Test results from Dar es Salaam ReH and Kilimanjaro PHC showed clear quality problems including suspicion of contamination during testing or aliquoting. After excluding these samples, 18.8% of 743 women were HPV positive at clinic level. The resulting careHPV reproducibility at different levels of the healthcare system was very good [agreement 95.7%, 95% confidence interval (CI), 94.0-96.9; kappa, 0.86, 95% CI, 0.81-0.91]. Intralaboratory agreement was also very good across four different experiments, with Fleiss' kappa between 0.87 (95% CI, 0.61-1.00) and 1.00 (0.75-1.00). CONCLUSIONS Rapid HPV testing was highly reproducible between lower and higher levels of the healthcare system in Tanzania; however, performance seems to be operator dependent. IMPACT The careHPV test seems to be a feasible option for cervical cancer screening in an organized, decentralized system and in limited-resource settings if quality assurance measures are in place.
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Affiliation(s)
- Armando Baena
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Hugo De Vuyst
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.
| | - David Mesher
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.,Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, United Kingdom
| | - Mabula Kasubi
- Department of Microbiology/Immunology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Safina Yuma
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Julius Mwaiselage
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Semi Zouiouich
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pendo Mlay
- Department of Gynecology and Obstetrics, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Crispin Kahesa
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sihem Landoulsi
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Maria de la Luz Hernandez
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Baldur-Felskov B, Mwaiselage J, Faber MT, Kjaerem M, de la Cour CD, Munk C, Kahesa C, Iftner T, Rasch V, Kjaer SK. Factors associated with a cervical high-grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women. Trop Med Int Health 2018; 24:229-237. [PMID: 30444556 DOI: 10.1111/tmi.13184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high-grade lesions on cytology. METHODS We conducted a large cross-sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio-demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs). RESULTS The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95% CI: 2.34-5.17) or to high-risk HPV (HrHPV) (OR = 1.97; 95% CI: 1.37-2.85). HrHPV was by far the strongest predictor of high-grade cytology (OR = 110.1; 95% CI: 50.4-240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95% CI: 0.78-2.08). After adjustment for HrHPV, HIV and age, the risk of high-grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity. CONCLUSIONS Infection with HrHPV is a major risk factor for high-grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.
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Affiliation(s)
- Birgitte Baldur-Felskov
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Julius Mwaiselage
- Division of Cancer Prevention, Ocean Road Center Institute, Dar es Salaam, Tanzania
| | - Mette Tuxen Faber
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Myassa Kjaerem
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of International Health, Public Health Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Crispin Kahesa
- Division of Cancer Prevention, Ocean Road Center Institute, Dar es Salaam, Tanzania
| | - Thomas Iftner
- Department of Experimental Virology, University Hospital Tübingen, Tübingen, Germany
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Determinants of Cervical Cancer Screening Accuracy for Visual Inspection with Acetic Acid (VIA) and Lugol's Iodine (VILI) Performed by Nurse and Physician. PLoS One 2017; 12:e0170631. [PMID: 28107486 PMCID: PMC5249231 DOI: 10.1371/journal.pone.0170631] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) are used to screen women for cervical cancer in low-resource settings. Little is known about correlates of their diagnostic accuracy by healthcare provider. We examined determinants of VIA and VILI screening accuracy by examiner in a cross-sectional screening study of 1528 women aged 30 years or older in a suburb of Kinshasa, Democratic Republic of Congo. METHODS We used a logistic regression model for sensitivity and specificity to estimate the diagnostic accuracy of VIA and VILI, independently performed by nurse and physician, as a function of sociodemographic and reproductive health characteristics. RESULTS Nurses rated tests as positive more often than physicians (36.3% vs 30.2% for VIA, 26.2% vs 25.2% for VILI). Women's age was the most important determinant of performance. It was inversely associated with sensitivity (nurse's VIA: p<0.001, nurse's VILI: p = 0.018, physician's VIA: p = 0.005, physician's VILI: p = 0.006) but positively associated with specificity (all four combinations: p<0.001). Increasing parity adversely affected sensitivity and specificity, but the effects on sensitivity were significant for nurses only. The screening performance of physician's assessment was significantly better than the nurse's (difference in sensitivity: VIA = 13%, VILI = 16%; difference in specificity: VIA = 6%, VILI = 1%). CONCLUSIONS Age and parity influence the performance of visual tests for cervical cancer screening. Proper training of local healthcare providers in the conduct of these tests should take into account these factors for improved performance of VIA and VILI in detecting cervical precancerous lesions among women in limited-resource settings.
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Msyamboza KP, Phiri T, Sichali W, Kwenda W, Kachale F. Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study. BMC Public Health 2016; 16:806. [PMID: 27535359 PMCID: PMC4989288 DOI: 10.1186/s12889-016-3530-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malawi has the highest cervical cancer incidence and mortality in the world with age-standardized rate (ASR) of 75.9 and 49.8 per 100,000 population respectively. In response, Ministry of Health established a cervical cancer screening programme using visual inspection with acetic acid (VIA) and treatment of precancerous lesions with cryotherapy. This paper highlights the roll out, integration with family planning services and HIV ART Programme, uptake and challenges of VIA and Cryotherapy programme. METHODS We analyzed program data, supportive supervision, quarterly and annual reports from the National Cervical Cancer Control Program. We evaluated the uptake and challenges of screening services by age, HIV serostatus and trends over a five year period (2011-2015). RESULTS Between 2011 and 2015, number of cervical cancer screening sites, number of women screened and coverage per annum increased from 75 to 130, 15,331 to 49,301 and 9.3 % to 26.5 % respectively. In this five year period, a total of 145,015 women were screened. Of these, 7,349 (5.1 %) and 6,289 (4.3 %) were VIA positive and suspect cancer respectively. Overall 13,638 (9.4 %) were detected to be VIA positive or had suspect cancer. Of the 48,588 women with known age screened in 2015; 13,642 (28.1 %), 27,275 (56.1 %) and 7,671 (15.8 %) were aged 29 or less, 30-45, 46 years or more. Among 39,101 women with data on HIV serostatus; 21,546 (55.1 %) were HIV negative, 6,209 (15.9 %) were HIV positive and 11, 346 (29.0 %) status was unknown. VIA positivity rate and prevalence of suspect cancer were significantly higher in HIV positive than HIV negative women (8.8 % vs 5.0 %, 6.4 % vs 3.0 %); in women aged 30-45 years than women aged 29 years or less (5.6 % vs 2.3 %, 2.6 % vs 1.2 %) respectively, all p <0.05). The main challenge of the programme was failure to treat VIA positive women eligible for cryotherapy. Over the five year period, the programme only treated 1,001 (43.3 %) out of 2,311 eligible women and only 266 (31.8 %) of the 836 women with large lesion or suspect cancer who were referred, received the health care at the referral centre. The reasons for failure to provide cryotherapy treatment were stock out of gas, faulty/broken cryotherapy machine (usually connectors or probes) or no cryotherapy machine at all in the whole district. For women with large lesion or suspect cancer; lack of loop electrosurgical excision procedure (LEEP) machine or inadequate gynaecologists at the referral centre, were the major reasons. Cancer radiotherapy services were not available in Malawi. CONCLUSIONS This study provided data on VIA positivity rate, prevalence of suspect cancer, failure rate of cryotherapy and challenges in the provision of cryotherapy and LEEP treatment in Malawi. These data could be used as baseline for monitoring and evaluation of Human Papillomavirus (HPV) vaccination programme which the country introduced in 2013, the linkage of cervical cancer screening and women on HIV ART and the long term effect of ART, voluntary male medical circumcision on the prevalence and incidence of cervical cancer.
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Affiliation(s)
- Kelias Phiri Msyamboza
- World Health Organization, Malawi Country Office, Lilongwe, Malawi
- WHO Malawi, ADL House, City Centre, P.O. Box 30390, Lilongwe, Malawi
| | - Twambilire Phiri
- Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
| | - Wesley Sichali
- Ministry of Health, Mzimba North District Hospital Office, Mzuzu, Malawi
| | - Willy Kwenda
- Ministry of Health, Balaka District Hospital Office, Balaka, Malawi
| | - Fanny Kachale
- Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
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Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health 2016; 16:29. [PMID: 27259656 PMCID: PMC4893293 DOI: 10.1186/s12905-016-0306-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/21/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. METHODS We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories. RESULTS A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts. CONCLUSIONS Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.
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Affiliation(s)
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - May Maloba
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Florence Ndikum-Moffor
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA
| | - Elizabeth Bukusi
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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Liu E, McCree R, Mtisi E, Fawzi WW, Aris E, Lema IA, Hertzmark E, Chalamilla G, Li N, Vermund SH, Spiegelman D. Prevalence and risk factors of cervical squamous intraepithelial lesions among HIV-infected women in Dar es Salaam, Tanzania. Int J STD AIDS 2016; 27:219-225. [PMID: 25957324 DOI: 10.1177/0956462415584466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 03/31/2015] [Indexed: 11/15/2022]
Abstract
To determine the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Tanzania, a cross-sectional study was conducted among HIV-infected women at HIV care and treatment clinics. A Papanicolaou (Pap) smear was used as a screening tool for detection of cervical SIL. From December 2006 to August 2009, 1365 HIV-infected women received cervical screening. The median age was 35 (interquartile range [IQR]: 30-42) years, and the median CD4 + cell count was 164 (IQR: 80-257) cells/mm(3). The prevalence of cervical SIL was 8.7% (119/1365). In multivariate analysis, older age (≥50 versus 30-<40 years: prevalence ratio [PR], 2.36; 95% confidence interval [CI], 1.45-3.84, p for trend = 0.001), lower CD4 + cell counts (<100 versus ≥200 cells/mm(3): PR, 1.55; 95% CI, 1.01-2.36, p for trend = 0.03) and cervical inflammation (PR, 1.73; 95% CI, 1.16-2.60, p = 0.008) were associated with an increased risk of cervical SIL. Women with advanced WHO HIV disease stage (IV versus I/II: PR, 3.45; 95% CI, 1.35-8.85, p for trend = 0.01) had an increased risk for high-grade SIL. In resource-limited settings where it is not feasible to provide cervical cancer prevention services to all HIV-infected women, greater efforts should focus on scaling-up services among those who are older than 50 years, with lower CD4 cell counts and advanced HIV disease stage.
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Affiliation(s)
- Enju Liu
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Renicha McCree
- National Cancer Institute, Center for Global Health, Rockville, MD, USA
| | | | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Eric Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Irene A Lema
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Ellen Hertzmark
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | - Nan Li
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Donna Spiegelman
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
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Increasing Cervical Cancer Awareness and Screening in Jamaica: Effectiveness of a Theory-Based Educational Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010053. [PMID: 26703641 PMCID: PMC4730444 DOI: 10.3390/ijerph13010053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022]
Abstract
Despite declines in cervical cancer mortality in developed countries, cervical cancer incidence and mortality rates remain high in Jamaica due to low levels of screening. Effective interventions are needed to decrease barriers to preventive behaviors and increase adoption of behaviors and services to improve prospects of survival. We enrolled 225 women attending health facilities in an intervention consisting of a pre-test, educational presentation and post-test. The questionnaires assessed attitudes, knowledge, risk factors, and symptoms of cervical cancer among women. Changes in knowledge and intention to screen were assessed using paired t-tests and tests for correlated proportions. Participants were followed approximately six months post-intervention to determine cervical cancer screening rates. We found statistically significant increases from pre-test to post-test in the percentage of questions correctly answered and in participants’ intention to screen for cervical cancer. The greatest improvements were observed in responses to questions on knowledge, symptoms and prevention, with some items increasing up to 62% from pre-test to post-test. Of the 123 women reached for follow-up, 50 (40.7%) screened for cervical cancer. This theory-based education intervention significantly increased knowledge of and intention to screen for cervical cancer, and may be replicated in similar settings to promote awareness and increase screening rates.
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Deksissa ZM, Tesfamichael FA, Ferede HA. Prevalence and factors associated with VIA positive result among clients screened at Family Guidance Association of Ethiopia, south west area office, Jimma model clinic, Jimma, Ethiopia 2013: a cross-sectional study. BMC Res Notes 2015; 8:618. [PMID: 26515769 PMCID: PMC4627428 DOI: 10.1186/s13104-015-1594-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is the 2nd most frequent and top killer cancer among women in Ethiopia. Prevalence and factors associated with visual inspection with acetic acid (VIA) positive result is not studied yet at the study area. Methods A cross-sectional study was conducted at Jimma model clinic of Family Guidance Association of Ethiopia, from September 11, 2013 to October 11, 2013. Pertinent data of 334 screened clients were transferred to Epidata version3.1 using checklist, double data entry verification done and exported to SPSS version16.0. After cleaning the data, descriptive analysis was done and logistic regression model employed to identify predictors of VIA positive result. Statistical significance was declared at P < 0.05. Results Out of 334 screened clients, 43 (12.9 %) had VIA positive result. Initiation of sexual intercourse earlier than 16 years was found to be an independent predictor increasing the risk of VIA positive by 2.2 times as compared to clients who started at the age of 16 or more years (AOR [95 % CI] = 2.2 [1.1, 4.3]). Conclusions Early initiation of sexual intercourse was an independent predictor of VIA positive result in this study. Thus, any cervical cancer prevention and control effort at the study area should address the problem of early initiation of sexual intercourse. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1594-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zewdie Mulissa Deksissa
- Columbia University, International Center for AIDS Care and Treatment Program, Addis Ababa office, P.O. Box 5566, Addis Ababa, Ethiopia.
| | | | - Henok Assefa Ferede
- Department of Epidemiology, College of Public Health and Medical Sciences, Jimma University, P.O. Box 1274, Jimma, Ethiopia.
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Lovgren K, Soliman AS, Ngoma T, Kahesa C, Meza J. Characteristics and geographic distribution of HIV-positive women diagnosed with cervical cancer in Dar es Salaam, Tanzania. Int J STD AIDS 2015; 27:1049-1056. [PMID: 26464500 DOI: 10.1177/0956462415606252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
Cervical cancer is the leading incident cancer and the main cause of cancer-related mortality among women in sub-Saharan Africa. Furthermore, HIV-infected women are at a higher risk of developing cervical cancer than HIV-negative women. The purpose of this study was to distinguish differences in characteristics of HIV-positive and HIV-negative patients with cervical cancer in Dar es Salaam, Tanzania. The HIV status of cervical cancer patients diagnosed and/or treated at Ocean Road Cancer Institute in Dar es Salaam, Tanzania, during the period 2007-2011 was abstracted from the medical records. Additional abstracted information included patient's name, age, place of residence, occupation, education, marital status, age at marriage, gravidity, and screening clinic visit results. Ocean Road Cancer Institute patients came from two sources: the screening clinic followed by treatment clinic or the treatment clinic without prior screening. HIV-positive and HIV-negative patients were compared regarding the above-listed clinical and epidemiologic factors. Multivariable analysis was also performed to assess the risk factors associated with cervical cancer treatment without prior screening at Ocean Road Cancer Institute. HIV-positive cervical cancer patients tended to be younger, with higher education and lower parity. Patients screened for cervical cancer prior to treatment were more likely to be HIV-positive (OR: 2.09, 95% CI: 1.36, 3.21), less likely to have higher disease stages (OR: 0.64, 95% CI: 0.43, 0.94), and less likely to reside outside of Dar es Salaam (OR: 0.44, 95% CI: 0.30, 0.65). Screening for cervical cancer at Ocean Road Cancer Institute is utilised by more HIV-positive patients from Dar es Salaam. Future studies should focus on identifying the reasons for lower utilisation of screening by HIV-negative patients and patients from other distant rural regions in Tanzania.
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Affiliation(s)
- Kathleen Lovgren
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amr S Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Twalib Ngoma
- Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania
| | - Crispin Kahesa
- Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania
| | - Jane Meza
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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