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Sarmiento-Medina MI, Velásquez-Jiménez CM, Ortiz-Hernández N. Experiences of a group of indigenous women from the Colombian Amazon with cervical cancer prevention screening. Qualitative study in the context of participatory research to reduce inequalities. ETHNICITY & HEALTH 2024:1-15. [PMID: 39107054 DOI: 10.1080/13557858.2024.2387112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 07/27/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVES Despite cervical cancer (CC) being a preventable disease, its incidence remains high in marginalized communities due to inequalities that restrict access to health services. This article investigates the experiences, perceptions, and attitudes regarding the screening of indigenous women in a region of the Colombian Amazon during a cervical cancer prevention initiative facilitated by community participation. DESIGN Qualitative study based on interviews conducted with women and indigenous leaders from Paujil reserve. They participated in research focused on cervical cancer prevention, which employed a methodology of collaboration between academia and communities aimed at enhancing women's health and reducing inequalities in access to healthcare services. The analysis utilized a deductive and inductive approach. RESULTS Five main themes were addressed: 'Barriers within health services'; 'Individual and cultural constraints'; 'Motivations and facilitators'; 'Positive experiences within the research framework'; and 'Suggestions for encouraging women's participation.' Challenges related to appointment scheduling and result delivery were frequently cited as obstacles to access. Misinformation, feelings of shame, fear, and distrust towards health services played significant roles in the reluctance to undergo screening. Factors such as support from family and community networks, respectful treatment, ease of scheduling appointments, the presence of female healthcare professionals, and involvement of leaders fluent in indigenous languages were identified as positive facilitators of screening acceptance. CONCLUSION Understanding the factors that influence access to screening is crucial for reducing inequalities in service delivery for indigenous women. The involvement of trained leaders who can identify these factors and motivate women can have a positive impact on the acceptance and guidance of cervical cancer prevention programs.
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Dzobo M, Dzinamarira T, Jaya Z, Kgarosi K, Mashamba-Thompson T. Experiences and perspectives regarding human papillomavirus self-sampling in sub-Saharan Africa: A systematic review of qualitative evidence. Heliyon 2024; 10:e32926. [PMID: 39021965 PMCID: PMC11253232 DOI: 10.1016/j.heliyon.2024.e32926] [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: 02/15/2024] [Revised: 05/08/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Cervical cancer screening coverage remains low in sub-Saharan Africa (SSA) due to limited access and low uptake of available services by women. The use of HPV-based self-sampling intervention for cervical cancer screening has the potential to increase screening coverage in the region. This study aimed to analyse qualitative evidence on the experiences and perspectives of women, healthcare workers, and policymakers regarding HPV self-sampling. Methods We reviewed qualitative studies from January 2011 to March 2023 in PubMed, Scopus, Medline Ovid, Cochrane, and WEB of Science databases for articles with qualitative data on HPV self-sampling from different countries in SSA. The socio-ecological model was used to guide data analysis and the study findings. Results Thirteen qualitative studies were included for analysis, and they revealed themes under the intrapersonal, interpersonal, community, and health systems constructs of the Socio-ecological model. Intrapersonal themes included the acceptability of self-sampling, self-efficacy, and the perceived value of self-sampling. The interpersonal construct had themes such as women's spousal relationships, peer support, and the health worker's relationship with the women. The community construct had two themes: social stigma and misinformation, and the influence of cultural norms and religion. Finally, the health systems construct had themes such as the setting for self-sampling, follow-up availability of treatment services and education and awareness. Conclusion This study highlights the factors influencing the acceptability and uptake of an HPV-based self-sampling intervention for cervical cancer screening in SSA. Considering these findings when designing interventions in SSA is crucial to ensure acceptance and demand among end-users. Self-sampling interventions offer the potential to reach many unscreened women and increase cervical cancer screening coverage in SSA, which is an essential strategy towards achieving the World Health Organisation's cervical cancer elimination targets by the close of the century.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Centre for International Programmes Zimbabwe Trust, Harare, Zimbabwe
| | - Ziningi Jaya
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Department of Library Services, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tivani Mashamba-Thompson
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Meneses-León J, Hernández-Salazar S, Torres-Ibarra L, Hernández-López R, Rivera-Paredez B, Robles-Rivera K, Lazcano-Ponce E, García-Vera A, Godínez-Pérez M, León-Maldonado L, Salmerón J. Performance of urine samples compared to cervical samples for detection of precancer lesions among HPV-positive women attending colposcopy clinic in Mexico City. Cancer Causes Control 2024; 35:935-942. [PMID: 38368574 PMCID: PMC11129980 DOI: 10.1007/s10552-024-01852-w] [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: 05/29/2023] [Accepted: 01/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND High-risk human papillomavirus (hrHPV) detection in self-collected urine samples (SeCUS) may be a promising alternative for cervical cancer screening because of its greater acceptability, as long as it can offer comparable sensitivity to clinician-collected cervical samples (CCoS) for detecting precancer lesions. OBJECTIVE To evaluate the performance of the SeCUS compared to that of the CCoS for cervical intraepithelial neoplasia grade 3 (CIN3) detection among hrHPV-positive women receiving colposcopy in Mexico City using different specific extended HPV typing procedures: HPV16/18, HPV16/18/35/39/68 or HPV16/18/35/39/68/31. METHODS From March 2017 to August 2018, 4,158 female users of the cervical cancer screening program at Tlalpan Sanitary Jurisdiction in Mexico City were invited to participate in the FRIDA-Tlalpan study. All participants provided ≥ 30 mL of SeCUS, and then a CCoS was obtained with Cervex-Brush®, which was used for hrHPV typing. Participants who tested positive for hrHPV in CCoS were referred for colposcopy for diagnostic confirmation, and all SeCUS of these women were also tested for hrHPV typing. RESULTS In total, 561 hrHPV-positive women were identified by CCoS via colposcopy, and 82.2% of the SeCUS of these women were also hrHPV positive. From both CCoS and SeCUS, 7 cases of CIN3 were detected. Considering HPV16/18 typing, CCoS and SeCUS detected 4 cases of CIN3, but after HPV16/18/35/39/68/31 extension typing, both CCoS and SeCUS detected all 7 of the CIN3 cases among the hrHPV-positive women. CONCLUSIONS Using extended hrHPV typing based on HPV16/18/35/39/68/31, our results suggest that the performance of SeCUS may be equivalent to that of CCoS for detecting CIN3 lesions. Although our results are inconclusive, they support the hypothesis that SeCUS may be an attractive alternative worthy of further research.
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Affiliation(s)
- Joacim Meneses-León
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Sonia Hernández-Salazar
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Rubí Hernández-López
- Oficina de Análisis del Plan de Salud, Subgerencia Técnica del Plan de Salud, Gerencia de Administración del Plan de Salud, Banco de México, Mexico, Mexico
| | - Berenice Rivera-Paredez
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Karina Robles-Rivera
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico
| | | | - Alba García-Vera
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Mélany Godínez-Pérez
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Leith León-Maldonado
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico, Mexico.
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Doubova SV, McClellan SP, Martinez-Vega IP, Ureña-Bogarín EL, Martínez-Montañez OG. HPV Self-Sampling in the Workplace: A Qualitative Study of Benefits, Barriers, and Opportunities for Improvement Perceived by Health Professionals and Managers. Arch Med Res 2024; 55:103009. [PMID: 38823184 DOI: 10.1016/j.arcmed.2024.103009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
AIM To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on the benefits, barriers, and opportunities for improvement of a pilot program. METHODS A qualitative descriptive study based on in-depth telephone interviews was conducted between June and August 2023. Data were analyzed through inductive thematic analysis. Fifteen health professionals from different companies and fifteen managers from the Mexican Institute of Social Security (IMSS) were interviewed. RESULTS Participants identified several benefits of the HPV-SS, including ease of use, privacy, convenience, affordability, reduced workplace absences, and promotion of a prevention culture. However, there were also individual and organizational barriers to program implementation. The former consisted of women's concerns about collecting a reliable sample or injuring themselves, lack of confidence in the HPV test, fear of positive results, and discomfort caused by the brush used to collect the sample. Organizational barriers included failure to follow up on positive test results, lack of knowledge of program indicators, perceived negative impact on the established Pap smear cervical cancer screening indicator, and the lack of government regulations supporting HPV testing. To improve the program, participants suggested disseminating information through mass media campaigns and social networks, providing companies with additional support from IMSS preventive staff, extending the work hours of IMSS Family Medicine clinics, and training IMSS health staff on the follow-up of women with HPV test results. CONCLUSIONS The study findings suggest potential areas for improvement in HPV-SS programs.
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Affiliation(s)
- Svetlana V Doubova
- Unidad de Investigación Epidemiológica y en Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Sean P McClellan
- Department of Family and Community Medicine, University of Illinois, Chicago, IL, USA
| | - Ingrid Patricia Martinez-Vega
- Unidad de Investigación Epidemiológica y en Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Traore B, Kassogue Y, Diakite B, Diarra F, Cisse K, Kassogue O, Diarra M, Coulibaly A, Coulibaly B, Diallo H, Diarra Z, Ly M, Maiga A, Sissoko SB, Sissoko AS, Traore CB, Kamate B, Teguete I, Bah S, Dolo G, Gursel DB, Holl J, Hou L, Maiga M. Prevalence of high-risk human papillomavirus genotypes in outpatient Malian women living with HIV: a pilot study. BMC Infect Dis 2024; 24:513. [PMID: 38778266 PMCID: PMC11110247 DOI: 10.1186/s12879-024-09412-y] [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: 01/31/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Long-term exposure to high-risk human papillomavirus (Hr-HPV) is a well-known necessary condition for development of cervical cancer. The aim of this study is to screen for Hr-HPV using vaginal self-sampling, which is a more effective approach to improve women's adherence and increase screening rates. METHODS This pilot study included a total of 100 Women living with HIV (WLWHIV), recruited from the Center for Listening, Care, Animation, and Counseling of People Living with HIV in Bamako. Hr-HPV genotyping was performed on Self-collected samples using the Cepheid GeneXpert instrument. RESULTS The median age of WLWHIV was 44 (interquartile range [IQR], 37-50) years. Approximately 92% of the study participants preferred self-sampling at the clinic, and 90% opted to receive result notifications via mobile phone contact. The overall prevalence of Hr-HPV among study participants was 42.6%, and the most frequent Hr-HPV sub-types observed were HPV18/45 (19.1%), HPV31/35/33/52/58 (13.8%), and HPV39/68/56/66 (12.8%), followed by HPV16 (5.3%), and HPV51/59 (5.3%). WLWHIV under 35 years of age had a higher frequency of Hr-HPV compared to their older counterparts, with rates of 30% versus 11.1% (p = 0.03). The duration of antiretroviral treatment showed an inverse association with Hr-HPV negativity, with patients on treatment for 15 (IQR, 10-18) years versus 12 (IQR = 7-14) years for Hr-HPV positive patients (95% CI [1.2-5.8], t = 3.04, p = 0.003). WLWHIV with baseline CD4 T-Cell counts below 200 exhibited a higher frequency of Hr-HPV compared to those with baseline CD4 T-Cell counts above 200 (17.9% versus 1.9%, p = 0.009). However, other demographics and clinical factors, such as marital status, age of sexual debut, parity, education, history of abortion, history of preeclampsia, and cesarean delivery, did not influence the distribution of Hr-HPV genotypes. CONCLUSION Our findings indicate that WLWHIV under the age of 35 years old exhibited the highest prevalence of Hr-HPV infection, with HPV18/45 being the most prevalent subtype. Additionally, WLWHIV with baseline CD4 T-Cell counts below 200 showed the highest infection rates.
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Affiliation(s)
- Ban Traore
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Yaya Kassogue
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali.
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Brehima Diakite
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fousseyni Diarra
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Kadidiatou Cisse
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Oumar Kassogue
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Modibo Diarra
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Aissata Coulibaly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Bourama Coulibaly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hama Diallo
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Zoumana Diarra
- Center of Listening, Care, Animation, and Counseling for People Living With HIV, Bamako, Mali
| | - Madani Ly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Aminata Maiga
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi Boula Sissoko
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Seydou Sissoko
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Bougadari Traore
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahima Teguete
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou Bah
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Guimogo Dolo
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Demirkan Besim Gursel
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Holl
- Department of Neurology, University of Chicago, Chicago, IL, 60637, USA
| | - Lifang Hou
- Institute for Global Health, Northwestern University, Chicago, IL, 60611, USA
- Preventive Medicine Department, Northwestern University, Chicago, IL, 60611, USA
| | - Mamoudou Maiga
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- Preventive Medicine Department, Northwestern University, Chicago, IL, 60611, USA
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Muslin C. Addressing the burden of cervical cancer for Indigenous women in Latin America and the Caribbean: a call for action. Front Public Health 2024; 12:1376748. [PMID: 38807996 PMCID: PMC11130434 DOI: 10.3389/fpubh.2024.1376748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Cervical cancer, primarily caused by human papillomavirus (HPV) infection, poses a significant global health challenge. Due to higher levels of poverty and health inequities, Indigenous women worldwide are more vulnerable to cervical cancer than their non-Indigenous counterparts. However, despite constituting nearly 10% of the population in Latin America and the Caribbean (LAC), the true extent of the burden of cervical cancer among Indigenous people in this region remains largely unknown. This article reviews the available information on cervical cancer incidence and mortality, as well as HPV infection prevalence, among Indigenous women in LAC. The limited existing data suggest that Indigenous women in this region face a heightened risk of cervical cancer incidence and mortality compared to non-Indigenous women. Nevertheless, a substantial knowledge gap persists that must be addressed to comprehensively assess the burden of cervical cancer among Indigenous populations, especially through enhancing cancer surveillance across LAC countries. Numerous structural, social and cultural barriers hindering Indigenous women's access to HPV vaccination and cervical cancer screening worldwide have been identified and are reviewed in this article. The discussion highlights the critical role of culturally sensitive education, community engagement, and empowerment strategies in overcoming those barriers. Drawing insights from the success of targeted strategies in certain high-income countries, the present article advocates for research, policies and healthcare interventions tailored to the unique context of LAC countries.
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Affiliation(s)
- Claire Muslin
- One Health Research Group, Faculty of Health Sciences, Universidad de las Américas, Quito, Ecuador
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Han E(F, Srinivasa S, Gurney J, Koea J. Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review. JCO Glob Oncol 2024; 10:e2300035. [PMID: 38359371 PMCID: PMC10881110 DOI: 10.1200/go.23.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Indigenous communities experience worse cancer outcomes compared with the general population partly because of lower cancer screening access. One-size-fits-all screening programs are unsuitable for reaching Indigenous communities. In this review, we summarize available evidence on the perspectives of these communities; with a view to informing the improvement of cancer screening services to achieve equitable access. METHODS We undertook a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the databases MEDLINE, Scopus, PubMed, and Google Scholar. The search terms used were "Indigenous community or Indigenous communities," "cancer screening," and "facilitators, enablers, desires, or needs." Qualitative studies published up to the August 30, 2022 investigating the perspectives of Indigenous communities on factors encouraging screening participation were included in the study. The included studies were reviewed and analyzed inductively by two independent reviewers, and key themes regarding indigenous access to cancer screening were then extracted. RESULTS A total of 204 unique articles were identified from the search. The title and abstracts of these studies were screened, and 164 were excluded on the basis of the exclusion and inclusion criteria. The full texts of the remaining 40 studies were examined and 18 were included in the review. Four key themes were identified pertaining to culturally tailored education and information dissemination, community involvement, positive relationships with health care providers, and individual empowerment and autonomy. CONCLUSION Improvements, on the basis of the key themes identified from this review, must be made at all levels of the health care system to achieve equitable screening participation in Indigenous communities. However, we recommend an investigation into the perspectives of the local Indigenous communities before the initiation of cancer screening programs.
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Affiliation(s)
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
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McClellan SP, Unger-Saldaña K, Espinosa-Tamez P, Suazo-Zepeda E, Potter MB, Barquet-Muñoz SA, Torres-Ibarra L, Lamadrid-Figueroa H, Lajous M. The Cervical Cancer Treatment Gap in Mexico Under Seguro Popular, 2006-2016. Health Syst Reform 2023; 9:2272371. [PMID: 37944505 DOI: 10.1080/23288604.2023.2272371] [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: 05/10/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
From 2005 to 2019, the Mexican government financed cervical cancer treatment for individuals without social security insurance through Seguro Popular's Fund for Protection against Catastrophic Health Expenses. To better understand the impact of this program on access to treatment, we estimated the cervical cancer treatment gap (the proportion of patients with cervical cancer in this population who did not receive treatment). To calculate the expected number of incident cervical cancer cases we used national surveys with information on insurance affiliation and incidence estimates from the Global Burden of Disease study. We used a national claims database to determine the number of cases whose treatment was financed by Seguro Popular. From 2006 to 2016, the national cervical cancer treatment gap changed from 0.61 (95% CI 0.59 to 0.62) to 0.45 (95% CI 0.43 to 0.48), with an average yearly reduction of -0.012 (95% CI -0.024 to -0.001). The gap was greater in states with higher levels of marginalization and in the youngest and oldest age groups. Although the cervical cancer treatment gap among individuals eligible for Seguro Popular decreased after the introduction of public financing for treatment, it remained high. Seguro Popular was eliminated in 2019; however, individuals without social security have continued to receive cancer care financed by the government in the same healthcare facilities. These results suggest that barriers to care persisted after the introduction of public financing for treatment. These barriers must be reduced to improve cervical cancer care in Mexico, particularly in states with high levels of marginalization.
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Affiliation(s)
- Sean P McClellan
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Karla Unger-Saldaña
- Epidemiology Research Unit, National Institute of Cancer, Mexico City, Mexico
| | - Priscilla Espinosa-Tamez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Erick Suazo-Zepeda
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Leticia Torres-Ibarra
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | | | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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García-Mayor J, Moreno-Llamas A, De La Cruz Sánchez E. A decade beyond the economic recession: A study of health-related lifestyles in urban and rural Spain (2006-2017). Nurs Health Sci 2023; 25:700-711. [PMID: 37937892 DOI: 10.1111/nhs.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
The 2008 economic recession may have affected health-related indicators differently depending on the living environment. We analyze health-related indicators in Spain using data from four Spanish health surveys (2006, 2011, 2014, and 2017, 95 924 individuals aged ≥16 years). In 2006-2011, physical activity decreased among men and women, while in 2006-2017, physical activity only decreased among urban women. Daily vegetable intake, except in rural women, increased in 2006-2011 but decreased in 2006-2017 in all groups. Smoking decreased among urban women in 2006-2011 and 2006-2014 but only decreased among men, and even increased among rural women, in 2006-2017. In 2006-2017, obesity increased among men and urban women, good self-rated health status increased in all groups and flu vaccination declined. Blood pressure and cholesterol control decreased in urban women in 2006-2011 but increased in 2006-2017 in all groups, as well as mammographic and cytological control. Our findings highlight the differential impact of the economic recession on health-related lifestyles according to sex and place of residence, underscoring the need for targeted health policies to address evolving health disparities over time.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Ernesto De La Cruz Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
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Narvaez L, Viviano M, Dickson C, Jeannot E. The acceptability of HPV vaginal self-sampling for cervical cancer screening in Latin America: A systematic review. PUBLIC HEALTH IN PRACTICE 2023; 6:100417. [PMID: 37564780 PMCID: PMC10410574 DOI: 10.1016/j.puhip.2023.100417] [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: 03/22/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
Objective This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America. Study design Systematic review. Method A systematic literature search was performed in PubMed, Web of Science, and Embase regarding the acceptance of HPV vaginal self-sampling by women over 18 years old. Articles were selected for research that was conducted in Latin America and published between January 1st, 1993, and December 31st, 2022. Results Fifteen publications were included. Eight publications reported an acceptance of HPV self-sampling as high as 80%, six papers found an acceptance rate between 50 and 80% and only one found an acceptance rate of less than 50%. Based on non-standardized questionnaires, women considered self-sampling more comfortable, easier, and less painful than conventional cytology. The procedure was associated with less embarrassment and a greater sense of privacy. Conclusion HPV vaginal-self sampling appears to be an acceptable screening method amongst eligible Latin American women.
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Affiliation(s)
- Luisa Narvaez
- Institute of Global Health - Faculty of Medicine, Chemin de Mines 9, 1202, Geneva, Switzerland
| | - Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205, Geneva, Switzerland
| | - Cheryl Dickson
- Community Psychiatric Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Emilien Jeannot
- Institute of Global Health - Faculty of Medicine, Chemin de Mines 9, 1202, Geneva, Switzerland
- Community Psychiatric Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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11
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Akoto EJ, Allsop MJ. Factors Influencing the Experience of Breast and Cervical Cancer Screening Among Women in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol 2023; 9:e2200359. [PMID: 37141559 DOI: 10.1200/go.22.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE The persistent high morbidity and mortality from breast and cervical cancer in low- and middle-income countries (LMICs) may be influenced by global disparities in the uptake of screening services. This review sought to synthesize existing evidence to determine factors that influence the experience of women relating to breast and cervical screening in LMICs. METHODS A qualitative systematic review of the literature identified through Global Health, Embase, PsycInfo, and MEDLINE. Eligible studies included those outlining primary qualitative research or mixed-method studies with reporting of qualitative findings, detailing women's experiences of involvement with programs for breast or cervical cancer screening. Framework synthesis was used to explore and organize findings from primary qualitative studies and the Critical Appraisal Skills Programme checklist used for quality assessment. RESULTS Database searches yielded 7,264 studies for title and abstract screening and 90 full-text articles for screening, with qualitative data from 17 studies and a total of 722 participants included in this review. Four stages influencing experiences of women were generated across both breast and cervical cancer screening approaches, with individual (eg, knowledge of cancer), social (eg, religion, cultural beliefs), and health system (eg, accessibility) factors identified that influence women's initial and subsequent engagement. CONCLUSION This study synthesizes existing evidence of factors that influence engagement with breast and cervical cancer screening in LMICs. Evidence-informed recommendations are proposed that may improve the experience of cancer screening in LMICs, with further research necessary to explore their operationalization and impact on cancer care delivery.
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Affiliation(s)
- Edem J Akoto
- Lekma Hospital, Accra, Ghana
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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12
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Seoud M, Jaafar I, Hamadeh R, Ammar W, Atallah D, El-Kak F. Feasibility of implementing cytology-based cervical cancer screening national program in Lebanon: A pilot study. Int J Gynaecol Obstet 2023; 161:86-92. [PMID: 36183305 DOI: 10.1002/ijgo.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review our national cervical cancer screening program using existing Ministry of Public Health primary healthcare centers (PHCs) and report the impact of women's knowledge, attitude, behavior, and practices on screening uptake and outcome. METHODS A cross-sectional study on cervical cancer screening offered to sexually active Lebanese women aged 21 years and above visiting PHCs. Exclusions were history of complete hysterectomy, gynecologic cancers, and current pregnancy. Data were collected through a questionnaire and conventional cervical smear performed by trained healthcare providers and sent to one centralized cytopathology laboratory. RESULTS Of 12 273 eligible women, 1.7% had an abnormal cervical smear test including 161 atypical squamous cells (ASC) of undetermined significance, 6 atypical glandular cells of undetermined significance, 16 low-grade squamous intraepithelial lesion (SIL), 17 ASC-cannot rule out high-grade SIL, 11 high-grade SIL, and one invasive carcinoma. Knowledge and attitudes significantly affected participation in screening; women lacking awareness had rarely undergone a cervical smear. CONCLUSION In Lebanon, cytology-based cervical cancer screening is feasible within the PHCs. Positive screen incidence was low. Despite previous campaigns, a low level of knowledge persists, and affects women's com with the screening guidelines. Advocacy and awareness activities by key healthcare providers may help to improve participation.
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Affiliation(s)
- Muhieddine Seoud
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.,Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Iman Jaafar
- Epidemiology Department, Cancer Center, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - David Atallah
- Department of Obstetrics and Gynecology, Hotel Dieu de France, Beirut, Lebanon
| | - Faysal El-Kak
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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13
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Blomberg K, Hälleberg-Nyman M. Experiences of human papillomavirus self-sampling by women >60 years old: A qualitative study. Health Expect 2023; 26:818-826. [PMID: 36633121 PMCID: PMC10010077 DOI: 10.1111/hex.13707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) self-sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self-sampling. OBJECTIVE The aim of this study was to describe how women (>60 years old) experience the offering of self-sampling of HPV, compared to having a sample collected by a healthcare professional. DESIGN AND PARTICIPANTS The study had a qualitative explorative design. Four focus group discussions were conducted with women 60-69 years old (n = 22). Data were analysed using principles of interpretive description. RESULTS Five themes were identified: self-sampling-convenient and without pain, lack of knowledge, worries related to HPV self-sampling, need for information and taking a societal perspective. CONCLUSION Women aged >60 years found that HPV self-sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self-sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer. PUBLIC CONTRIBUTION Women who had performed HPV self-sampling participated in the focus group discussion.
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Affiliation(s)
- Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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14
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Meenan RT, Troja C, Buist DSM, Tiro JA, Lin J, Anderson ML, Gao H, Green BB, Winer RL. Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening. JAMA Netw Open 2023; 6:e234052. [PMID: 36947040 PMCID: PMC10034577 DOI: 10.1001/jamanetworkopen.2023.4052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Importance Human papillomavirus (HPV) self-sampling addresses barriers to cervical cancer screening, and mailed self-sampling kits have been reported to increase screening uptake. International research suggests mailed kits are cost-effective in certain settings. However, the cost-effectiveness of mailing HPV self-sampling kits for increasing screening uptake has not been evaluated in the US. Objective To conduct an economic evaluation of a mailed HPV self-sampling intervention among underscreened women enrolled in an integrated US health care system. Design, Setting, and Participants This economic evaluation involved a cost-effectiveness analysis of results from a randomized clinical trial of 19 851 women aged 30 to 64 years enrolled in a health plan from Kaiser Permanente Washington (KPWA), a US-based integrated health care system. Women were identified through electronic medical records, and eligible participants were enrolled in a health plan for at least 3 years and 5 months, had a primary care clinician, had not received a Papanicolaou test for at least 3 years and 5 months, and had not received a hysterectomy. Enrollment occurred from February 25, 2014, to August 29, 2016, with follow-up through February 25, 2018. The current economic evaluation was conducted between August 2, 2021, and July 30, 2022. Intervention delivery costs were calculated from both the KPWA and Medicare perspectives and were based on either wellness visit or Papanicolaou test-only visit costs. Intervention Participants in the control group received usual care, which comprised patient reminders and ad hoc outreach for screening. Participants in the intervention group received usual care plus a mailed HPV self-sampling kit. Main Outcome and Measures The primary economic outcome was the incremental cost-effectiveness ratio (ICER) for increased screening uptake, defined as the incremental difference in cost (intervention group minus control group) divided by the difference in the number of participants completing screening (intervention group minus control group) within 6 months of randomization. Results Among 19 851 women (mean [SD] age, 50.1 [9.5] years; 76.7% White), 9960 were randomized to the intervention group, and 9891 were randomized to the control group. Baseline ICERs ranged from $85.84 (95% CI, $85.68-$85.99) using KPWA wellness visits as the cost basis to $146.29 (95% CI, $146.20-$146.38) using Medicare Papanicolaou test-only visits as the cost source. Subgroups of participants aged 50 to 64 years and participants most recently overdue for screening achieved cost-effectiveness at lower levels of willingness to pay for an additional completed screening than other subgroups. Conclusions and Relevance In this economic evaluation, mailing HPV self-sampling kits to women overdue for cervical cancer screening was cost-effective for increased screening uptake relative to usual care. These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates among eligible women in US health care systems.
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Affiliation(s)
- Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Catherine Troja
- Department of Epidemiology, University of Washington School of Public Health, Seattle
| | - Diana S M Buist
- Department of Epidemiology, University of Washington School of Public Health, Seattle
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jasmin A Tiro
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, Seattle
| | | | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle
- Washington Permanente Medical Group, Seattle
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, Seattle
- Kaiser Permanente Washington Health Research Institute, Seattle
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Hurtado-Salgado E, Ortiz-Panozo E, Salmerón J, Luna-Gordillo R, Allen-Leigh B, Saavedra-Lara N, Franco EL, Lazcano-Ponce E. Prevalence of cervical human papillomavirus in Mexico, 2010-2017: analysis of 2.7 million women. Cancer Causes Control 2023; 34:123-132. [PMID: 36273050 DOI: 10.1007/s10552-022-01642-2] [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: 02/05/2021] [Accepted: 09/29/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Prevalence of cervical high-risk human papillomavirus (hrHPV) infection varies greatly. Data on distribution of hrHPV infection constitute important evidence for decision-making when implementing HPV testing into cervical cancer screening programs. We estimate the prevalence of cervical hrHPV infection in a large sample of women in a middle-income country and explore variation by age, community marginalization and region in women using public cervical cancer screening services. METHODS Records covering 2010-2017 from a registry of hrHPV test results (Hybrid Capture 2 and polymerase chain reaction) in 2,737,022 women 35-64 years were analyzed. In this observational study, 32 states were categorized into five geographical regions and classified by degree of marginalization. We stratified by test type and estimated crude and adjusted prevalence and rate ratios and used Poisson models and joinpoint regression analysis. RESULTS Prevalence was higher in women 35-39 years, at 10.4% (95% CI 10.3-10.5) and women 60-64 years, at 10.1% (95% CI 10.0-10.3). Prevalence was higher in the southeast, at 10.5% (95% CI 10.4-10.6). Women living in less marginalized areas had a significantly higher prevalence, at 10.3% (95% CI 10.2-10.4) compared to those in highly marginalized areas, at 8.7% (95% CI 8.5-8.7). HPV16 infection was detected in 0.92% (2,293/23,854) of women and HPV18 infection was detected in 0.39% (978/23,854) of women. CONCLUSION Understanding the distribution of HPV prevalence has value as evidence for developing policy in order to improve cervical cancer screening strategies. These results will constitute evidence to allow decision makers to better choose where to focus those resources that they do have.
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Affiliation(s)
- Erika Hurtado-Salgado
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Political, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Eduardo Lazcano-Ponce
- National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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16
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola G, Guy R, Vallely AJ, Kelly-Hanku A. Women's acceptability of a self-collect HPV same-day screen-and-treat program in a high burden setting in the Pacific. BMC Health Serv Res 2022; 22:1514. [PMID: 36510192 PMCID: PMC9746197 DOI: 10.1186/s12913-022-08842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A field trial to evaluate a self-collect point-of-care HPV screen-and-treat (HPV S&T) program was implemented in two Well Women Clinics in Papua New Guinea (Papua New Guinea). Assessing the acceptability of a health intervention is a core element of evaluation. In this study, we examined women's acceptability of both self-collection and HPV S&T intervention in Papua New Guinea. METHODS: Sixty-two semi-structured interviews were conducted with women who had undergone cervical screening in the same-day self-collected HPV screen-and-treat program in Madang and Western Highlands Provinces, Papua New Guinea. Data were thematically analysed using the Theoretical Framework of Acceptability (TFA) and managed using NVivo 12.5. RESULTS Most women agreed that self-collection was transformative: it helped circumvent the culturally embarrassing pelvic examination and increased their self-efficacy, especially due to the provision of health education, instructions, and pictorial aids. The availability of same-day results, and treatment if indicated, was particularly valued by the women because it reduced the financial and temporal burden to return to the clinic for results. It also meant they did not need to wait anxiously for long periods of time for their results. Women also appreciated the support from, and expertise of, health care workers throughout the process and spoke of trust in the HPV-DNA testing technology. Most women were willing to pay for the service to ensure its sustainability and timely scale-up throughout Papua New Guinea to support access for women in harder to reach areas. CONCLUSION This study reported very high levels of acceptability from a field trial of self-collection and HPV same-day screen-and-treat. The program was deemed culturally congruent and time efficient. This innovative cervical screening modality could be the 'solution' needed to see wider and more immediate impact and improved outcomes for women in Papua New Guinea and other high-burden, low-resource settings.
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Affiliation(s)
- Hawa Camara
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Somu Nosi
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Gloria Munnull
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea ,Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Steven G. Badman
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - John Bolgna
- Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Mt Hagen Provincial Hospital, PO Box 36, Mt Hagen, WHP 281 Papua New Guinea
| | - Glen Mola
- grid.412690.80000 0001 0663 0554School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD Papua New Guinea
| | - Rebecca Guy
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Andrew J. Vallely
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Angela Kelly-Hanku
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
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Dartibale CB, Prado GDC, Carobeli LR, Meirelles LEDF, Damke GMZF, Damke E, Morelli F, Souza RP, da Silva VRS, Consolaro MEL. Recent HPV self-sampling use for cervical cancer screening in Latin America and Caribbean: a systematic review. Front Oncol 2022; 12:948471. [PMID: 36338730 PMCID: PMC9627290 DOI: 10.3389/fonc.2022.948471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/03/2022] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Cervical cancer is one of the deadliest cancers among women in Latin America and Caribbean (LAC), where most of the countries have not been successful in implementing population-level cytology-based screening programs. An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human papillomavirus (HPV) screening. Therefore, this work aims to summarize recent HPV self-sampling approaches in LAC. METHOD We performed a systematic review to identify studies focused on "Self-sampling", and "Human Papillomavirus DNA test" and "Latin America" in PubMed, Embase, Web of Science, Cochrane library and SCOPUS databases for publications dating between 01 January 2017 and 15 March 2022 based on the Preferred Reporting Items for systematic reviews and meta-analysis (PRISMA) statement. Additionally, the references of the articles were carefully reviewed. RESULTS Of the 97 records selected, 20 studies including 163,787 participants, with sample sizes for individual studies ranging from 24 to 147,590 were included in this review. Studies were conducted in 10 LAC countries (18.5%), most with upper medium-income economies (70%). The range of age was 18 to ≥65 years. The vast majority of the studies (85%) addressed the HPV self-sampling strategy for primary cervical cancer screening with overall success for all women including under/never screened and those from special populations (rural, indigenous and gender minorities). Women generally found HPV self-sampling highly acceptable regardless of age, setting of collection, target population or country of residence. CONCLUSIONS HPV self-sampling is a promising strategy to overcome the multiple barriers to cervical cancer screening in LAC settings and increasing attendance in underscreened women in countries/territories with well-established screening programs. Furthermore, this strategy is useful even in LAC countries/territories without organized cervical cancer screening and in special populations such as indigenous, rural and transgender women. Therefore, the information generated by the recent initiatives for HPV self-sampling approach in LAC can be beneficial for decision-making in both new and existing programs in the region.
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Leston J, Wenger H, Reilley B, Craig Rushing S, Rink E, Warren H, Howe J, Bloomquist P, Tah T, Jeffries I, Iralu J, Thorpe P, Apostolou A, Taylor MM. Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review. Sex Health 2022; 19:286-298. [PMID: 35760766 PMCID: PMC11081199 DOI: 10.1071/sh22040] [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: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.
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Affiliation(s)
- Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Brigg Reilley
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | | | - Hannah Warren
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jean Howe
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | | | - Tina Tah
- Indian Health Service Headquarters, Rockville, MD, USA
| | - Itai Jeffries
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jonathan Iralu
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA
| | - Phoebe Thorpe
- U.S. Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | | | - Melanie M. Taylor
- U.S. Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
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19
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Shrestha AD, Andersen JG, Gyawali B, Shrestha A, Shrestha S, Neupane D, Ghimire S, Campbell C, Kallestrup P. Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis. Public Health 2022; 210:16-25. [PMID: 35863158 DOI: 10.1016/j.puhe.2022.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal. STUDY DESIGN Systematic literature review and meta-analysis. METHODS PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion. RESULTS The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening. CONCLUSION Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.
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Affiliation(s)
- A D Shrestha
- Center for Global Health, Department of Public Health, Aarhus University, Denmark; COBIN, Nepal Development Society, Bharatpur, Nepal.
| | - J G Andersen
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
| | - B Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - A Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA; Institute for Implementation Science, Kathmandu, Nepal
| | - S Shrestha
- School of Public Health, University of Alabama, Birmingham, AL, USA
| | - D Neupane
- COBIN, Nepal Development Society, Bharatpur, Nepal; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S Ghimire
- Nepal Cancer Care Foundation, Lalitpur, Nepal
| | - C Campbell
- Usher Institute, University of Edinburgh, EH8 9AG, United Kingdom
| | - P Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
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20
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Grigore M, Vasilache IA, Cianga P, Constantinescu D, Duma O, Matasariu RD, Scripcariu IS. Acceptability of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening in a Cohort of Patients from Romania (Stage 2). J Clin Med 2022; 11:jcm11092503. [PMID: 35566630 PMCID: PMC9099630 DOI: 10.3390/jcm11092503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Low patient’s adherence to conventional cervical cancer screening methods determined the need to take into consideration alternative approaches, and vaginal HPV self-sampling is one of them. We aimed to evaluate, using an online survey, the Romanian women’s acceptability of vaginal HPV self-sampling. (2) Methods: A 13-questions online survey was distributed on three Facebook groups, and the results were summarized. (3) Results: Despite of good educational background, 10.8% (n = 60) of the respondents did not know what a Pap smear is, and 33% (n = 183) were not informed about the free national cervical cancer screening program. Multivariate analysis revealed an increased likelihood of vaginal self-sampling acceptance among respondents who did not know about Pap test (OR: 7.80; 95%CI: 1.062−57.431; p = 0.021), national cervical cancer screening program (OR: 1.96; 95%CI: 1.010−3.806; p = 0.02), HPV infection (OR: 7.35; 95%CI: 3.099−17.449; p< 0.001) or HPV test (OR: 1.67; 95%CI: 0.950−2.948; p = 0.03). Moreover, women who did not previously undergo a cervical cancer screening program were more likely to accept the new screening method (OR: 1.62; 95%CI: 0.878−3.015; p = 0.04). (4) Conclusions: Our results showed high acceptability rates of vaginal HPV self-sampling among participants.
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Affiliation(s)
- Mihaela Grigore
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.G.); (R.D.M.); (I.-S.S.)
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.G.); (R.D.M.); (I.-S.S.)
- Correspondence:
| | - Petru Cianga
- Department of Immunology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.); (D.C.)
| | - Daniela Constantinescu
- Department of Immunology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.); (D.C.)
| | - Odetta Duma
- Department of Epidemiology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Roxana Daniela Matasariu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.G.); (R.D.M.); (I.-S.S.)
| | - Ioana-Sadiye Scripcariu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.G.); (R.D.M.); (I.-S.S.)
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21
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Cicconi P, Wells C, McCarthy B, Wareing S, Andersson MI, Fox J, Lwanga J, Pal N, Burns F, Woodward C, Malek R, Sabin CA, Dorrell L. Re-valuation of annual cytology using HPV self-sampling to upgrade prevention (REACH UP): A feasibility study in women living with HIV in the UK. HIV Med 2022; 23:390-396. [PMID: 35243750 PMCID: PMC9314078 DOI: 10.1111/hiv.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022]
Abstract
Introduction Current UK guidelines for cervical cancer screening are based on the assumption that most women living with HIV (WLWH) are also high‐risk (HR) human papillomavirus (HPV)‐positive. We aimed to provide data on prevalence of HR‐HPV in WLWH in the UK and to assess feasibility and acceptability of HR‐HPV self‐sampling in this group. Methods Women living with HIV attending six HIV services in London/south of England, with no history of cervical cancer, were enrolled. Participants self‐collected a vaginal swab for the detection of HR‐HPV, completed a survey about sexual/gynaecological history, attitudes towards annual screening and perception of HR‐HPV self‐sampling, and were asked to have their annual cervical smear. Results In all, 67 women were included: 86.5% were of black ethnicity, the median (range) age was 47 (24–60) years, median CD4 T‐cell count was 683 cells/µL [interquartile range (IQR): 527–910], and 95.4% had viral load ≤ 50 copies/mL. All performed the vaginal swab. Eighteen (27%) had no cervical smear results; none of these women attended HIV services where this was routinely offered. No cervical samples were positive for HR‐HPV. Three‐quarters (75.8%) of participants reported adherence to annual screening, with only one woman (1.5%) attending irregularly. On visual analogue scales (from 0 to 100), median (IQR) acceptability and necessity of smear tests were 100 (75–100) and 100 (85–100), respectively. Conclusions Our results suggest that the prevalence of HR‐HPV in WLWH in the UK may be low. Self‐sampling seems to be acceptable, suggesting, if validated, its potential role in supporting less frequent smear testing and improving screening uptake in WLWH.
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Affiliation(s)
- Paola Cicconi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Wells
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Blanka McCarthy
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan Wareing
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Monique Ingrid Andersson
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Nisha Pal
- The Garden Clinic, Upton Hospital, Slough, UK
| | - Fiona Burns
- Institute for Global Health University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Clare Woodward
- HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Ramona Malek
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Caroline Anne Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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22
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Banila C, Lorincz AT, Scibior-Bentkowska D, Clifford GM, Kumbi B, Beyene D, Wheeler CM, Cuschieri K, Cuzick J, Nedjai B. Clinical performance of methylation as a biomarker for cervical carcinoma in situ and cancer diagnosis: A worldwide study. Int J Cancer 2022; 150:290-302. [PMID: 34562270 PMCID: PMC8627461 DOI: 10.1002/ijc.33815] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/31/2021] [Indexed: 01/17/2023]
Abstract
The shift towards primary human papillomavirus (HPV)-based screening has necessitated the search for a secondary triage test that provides sufficient sensitivity to detect high-grade cervical intraepithelial neoplasia (CIN) and cancer, but also brings an improved specificity to avoid unnecessary clinical work and colposcopy referrals. We evaluated the performance of the previously described DNA-methylation test (S5) in detecting CIN3 and cancers from diverse geographic settings in high-, medium- and low-income countries, using the cut-off of 0.80 and exploratory cut-offs of 2.62 and 3.70. Assays were performed using exfoliated cervical specimens (n = 808) and formalin-fixed biopsies (n = 166) from women diagnosed with cytology-negative results (n = 220), CIN3 (n = 204) and cancer stages I (n = 245), II (n = 249), III (n = 28) and IV (n = 22). Methylation increased proportionally with disease severity (Cuzick test for trend, P < .0001). S5 accurately separated women with negative-histology from CIN3 or cancer (P < .0001). At the 0.80 cut-off, 543/544 cancers were correctly identified as S5 positive (99.81%). At cut-off 3.70, S5 showed a sensitivity of 95.77% with improved specificity. The S5 odds ratios of women negative for cervical disease vs CIN3+ were significantly higher than for HPV16/18 genotyping at all cut-offs (all P < .0001). At S5 cut-off 0.80, 96.15% of consistently high-risk human papillomavirus (hrHPV)-negative cancers (tested with multiple hrHPV-genotyping assay) were positive by S5. These cancers may have been missed in current primary hrHPV-screening programmes. The S5 test can accurately detect CIN3 and malignancy irrespective of geographic context and setting. The test can be used as a screening and triage tool. Adjustment of the S5 cut-off can be performed considering the relative importance given to sensitivity vs specificity.
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Affiliation(s)
- Cristiana Banila
- Centre for Cancer Prevention, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Attila T. Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Dorota Scibior-Bentkowska
- Centre for Cancer Prevention, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Birhanu Kumbi
- College of Natural and Computational Sciences Department of Microbial, Cellular and Molecular Biology Addis Ababa University, Ethiopia
| | - Dereje Beyene
- College of Natural and Computational Sciences Department of Microbial, Cellular and Molecular Biology Addis Ababa University, Ethiopia
| | - Cosette M. Wheeler
- Centre for HPV Prevention, University of New Mexico Comprehensive Cancer Centre, Albuquerque, NM, USA
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Belinda Nedjai
- Centre for Cancer Prevention, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, United Kingdom
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23
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Shrestha S, Thapa S, Sims P, Ardelean A, Basu A, Caws M, Gurung SC, Holdsworth G. Feasibility of HPV self-sampling pathway in Kathmandu Valley, Nepal using a human-centred design approach. Sex Reprod Health Matters 2021; 29:2005283. [PMID: 34928198 PMCID: PMC8725933 DOI: 10.1080/26410397.2021.2005283] [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] [Indexed: 11/10/2022] Open
Abstract
Cervical cancer is preventable and curable yet causes almost 2000 deaths in Nepali women each year. The present study aims to explore the feasibility and acceptability of a self-sampling-based approach for cervical cancer screening in urban and peri-urban Nepal and develop pathways for self-sampling using a co-design methodology. An iterative design approach was applied. Semi-structured in-depth interviews were conducted with 30 healthy women and four women who had had a prior cancer diagnosis on topics which included: sexual and reproductive health knowledge and human papillomavirus (HPV); use of the internet/social media platforms; their views regarding acceptability and usability of the self-sampling kit and the proposed user journey. Data collection was done between December 2020 and January 2021. Seven medical experts were also interviewed to explore the current service configuration for cervical cancer screening in Nepal. Knowledge regarding HPV and its association with cervical cancer was absent for the majority of participants. Although 70% (n = 21/30) had purchased items online previously, there was a general lack of trust in online shopping. Half of the women (n = 17/30; 56.7%) expressed a willingness to self-sample and provided recommendations to improve the clarity of the instructions. The proposed user journey was considered feasible in the urban area. There is a clear unmet need for information about HPV and alternative cervical screening options in Nepal. An online pathway for self-sampling service delivery to urban women is feasible but will need to be optimally designed to address barriers such as confidence in self-sampling and trust in online purchasing.
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Affiliation(s)
- Swastika Shrestha
- Research Officer, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal. Correspondence:
| | - Saki Thapa
- Advocacy Networking and Resource Mobilization Manager, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Paul Sims
- Service Designer, Sexual Health 24 Hours (SH:24), London, UK
| | | | - Anamika Basu
- Public Health Registrar, Sexual Health 24 Hours (SH:24), London, UK
| | - Maxine Caws
- Senior Researcher, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Suman Chandra Gurung
- Executive Director, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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24
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Hurtado-Salgado E, Cárdenas-Cárdenas L, Salmerón J, Luna-Gordillo R, Ortiz-Panozo E, Allen-Leigh B, Saavedra-Lara N, Franco EL, Lazcano-Ponce E. Comparative performance of the human papillomavirus test and cytology for primary screening for high-grade cervical intraepithelial neoplasia at the population level. Int J Cancer 2021; 150:1422-1430. [PMID: 34921727 DOI: 10.1002/ijc.33905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
The World Health Organization recommends high-risk human papillomavirus (hrHPV)-based screening for women 39 to 49 years, based on the greater accuracy of hrHPV-based screening for cervical cancer detection. Many cervical cancer screening programs have incorporated hrHPV testing and multiple early cervical cancer detection strategies have been evaluated, mostly under controlled conditions. However, there are few evaluations of combined hrHPV and cytology strategies post-implementation at the population level. Our study sought to estimate the relative yield of hrHPV testing compared to cervical cytology, as a primary screening test for cervical intraepithelial neoplasia grade 2+ (CIN2+), used at the population level. We analyzed screening data from Mexico's public cervical cancer prevention program from 2010 to 2015 in women 35 to 64 years. The study population consisted of two cohorts: one from a total of 2 881 962 cytology-based screening tests and another from a total of 2 004 497 hrHPV-based screening tests, which are concurrent in time. We performed a relative yield analysis using Poisson regression models to compare the effectiveness of hrHPV testing for CIN2+ with cervical cytology. A total of 4 886 459 records were analyzed, including 23 999 biopsies; 0.12% (n = 6166) had a CIN2+ histologic diagnosis. hrHPV testing with cytological triage detects twice as many CIN2+ cases as screening using cytology alone.
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Affiliation(s)
- Erika Hurtado-Salgado
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luz Cárdenas-Cárdenas
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Salmerón
- Political, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Nenetzen Saavedra-Lara
- School of Public Health of Mexico, National Institute of Public Health, Cuernavaca, Mexico
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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25
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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26
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Camara H, Zhang Y, Lafferty L, Vallely AJ, Guy R, Kelly-Hanku A. Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis. BMC Public Health 2021; 21:1503. [PMID: 34348689 PMCID: PMC8336264 DOI: 10.1186/s12889-021-11554-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Cervical cancer is the fourth most common cancer affecting women worldwide, with 85% of the burden estimated to occur among women in low and middle-income countries (LMICs). Recent developments in cervical cancer screening include a novel self-collection method for the detection of oncogenic HPV strains in the collected samples. The purpose of this review is to synthesise qualitative research on self-collection for HPV-based testing for cervical screening and identify strategies to increase acceptability and feasibility in different settings, to alleviate the burden of disease. Methods This review includes qualitative studies published between 1986 and 2020. A total of 10 databases were searched between August 2018 and May 2020 to identify qualitative studies focusing on the perspectives and experiences of self-collection for HPV-based cervical screening from the point of view of women, health care workers and other key stakeholders (i.e., policymakers). Two authors independently assessed studies for inclusion, quality, and framework thematic synthesis findings. The Socio-Ecological Model (SEM) was used to synthesize the primary studies. Results A total of 1889 publications were identified, of which 31 qualitative studies were included. Using an adapted version of SEM, 10 sub-themes were identified and classified under each of the adapted model’s constructs: (a) intrapersonal, (b) interpersonal, and (c) health systems/public policy. Some of the themes included under the intrapersonal (or individual) construct include the importance of self-efficacy, and values attributed to self-collection. Under the intrapersonal construct, the findings centre around the use of self-collection and its impact on social relationships. The last construct of health systems focuses on needs to ensure access to self-collection, the need for culturally sensitive programs to improve health literacy, and continuum of care. Conclusion This review presents the global qualitative evidence on self-collection for HPV-based testing and details potential strategies to address socio-cultural and structural barriers and facilitators to the use of self-collection. If addressed during the design of an HPV-based cervical cancer screening testing intervention program, these strategies could significantly increase the acceptability and feasibility of the intervention and lead to more effective and sustainable access to cervical screening services for women worldwide. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11554-6.
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Affiliation(s)
- Hawa Camara
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Ye Zhang
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Lise Lafferty
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Centre for Social Research in Health, UNSW Sydney, Goodsell Building, Sydney, NSW, 2052, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
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27
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Sethi S, Poirier B, Canfell K, Smith M, Garvey G, Hedges J, Ju X, Jamieson LM. Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review. BMJ Open 2021; 11:e050113. [PMID: 34193502 PMCID: PMC8246376 DOI: 10.1136/bmjopen-2021-050113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers. OBJECTIVE This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers. METHODS Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a 'meta-study' approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated. RESULTS Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation. CONCLUSION The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers. PROSPERO REGISTRATION NUMBER CRD42020207643.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Brisbane Office, Brisbane, Queensland, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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28
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Sethi S, Ali A, Ju X, Antonsson A, Logan R, Canfell K, Smith M, Garvey G, Hedges J, Jamieson L. A systematic review and meta-analysis of the prevalence of human papillomavirus infection in Indigenous populations - A Global Picture. J Oral Pathol Med 2021; 50:843-854. [PMID: 34008187 DOI: 10.1111/jop.13201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Recent trends have shown a decline in the rates of human papillomavirus (HPV)-associated cervical cancer in the vaccinated population but there has been a spike in the HPV-associated oropharyngeal, anal and penile cancers in the majority of the unvaccinated population which are young and middle-aged males. Indigenous populations at an international level carry a disproportionate burden of most diseases. The aim of this meta-analysis was to ascertain the worldwide prevalence of HPV infection in Indigenous populations stratified by sex and site and to document the most commonly reported HPV types. METHODS Published articles on HPV infection in Indigenous populations from PubMed, Scopus, EMBASE and Web of Science were systematically searched from inception until 23 December 2019. RESULTS A total of 41 studies were included in the final analysis. The pooled worldwide prevalence of HPV infection (for both oral and genital sites, both males and females) in Indigenous populations was 34.2% (95% CI: 28.9%-39.8%). Subgroup analysis (geographical) showed that the pooled prevalence for African Indigenous, American Indigenous and Asian-Oceanic Indigenous populations were 33.0% (95% CI: 12.8%-57.1%), 33.0% (95% CI: 27.4%-38.9%) and 33.3% (95% CI: 0.17.5%-51.3%), respectively. CONCLUSION There are not enough data on the burden of the infection carried by males especially with respect to highly suspicious sites like oropharynx. Also, we conclude an overall high prevalence of HPV infection in the Indigenous populations and increasing their susceptibility to benign and malignant manifestations of HPV.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Richard Logan
- Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Canfell
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Megan Smith
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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Kamath Mulki A, Withers M. Human Papilloma Virus self-sampling performance in low- and middle-income countries. BMC WOMENS HEALTH 2021; 21:12. [PMID: 33407355 PMCID: PMC7789658 DOI: 10.1186/s12905-020-01158-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
Background Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. Methods This study’s objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs.
Results Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86–97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants’ homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75–97%, 18 studies), painless (60–90%, nine studies), and preferred over provider-collected sampling (57–100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. Conclusion Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.
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Affiliation(s)
- Ashwini Kamath Mulki
- Department of Family Medicine, Lehigh Valley Health Network, 1730 Chew St, Allentown, PA, 18104, USA. .,Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA.
| | - Mellissa Withers
- Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA
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Megersa BS, Bussmann H, Bärnighausen T, Muche AA, Alemu K, Deckert A. Community cervical cancer screening: Barriers to successful home-based HPV self-sampling in Dabat district, North Gondar, Ethiopia. A qualitative study. PLoS One 2020; 15:e0243036. [PMID: 33306681 PMCID: PMC7732077 DOI: 10.1371/journal.pone.0243036] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To explore the barriers to successful home-based human papillomavirus (HPV) self-sampling in North Gondar, Ethiopia. METHODS The study participants were women who had previously participated in a community-wide home-based HPV self-sampling pilot study, community health workers, women's development army leaders, and the sample collectors of the home-based HPV self-sampling pilot study. A community based qualitative descriptive study was conducted. We applied purposive and convenience sampling. In total, 47 women participated in the study (in-depth interviews n = 22, four focus group discussions n = 25, 6-7 participants each). The study employed thematic analysis for clustering the emerged themes. RESULTS Husband disapproval was identified as the main barrier to the acceptance of home-based HPV self-sampling. Social influence, lack of knowledge about cervical cancer and screening, lack of health education on cervical cancer and HPV-based screening, feeling healthy, and religious influence were identified as additional barriers. Fear of using Evalyn brush® for self-sampling was found to be the main barrier to the provision of a quality sample. The inability of the sample collectors to check the proper utilization of Evalyn brush® and the difficulty in understanding the instructions did also contribute to the low-quality. Providing health education concerning cervical cancer and HPV self-sapling to women, male involvement in the screening program, and linking the screening service to existing local health facilities were suggested to guarantee the success of home-based HPV self-sampling. CONCLUSIONS Educating women regarding cervical cancer and HPV testing, providing clear instructions on how to collect self-sample, and male involvement in the screening program are prerequisites for a successful implementation of home-based HPV testing. Women empowerment should also be focused to overcome the identified sociocultural barriers. Furthermore, the screening program should guarantee the timely provision of the test results and offering women follow-up examinations and treatment for abnormal findings.
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Affiliation(s)
- Bikila Soboka Megersa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Hermann Bussmann
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Taku O, Meiring TL, Gustavsson I, Phohlo K, Garcia-Jardon M, Mbulawa ZZA, Businge CB, Gyllensten U, Williamson AL. Acceptability of self- collection for human papillomavirus detection in the Eastern Cape, South Africa. PLoS One 2020; 15:e0241781. [PMID: 33170891 PMCID: PMC7654756 DOI: 10.1371/journal.pone.0241781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) testing on vaginal self-collected and cervical clinician-collected specimens shows comparable performance. Self-sampling on FTA cards is suitable for women residing in rural settings or not attending regular screening and increases participation rate in the cervical cancer screening programme. We aimed to investigate and compare high-risk (HR)-HPV prevalence in clinician-collected and self-collected genital specimens as well as two different HPV tests on the clinician collected samples. A total of 737 women were recruited from two sites, a community health clinic (n = 413) and a referral clinic (n = 324) in the Eastern Cape Province. Cervical clinician-collected (FTA cards and Digene transport medium) and vaginal self-collected specimens were tested for HR-HPV using the hpVIR assay (FTA cards) and Hybrid Capture-2 (Digene transport medium). There was no significant difference in HR-HPV positivity between clinician-collected and self-collected specimens among women from the community-based clinic (26.4% vs 27.9%, p = 0.601) or the referral clinic (83.6% vs 79.9%, p = 0.222). HPV16, HPV35, and HPV33/52/58 group were the most frequently detected genotypes at both study sites. Self-sampling for HPV testing received a high positive response of acceptance (77.2% in the community-based clinic and 83.0% in referral clinic). The overall agreement between hpVIR assay and HC-2 was 87.7% (k = 0.754). The study found good agreement between clinician-collected and self-collected genital specimens. Self-collection can have a positive impact on a cervical screening program in South Africa by increasing coverage of women in rural areas, in particular those unable to visit the clinics and women attending clinics where cytology-based programs are not functioning effectively.
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Affiliation(s)
- Ongeziwe Taku
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Tracy L. Meiring
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Keletso Phohlo
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Mirta Garcia-Jardon
- Department of Pathology at Walter Sisulu University and National Health Laboratory Service, Mthatha, South Africa
| | - Zizipho Z. A. Mbulawa
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Laboratory Medicine and Pathology, National Health Laboratory Service Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Medical Virology, National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Charles B. Businge
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Mthatha, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Anna-Lise Williamson
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Chatzistamatiou K, Vrekoussis T, Tsertanidou A, Moysiadis T, Mouchtaropoulou E, Pasentsis K, Kitsou A, Moschaki V, Ntoula M, Zempili P, Halatsi D, Truva T, Piha V, Agelena G, Daponte A, Vanakara P, Paschopoulos M, Stefos T, Lymberis V, Kontomanolis EN, Makrigiannakis A, Deligeoroglou E, Panoskaltsis T, Adonakis G, Michail G, Stamatopoulos K, Agorastos T. Acceptability of Self-Sampling for Human Papillomavirus-Based Cervical Cancer Screening. J Womens Health (Larchmt) 2020; 29:1447-1456. [DOI: 10.1089/jwh.2019.8258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kimon Chatzistamatiou
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Thomas Vrekoussis
- Department of Obstetrics and Gynecology, University of Crete, Herakleion University Hospital, Herakleion, Greece
| | - Athena Tsertanidou
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Centre for Research & Technology—Hellas, Thessaloniki, Greece
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Konstantinos Pasentsis
- Institute of Applied Biosciences, Centre for Research & Technology—Hellas, Thessaloniki, Greece
| | - Anastasia Kitsou
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Viktoria Moschaki
- Department of Neonatology, Hippokratio General Hospital, Midwifery Association of Thessaloniki, Thessaloniki, Greece
| | - Maria Ntoula
- Primary Health Care Unit 25th Martiou, Thessaloniki, Midwifery Network Coordinator, 4th Health District, Thessaloniki, Greece
| | - Paraskevi Zempili
- Department of Obstetrics and Gynecology, General Hospital of Komotini, Midwifery Association of Thrace, Komotini, Greece
| | - Despina Halatsi
- Department of Obstetrics and Gynecology, Hatzikosta General Hospital of Ioannina, Midwifery Association of Ioannina, Ioannina, Greece
| | - Theoni Truva
- Health Center Palama, Midwifery Association of Larissa, Karditsa, Greece
| | - Vaia Piha
- Department of Obstetrics and Gynecology, General Hospital of Chania, Midwifery Association of Crete, Chania, Greece
| | - Georgia Agelena
- Department of Obstetrics and Gynecology, General Hospital of Korinth, Midwifery Association of Nafplion, Korinth, Greece
| | - Alexandros Daponte
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa University Hospital, Larissa, Greece
| | - Polyxeni Vanakara
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa University Hospital, Larissa, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina University Hospital, Ioannina, Greece
| | - Theodoros Stefos
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina University Hospital, Ioannina, Greece
| | - Vasilis Lymberis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, University of Crete, Herakleion University Hospital, Herakleion, Greece
| | - Efthimios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, National Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Theodoros Panoskaltsis
- 2nd Department of Obstetrics and Gynecology, National Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - George Adonakis
- Department of Obstetrics and Gynecology, University of Patras, Patras University Hospital, Patras, Greece
| | - George Michail
- Department of Obstetrics and Gynecology, University of Patras, Patras University Hospital, Patras, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research & Technology—Hellas, Thessaloniki, Greece
| | - Theodoros Agorastos
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
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Greibe Andersen J, Shrestha AD, Gyawali B, Neupane D, Kallestrup P. Barriers and facilitators to cervical cancer screening uptake among women in Nepal - a qualitative study. Women Health 2020; 60:963-974. [PMID: 32643576 DOI: 10.1080/03630242.2020.1781742] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband's support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.
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Affiliation(s)
| | | | - Bishal Gyawali
- Department of Public Health, Global Health Section, University of Copenhagen, Denmark
| | - Dinesh Neupane
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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He L, He J. Attitudes towards HPV self-sampling among women in Chengdu, China: A cross-sectional survey. J Med Screen 2020; 27:201-206. [PMID: 31896295 DOI: 10.1177/0969141319895543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cervical cancer screening participation in China remains insufficient, possibly because of embarrassment or discomfort. We assessed knowledge of HPV and its link to cervical cancer, and whether HPV self-sampling might be an acceptable alternative to clinician-based screening, among Sichuan women. METHODS A sample of healthy women undergoing routine physical examinations in 2017 at the West China Hospital, Sichuan University, completed a questionnaire. RESULTS From 3000 questionnaires distributed, 1810 were completed and analyzed. Only 29.94% of respondents (n = 542) had heard of HPV, among whom 65.75% knew that it caused cervical cancer. Among the 766 (42.32%) who considered that HPV self-sampling for cervical cancer screening was an acceptable option, over 90% thought it would be convenient, private, not embarrassing, and not painful. However, 1044 women (57.68%) did not consider self-sampling acceptable, mainly because the result might not be accurate (85.63%), specimens may have gone bad (83.05%), and they may not perform the test correctly (79.98%). Respondents who believed HPV self-sampling was acceptable were more likely than other respondents to be young, and to have completed at least secondary education. Of the 1810 respondents, 1312 (72.49%) reported that they would be willing to be vaccinated against HPV. CONCLUSION Most women in Chengdu lack basic knowledge about HPV. Over 40% of women believed HPV self-sampling for cervical cancer screening was an acceptable option. To increase screening coverage, public health efforts to educate the public about HPV and HPV self-sampling for cervical cancer screening should be strengthened and expanded.
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Affiliation(s)
- Lixia He
- Department of Obstetrics and Gynecology, West China Second University Hospital, West China Women's and Children's Hospital, Sichuan University, Sichuan, China
| | - Junyong He
- Health Management Center of West China Hospital of Sichuan University, Sichuan, China
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Effectiveness of patient-targeted interventions to increase cancer screening participation in rural areas: A systematic review. Int J Nurs Stud 2020; 101:103401. [DOI: 10.1016/j.ijnurstu.2019.103401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 01/22/2023]
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Brandt T, Wubneh SB, Handebo S, Debalkie G, Ayanaw Y, Alemu K, Jede F, von Knebel Doeberitz M, Bussmann H. Genital self-sampling for HPV-based cervical cancer screening: a qualitative study of preferences and barriers in rural Ethiopia. BMC Public Health 2019; 19:1026. [PMID: 31366402 PMCID: PMC6669971 DOI: 10.1186/s12889-019-7354-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 07/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background In the context of WHO’s “task shifting” project and growing global consensus on primary HPV-based cervical cancer screening, self-sampling is a promising new tool to expand screening access, uptake and coverage for women worldwide. We aimed to explore perceptions and acceptability of HPV self-sampling-based cervical cancer screening among community members and health professionals in rural northwest Ethiopia and to identify preferences and socio-cultural barriers regarding self-sampling in order to design a suitable high-coverage screening intervention for a rural African setting. Methods Four community-based focus group discussions (FGD) were conducted in the rural district of Dabat, Northwest Ethiopia, each comprising 8 to 14 female participants, counting a total of 41 participants. The groups were homogenously composed in terms of their socio-economic status in the community. They included health centre attendees, community members, nurses and health development army leaders (HDAL). Two qualitative data collection experts conducted the interviews in the local language, using a FGD guide with several thematic areas. All participants granted written informed consent prior to the conduct of the interviews. As a concrete example of an existing self-sampling approach for cervical cancer screening we used the Evalyn® Brush. Results Emerging themes included (i) misconceptions and low awareness about cervical cancer among community residents and primary health care providers in rural northwest Ethiopia, (ii) stigmatization and social exclusion of affected women, (iii) delay in seeking of health care due to poor access and availability of services, and lacking of a concept of early cancer prevention, (iv) need of spousal permission, (v) fear of financial burden and (vi) fear of social marginalization. The self-sampling device was regarded to be acceptable and was judged to be easy to use for most women. The existing Ethiopian health care structure could facilitate a community approach. Conclusion Home-based self-sampling for cervical cancer screening is a socially acceptable and feasible “task shifting” method that will increase cervical cancer screening access and coverage in the Ethiopian study community. Education, awareness creation, community mobilization and family inclusion are identified as key activities to promote, implement and facilitate “task shifting” approaches like self-sampling. Electronic supplementary material The online version of this article (10.1186/s12889-019-7354-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Theresa Brandt
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
| | - Solomon Berhe Wubneh
- Department of Gynaecology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Simegnew Handebo
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getu Debalkie
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohanes Ayanaw
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Felix Jede
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Hermann Bussmann
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
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Lorenzi NPC, Termini L, Longatto Filho A, Tacla M, de Aguiar LM, Beldi MC, Ferreira-Filho ES, Baracat EC, Soares-Júnior JM. Age-related acceptability of vaginal self-sampling in cervical cancer screening at two university hospitals: a pilot cross-sectional study. BMC Public Health 2019; 19:963. [PMID: 31319838 PMCID: PMC6637504 DOI: 10.1186/s12889-019-7292-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether age is a barrier against acceptability of cervicovaginal self-sampling in screening for cervical cancer at two gynecology outpatient clinics. METHODS This is a cross-sectional study involving 116 women over 21 years of age with an abnormal Pap smear. Clinical and laboratorial data were recorded in electronic files. Women received detailed self-collection instructions. After the self-sampling procedure (Evalyn Brush®), women were instructed to answer a questionnaire about vaginal self-sampling acceptability that consisted of seven multiple-choice items. The participants were divided into three age brackets: 21 to 29 years, 30 to 49 years, and 50 years and over. Chi-square, Fischer exact, Kolmogorov-Smirnov and Kruskal-Wallis tests were used. RESULTS The analysis of the participants' perception of the procedure stratified according to age groups showed a decline in the fear of hurting oneself during the procedure as age increased. Most participants reported that it was very easy to understand how to use the self-sampling brush and that it was easy to use it. Most of them were neither embarrassed nor afraid of getting hurt during the procedure. The majority preferred self-sampling to collection by a healthcare professional. The main reason was practicality: the possibility of choosing the place and time for sampling. CONCLUSIONS The participating women found self-collection simple to understand and easy to accept regardless of age. The younger women indicated more fear and discomfort in self-sampling, which points to the need for attraction strategies that are more appealing to the younger generations.
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Affiliation(s)
| | - Lara Termini
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Adhemar Longatto Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital/Pio XII Foundation, Barretos, SP, Brazil.,Department of Pathology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute of Life and Health Sciences (ICVS), University of Minho, Braga, Portugal.,8ICVS / 3B's - Associated Laboratory to the Government of Portugal, Braga / Guimarães, Portugal
| | - Maricy Tacla
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lana Maria de Aguiar
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Carmezim Beldi
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Edson Santos Ferreira-Filho
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Narasimhan M, Allotey P, Hardon A. Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance. BMJ 2019; 365:l688. [PMID: 30936087 PMCID: PMC6441866 DOI: 10.1136/bmj.l688] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Manjulaa Narasimhan
- World Health Organization, including Special Programme for Human Reproduction, Geneva, Switzerland
| | - Pascale Allotey
- UN University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Anita Hardon
- Amsterdam Institute for Advanced Studies, Amsterdam, Netherlands
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Allende G, Surriabre P, Cáceres L, Bellot D, Ovando N, Torrico A, Calle P, Ascarrunz C, Alexander S, Bossens M, Fontaine V, Rodríguez P. Evaluation of the self-sampling for cervical cancer screening in Bolivia. BMC Public Health 2019; 19:80. [PMID: 30654774 PMCID: PMC6337790 DOI: 10.1186/s12889-019-6401-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background Incidence and mortality rates of cervical cancer in Bolivia are the highest in Latin America. Vaginal cell self-sampling can improve screening coverage. Information on common reasons for low screening coverage and preferences for future screening are essential to reduce cervical cancer incidence. We aimed to evaluate the knowledge about human papillomavirus (HPV) and cervical cancer of Bolivian women from urban, peri-urban and rural areas of Cochabamba and to determine their degree of acceptability and confidence towards vaginal HPV self-sampling. In addition, we assessed the impact of self-sampling on cervical cancer screening coverage in a selected peri-urban area. Methods We gathered information from women living in urban, peri-urban and rural areas of Cochabamba province in Bolivia using two different structured questionnaires. In Survey1, we collected information from 222 women about their knowledge on HPV and cervical cancer. In Survey 2, the acceptance and confidence towards vaginal HPV self-sampling compared to the physician-sampling was assessed in 221 women. A non-probabilistic stratified sampling by areas was carried out for the two questionnaires. In the third phase of the study, we determined the impact of HPV self-sampling collection on screening coverage in a peri-urban area of Cochabamba. Results Bolivian women knew little or nothing about cervical cancer and HPV infection in all areas. They all found self-sampling collection easier to perform (86.9 to 93.2%) and more comfortable (79.4 to 83.3%) compared to physician sampling. Sampling accuracy to detect cervical cancer was probably higher in their point of view when it was taken by physician (35.1 to 63.5%). However in rural areas women preferred self-sampling. Accordingly, the campaign of vaginal HPV self-sampling in this peri-urban area increased screening coverage, reaching in three months the annual rate average. Conclusions The knowledge about cervical cancer and HPV infection is poor in Bolivia. Despite greater acceptance of the vaginal HPV self-sampling in all areas, women kept greater confidence in the screening performed by the gynecologist although HPV self-sampling improved coverage rate. Electronic supplementary material The online version of this article (10.1186/s12889-019-6401-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gustavo Allende
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles (U.L.B.), CP205/2, Campus Plaine, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Pedro Surriabre
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles (U.L.B.), CP205/2, Campus Plaine, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Leyddy Cáceres
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Diego Bellot
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Neli Ovando
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Andrea Torrico
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Pamela Calle
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Carla Ascarrunz
- Institute of Social Sciences Research (INCISO). Faculty of Social Sciences, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Sophie Alexander
- Ecole de Santé Publique, Université Libre de Bruxelles (U.L.B.), CP596, route de Lennik 808, 1070, Brussels, Belgium
| | - Michel Bossens
- Research laboratory in human reproduction, Campus Erasme, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Fontaine
- Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles (U.L.B.), CP205/2, Campus Plaine, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Patricia Rodríguez
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.
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Rodrigues LLS, Morgado MG, Sahasrabuddhe VV, De Paula VS, Oliveira NS, Chavez-Juan E, Da Silva DM, Kast WM, Nicol AF, Pilotto JH. Cervico-vaginal self-collection in HIV-infected and uninfected women from Tapajós region, Amazon, Brazil: High acceptability, hrHPV diversity and risk factors. Gynecol Oncol 2018; 151:102-110. [PMID: 30087059 PMCID: PMC6151287 DOI: 10.1016/j.ygyno.2018.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We evaluated acceptability of cervico-vaginal self-collection (CVSC) and prevalence of human papillomavirus (HPV) in Human immunodeficiency virus (HIV)-infected and HIV-uninfected women living in the Tapajós region, Amazon, Brazil. METHODS Cross-sectional study recruited 153 non-indigenous women (HIV-uninfected, n = 112 and HIV-infected, n = 41) who voluntarily sought assistance in health services. Peripheral blood for HIV screening and cervical scraping (CS) for HPV detection were collected. Women who accepted to perform CVSC received instructions and individual collection kits. Risk factors for high-risk HPV genotypes (hrHPV) were identified by uni- and multivariate analyses. RESULTS The overall acceptability of CVSC was 87%. Only HIV-infected women had cytological abnormalities (12.2%). Prevalence of any HPV and hrHPV infection was 42.9% and 47.9% for HIV-uninfected and 97.6% and 77.5% for HIV-infected women, respectively. There was significant agreement in the detection of HPV (88%, 0.76, 95% confidence interval [CI], 0.65-0.87) and hrHPV (79.7%, 0.56, 95% CI, 0.41-0.71) between self-collected and clinician-collected samples. The most prevalent hrHPV types were HPV16 and HPV18 in HIV-uninfected and HPV16, HPV51 and HPV59 in HIV-infected women. HIV-infected women with hrHPV infection had multiple hrHPV infections (p = 0.005) and lower CD4 count (p = 0.018). Risk factors for hrHPV infection included being HIV-infected and having five or more sexual partners. CONCLUSIONS CVSC had high acceptability and high prevalence of hrHPV types in women living in the Tapajós region, Amazon, Brazil.
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Affiliation(s)
- Luana L S Rodrigues
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro, Brazil; Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará, Santarém, Pará, Brazil.
| | - Mariza G Morgado
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro, Brazil.
| | | | | | - Nathália S Oliveira
- Programa de Pós-Graduação em Patologia, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Elena Chavez-Juan
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Diane M Da Silva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - W Martin Kast
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Department of Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA, USA
| | - Alcina F Nicol
- Instituto Nacional de Infectologia Evandro Chagas, INI-FIOCRUZ, Rio de Janeiro, Brazil; Laboratório Interdisciplinar de Pesquisas Médicas, IOC-FIOCRUZ, Rio de Janeiro, Brazil
| | - José H Pilotto
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro, Brazil
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Ejegod DM, Pedersen H, Alzua GP, Pedersen C, Bonde J. Time and temperature dependent analytical stability of dry-collected Evalyn HPV self-sampling brush for cervical cancer screening. PAPILLOMAVIRUS RESEARCH 2018; 5:192-200. [PMID: 29689311 PMCID: PMC6026099 DOI: 10.1016/j.pvr.2018.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022]
Abstract
As a new initiative, HPV self-sampling to non-attenders using the dry Evalyn self-sampling brush is offered in the Capital Region of Denmark. The use of a dry brush is largely uncharted territory in terms of analytical stability. In this study we aim to provide evidence on the analytical quality of dry HPV self-sampling brushes as a function of time and temperature. We assessed the analytical stability of dry stored Evalyn brushes at three different temperatures, (4 °C, room temperature, 30 °C) and five different storage time points; T = 0 (baseline), 2, 4, 8, 16, and 32 weeks prior to HPV analysis using the BD Onclarity HPV assay. Mean Ct value of the Onclarity internal control was used as comparator of cellularity across time and temperatures, with no or only borderline statistical differences observed. HPV detection was stable throughout the five time points. In addition, analytically amplifiable DNA copy numbers and DNA fragmentation was assessed using the Agena iPLEX Exome QC assay, with no or only borderline statistical differences observed. In conclusion, the Evalyn brush is analytically stable with respect to human genomic material and HPV detection for up to 32 weeks at temperatures ranging from 4 °C to 30 °C. The Capital Region of Denmark is implementing HPV self-sampling using a dry brush. But how analytically stable is a dry collected self-sampling device? Stability was established for both human DNA (all, N = 637) and HPV (positives, N = 41). We found the Evalyn Self-sampling brush stable up to 6 month. Neither 4 °C nor 30 °C changed the analytical stability of the dry brush.
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Affiliation(s)
- Ditte Møller Ejegod
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | - Helle Pedersen
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Garazi Peña Alzua
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Camilla Pedersen
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
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Gupta S, Palmer C, Bik EM, Cardenas JP, Nuñez H, Kraal L, Bird SW, Bowers J, Smith A, Walton NA, Goddard AD, Almonacid DE, Zneimer S, Richman J, Apte ZS. Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health 2018; 6:77. [PMID: 29686981 PMCID: PMC5900042 DOI: 10.3389/fpubh.2018.00077] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/01/2018] [Indexed: 12/23/2022] Open
Abstract
In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample will visit a clinic for follow-up diagnosis and management. In addition, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zachary S Apte
- uBiome, San Francisco, CA, United States.,University of California San Francisco, San Francisco, CA, United States
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