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Park NJY, Park CSY, Jeong JY, Kim M, Yoo SH, Chong GO, Hong DG, Park JY. Strategic Significance of Low Viral Load of Human Papillomavirus in Uterine Cervical Cytology Specimens. Diagnostics (Basel) 2022; 12:diagnostics12081855. [PMID: 36010208 PMCID: PMC9406681 DOI: 10.3390/diagnostics12081855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Infection with high-risk (HR) Human Papillomavirus (HPV) is associated with the development of precancerous lesions or invasive carcinoma of the uterine cervix. Thus, the high viral load (VL) of HR-HPV DNA currently serves as a representative quantitative marker for cervical cancer. However, the clinical significance of low HPV DNA VL remains undetermined. This study aimed to evaluate the clinical association between the low HPV DNA VL and cytology/histologic diagnosis of cervical samples. We searched the electronic medical databases for the resultant analyses of HPV genotyping among patients who underwent treatment for any cervical lesion or who had undergone gynecological examinations with any positive HPV results according to the national cancer screening service between 2015 and 2016. HPV testing with genotyping and semi-quantitative VL measurement was conducted using an AnyplexTM II H28 Detection assay (H28 assay, Seegene, Seoul, Republic of Korea). The H28 assay is a multiplex semi-quantitative real-time PCR test using the tagging of oligonucleotide cleavage and extension (TOCE) technology. The VL was semi-quantified as high (3+; positive signal before 31 PCR cycles), intermediate (2+; positive between 31 and 39 PCR cycles), or low (1+; positive after 40 PCR cycles). Out of 5940 HPV VL analyses, 356 assays (5.99%) were reported as low VL (1+) of HPV DNA. Matched cytology diagnoses were mostly negative findings (n = 347, 97.5%), except for seven cases of atypical squamous cells of undetermined significance (1.9%) and two cases of atypical glandular cells (0.6%). During the follow-up periods, abnormal cytologic diagnoses were identified, including one case of high-grade squamous intraepithelial lesion (HSIL) and two low-grade squamous intraepithelial lesions (LSILs). The matched, confirmative histologic diagnosis of HSIL cytology was compatible with chronic inflammation, wherein the two LSILs had regular check-ups. None revealed clinically concerned outcomes associated with HPV-related squamous lesions. The cytology was most likely negative for malignancy when the VL of HPV DNA was low (1+). Additional strategic monitoring and management may thus be unnecessary.
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Affiliation(s)
- Nora Jee-Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea; (N.J.-Y.P.); (J.Y.J.); (M.K.)
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu 41405, Korea;
- KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Science, Kyungpook National University, Daegu 41566, Korea
| | | | - Ji Yun Jeong
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea; (N.J.-Y.P.); (J.Y.J.); (M.K.)
| | - Moonsik Kim
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea; (N.J.-Y.P.); (J.Y.J.); (M.K.)
| | - Su Hyun Yoo
- Department of Pathology, National Police Hospital, Seoul 05715, Korea;
| | - Gun Oh Chong
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu 41405, Korea;
- KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Science, Kyungpook National University, Daegu 41566, Korea
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea;
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea;
| | - Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea; (N.J.-Y.P.); (J.Y.J.); (M.K.)
- Correspondence: ; Tel.: +82-53-200-3405; Fax: +82-53-200-3399
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Tran PT, Riaz M, Chen Z, Truong CB, Diaby V. An Umbrella Review of the Cost Effectiveness of Human Papillomavirus Vaccines. Clin Drug Investig 2022; 42:377-390. [PMID: 35488964 DOI: 10.1007/s40261-022-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Although many systematic reviews for the human papillomavirus vaccines cost effectiveness have been published, they vary in perspectives, methods, and quality. We aimed to condense systematically such evidence to facilitate locating, processing, and learning, not only about the consensus of findings but also how models were built and their evolution over time and across settings. METHODS We conducted an umbrella review of cost-effectiveness studies for human papillomavirus vaccines using three databases (PubMed, Embase, and Cochrane). Based on their objectives, we classified studies into three groups (human papillomavirus vaccines cost effectiveness, model characteristics, and all-type vaccines, including human papillomavirus vaccines). We used the AMTAR2 to assess the quality of the studies. Additionally, we provided a summary of study findings, discussions, and evidence gaps in the literature. RESULTS Though most studies were critically low quality and had a low quality of reporting, the human papillomavirus vaccine was consistently cost effective in young girls and men who have sex with men. Stratified analyses by rated quality did not change the results. The quality assessment of the reviews did not necessarily reflect the quality assessment of underlying studies. The human papillomavirus vaccine models became more complex over time, capturing more realistic disease transmission with different human papillomavirus strains and herd immunities. CONCLUSIONS Additional evidence is needed for vulnerable populations (e.g., childhood cancer survivors) who are at high risk for human papillomavirus vaccine-related cancers and, therefore, may be more cost effective when receiving human papillomavirus vaccines. Quantifying human papillomavirus vaccine cost effectiveness via meta-analyses is feasible if investigators can increase the homogeneity of their populations.
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Affiliation(s)
- Phuong T Tran
- Faculty of Pharmacy, HUTECH University, 475A Dien Bien Phu Street, Ward 25, Binh Thanh District, Ho Chi Minh City, 700000, Vietnam. .,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
| | - Munaza Riaz
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Ziyan Chen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Cong Bang Truong
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Tejada RA, Malagón T, Franco EL. Cost-effectiveness of human papillomavirus vaccination in girls living in Latin American countries: A systematic review and meta-analysis. Vaccine 2022; 40:2667-2678. [DOI: 10.1016/j.vaccine.2022.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 01/22/2023]
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Muresu N, Sotgiu G, Marras S, Gentili D, Sechi I, Cossu A, Dettori A, Pietri RE, Paoni L, Ghi ME, Bagella MP, Marrazzu A, Cossu A, Genovesi A, Piana A, Saderi L. Cervical Screening in North Sardinia (Italy): Genotype Distribution and Prevalence of HPV among Women with ASC-US Cytology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020693. [PMID: 35055515 PMCID: PMC8775344 DOI: 10.3390/ijerph19020693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
The assessment of human papillomavirus (HPV) genotype dynamics could support the adoption of more tailored preventive actions against cervical cancer. The aim of the study was to describe the prevalence of HPV infection, HPV genotype distribution, and the epidemiological characteristics of women with ASC-US cytology since the introduction of HPV-DNA testing in Sardinia (Italy), (March 2016–December 2020). Specimens were tested by RT-PCR for 14 high-risk HPV genotypes. A total of 1186 patients were enrolled, with a median (IQR) age of 41 (38–48) years. Of these women, 48.1% were positive for at least one HPV genotype; 311 (26.2%) women were vaccinated with a median (IQR) age of 38 (30/47) years. The percentage of prevalence of HPV-16, -31, -66, -56, and -51 was 36.3%, 18.7%, 11.9%, 11.4% and 10.7%, respectively. The highest prevalence of infection was found in women aged <41 years, and single women. Moreover, women aged >41 years (OR: 0.51, 95% CI: 0.31–0.86; p-value: 0.01), having parity (OR: 0.57, 95% CI: 0.34–0.96, p-value: 0.04), and higher educational level (OR: 0.39, 95% CI: 0.18–0.87; p-value: 0.02) were associated with a lower CIN2+ risk. We did not find a significant difference in terms of prevalence of HPV-16 infection between vaccinated and non-vaccinated (18.3% vs. 17.1%; p-value < 0.001). Our results support the adoption of nonavalent HPV-vaccine to prevent the most prevalent infections caused by HPV-16 and -31 genotypes and underscore the need of surveillance to implement tailored vaccination programs and preventive strategies.
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Affiliation(s)
- Narcisa Muresu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy; (N.M.); (S.M.); (D.G.); (I.S.); (A.C.); (A.P.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy;
- Correspondence: ; Tel.: +39-079-228472
| | - Silvia Marras
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy; (N.M.); (S.M.); (D.G.); (I.S.); (A.C.); (A.P.)
| | - Davide Gentili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy; (N.M.); (S.M.); (D.G.); (I.S.); (A.C.); (A.P.)
| | - Illari Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy; (N.M.); (S.M.); (D.G.); (I.S.); (A.C.); (A.P.)
| | - Andrea Cossu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy; (N.M.); (S.M.); (D.G.); (I.S.); (A.C.); (A.P.)
| | - Arianna Dettori
- Biomedical Science Ph.D. School, Biomedical Science Department, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy;
| | - Roberto Enrico Pietri
- ASSL Sassari, Coordinamento Consultori Familiari ASSL, Sassari 07100, Italy; (R.E.P.); (L.P.); (M.E.G.); (M.P.B.); (A.M.)
| | - Luisa Paoni
- ASSL Sassari, Coordinamento Consultori Familiari ASSL, Sassari 07100, Italy; (R.E.P.); (L.P.); (M.E.G.); (M.P.B.); (A.M.)
| | - Maria Eugenia Ghi
- ASSL Sassari, Coordinamento Consultori Familiari ASSL, Sassari 07100, Italy; (R.E.P.); (L.P.); (M.E.G.); (M.P.B.); (A.M.)
| | - Maria Paola Bagella
- ASSL Sassari, Coordinamento Consultori Familiari ASSL, Sassari 07100, Italy; (R.E.P.); (L.P.); (M.E.G.); (M.P.B.); (A.M.)
| | - Adriano Marrazzu
- ASSL Sassari, Coordinamento Consultori Familiari ASSL, Sassari 07100, Italy; (R.E.P.); (L.P.); (M.E.G.); (M.P.B.); (A.M.)
| | - Antonio Cossu
- Department of Medical, Surgical and Experimental Sciences, Institute of Pathology, University of Sassari, Via Matteotti, 07100 Sassari, Italy;
| | - Antonio Genovesi
- Department Health Education, Prevention, and Health Promotion Activities, 07100 Sassari, Italy;
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy; (N.M.); (S.M.); (D.G.); (I.S.); (A.C.); (A.P.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street, 07100 Sassari, Italy;
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Chowdhury S, Ara R, Roy S, Tanvir SMS, Eva FN, Neela TM, Moonmoon AA, Sifat S, Zamila M, Hawlader MDH. Knowledge, attitude, and practices regarding human papillomavirus and its’ vaccination among the young medical professionals and students of Bangladesh. Clin Exp Vaccine Res 2022; 11:63-71. [PMID: 35223666 PMCID: PMC8844672 DOI: 10.7774/cevr.2022.11.1.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Sexually transmitted infections are a major worldwide concern, and human papillomavirus (HPV) is one of the significant risk factors. Many populations suffer from various diseases caused by HPV, and the overall death toll due to cervical carcinoma is remarkable. Despite vaccine availability, perception about vaccine safety and efficacy, its’ preventive outcome is still inferior among the health professionals and vaccine providers. So, this study aims to assess the knowledge, attitude, and practice level of HPV and its’ vaccination among doctors, dentists, and medical students. Materials and Methods This cross-sectional survey was carried out between April to August 2021, where 626 participants from all types of medical institutions of Bangladesh were interviewed using a validated and structured questionnaire that consists of four extensive areas; socio-demographic characteristics, HPV knowledge, attitude, and practices regarding vaccination. Results The knowledge and practice standards showed very poor outcomes where 43.29% of the participants showed good knowledge and only 11.82% conveyed good practices. Nevertheless, the attitude towards HPV vaccination was revealed high (75.88%). Female participants showed more positive attitudes than males. Conclusion Physicians and dentists play vital roles in raising public knowledge about HPV and awareness regarding HPV vaccination programs. The provision of medical education on HPV must be prioritized, and current training techniques must be re-evaluated. Thus, by implementing this strategy, improvement in national vaccination policy can be expected.
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Affiliation(s)
| | - Rifat Ara
- Department of Public Health, North South University, Dhaka, Bangladesh
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Simanta Roy
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | | | | | | | - Shamma Sifat
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Mushfera Zamila
- Department of Public Health, North South University, Dhaka, Bangladesh
- Pharmacovigilance Department, Beacon Pharmaceuticals Limited, Dhaka, Bangladesh
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Shi W, Cheng X, Wang H, Zang X, Chen T. Cost-effectiveness of human papillomavirus vaccine in China: a systematic review of modelling studies. BMJ Open 2021; 11:e052682. [PMID: 34880019 PMCID: PMC8655525 DOI: 10.1136/bmjopen-2021-052682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES China suffers from high burdens of human papillomavirus (HPV) and cervical cancer, whereas the uptake of HPV vaccine remains low. The first Chinese domestic HPV vaccine was released in 2019. However, collective evidence on cost-effectiveness of HPV vaccination in China has yet to be established. We summarised evidence on the cost-effectiveness of HPV vaccine in China. DESIGN Systematic review and narrative synthesis DATA SOURCES: PubMed, EMBASE, China National Knowledge Infrastructure and Wanfang Data were searched through 2 January 2021 ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Cost-effectiveness studies using a modelling approach focusing on HPV vaccination interventions in the setting of China were included for review. DATA EXTRACTION AND SYNTHESIS We extracted information from the selected studies focusing on cost-effectiveness results of various vaccination programmes, key contextual and methodological factors influencing cost-effectiveness estimates and an assessment of study quality. RESULTS A total of 14 studies were included for review. Considerable heterogeneity was found in terms of the methodologies used, HPV vaccination strategies evaluated and study quality. The reviewed studies generally supported the cost-effectiveness of HPV vaccine in China, although some reached alternative conclusions, particularly when assessed incremental to cervical cancer screening. Cost of vaccination was consistently identified as a key determinant for the cost-effectiveness of HPV vaccination programmes. CONCLUSIONS Implementing HPV vaccination programmes should be complemented with expanded cervical cancer screening, while the release of lower-priced domestic vaccine offers more promising potential for initiating public HPV vaccination programmes. Findings of this study contributes important evidence for policies for cervical cancer prevention in China and methodological implications for future modelling efforts.
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Affiliation(s)
- Wenchuan Shi
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiaoli Cheng
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haitao Wang
- Office of Financial Affairs, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China, Chongqing, China
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Tingting Chen
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Dapaah G, Hille J, Faquin WC, Whittaker J, Dittrich CM, Ebrahim AK, Schneider JW, van Wyk AC, Opperman J, Merven M, Naidoo K, Loock JW, Afrogheh AH. The Prevalence of Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma at One of the Largest Tertiary Care Centers in Sub-Saharan Africa. Arch Pathol Lab Med 2021; 146:1018-1023. [PMID: 34871360 DOI: 10.5858/arpa.2021-0021-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Limited data exist on the prevalence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma in sub-Saharan Africa. OBJECTIVE.— To determine the prevalence of HPV-positive oropharyngeal squamous cell carcinoma at a large tertiary care center in South Africa. DESIGN.— A total of 266 oropharyngeal squamous cell carcinomas diagnosed during an 11-year period (2007-2017) were selected for evaluation. Cases staining positive for p16 immunohistochemistry were evaluated for high-risk HPV using the BD Onclarity assay (BD Diagnostics, Sparks, Maryland). RESULTS.— Of 266 oropharyngeal squamous cell carcinomas, 14% (n = 36) were positive for p16. Polymerase chain reaction for high-risk HPV performed on the p16-positive cases was negative in 23 cases and positive in 13 cases (13 of 266; 5%). p16 showed a positive predictive value of 36.1%. The HPV subtypes were HPV-16 (n = 10), HPV-18 (n = 1), HPV-52 (n = 1), and HPV-31 (n = 1). Human papillomavirus-positive cases occurred in 10 men and 3 women (mean age, 51 years) and arose from the tonsil (n = 10) or base of the tongue (n = 3). The HPV-positive cases were non-keratinizing (n = 10) or partially keratinizing (n = 1). Partially/nonkeratinizing cases revealed a modest improvement in p16 positive predictive value (11 of 21; 52.4%). CONCLUSIONS.— The presence of high-risk HPV in 5% of cases suggests that high-risk HPV is a minor etiologic agent in oropharyngeal squamous cell carcinoma in this region. Given its suboptimal positive predictive value, p16 is not a reliable marker for high-risk HPV infection in this region. When p16 is positive, HPV-specific testing is necessary. The identification of less common high-risk HPV types, HPV-52 and HPV-31, may influence current local vaccination strategies.
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Affiliation(s)
- Gloria Dapaah
- From the Department of Oral and Maxillofacial Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, University of the Western Cape, Cape Town, South Africa (Dapaah, Hille, Opperman, Afrogheh)
| | - Jos Hille
- From the Department of Oral and Maxillofacial Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, University of the Western Cape, Cape Town, South Africa (Dapaah, Hille, Opperman, Afrogheh)
| | - William C Faquin
- the Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston (Faquin)
| | - Judith Whittaker
- Lancet Laboratories, Cape Town, South Africa (Whittaker, Dittrich)
| | | | - Abdul-Kader Ebrahim
- The Department of Ear, Nose and Throat (Ebrahim, Merven, Loock), Tygerberg Academic Hospital, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Johann W Schneider
- Division of Anatomical Pathology, National Health Laboratory Service (Schneider, van Wyk), Tygerberg Academic Hospital, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Abraham C van Wyk
- Division of Anatomical Pathology, National Health Laboratory Service (Schneider, van Wyk), Tygerberg Academic Hospital, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Johan Opperman
- From the Department of Oral and Maxillofacial Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, University of the Western Cape, Cape Town, South Africa (Dapaah, Hille, Opperman, Afrogheh)
| | - Marc Merven
- The Department of Ear, Nose and Throat (Ebrahim, Merven, Loock), Tygerberg Academic Hospital, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Komeela Naidoo
- and the Division of Radiation Oncology, Department of Medical Imaging and Clinical Oncology (Naidoo), Tygerberg Academic Hospital, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - James W Loock
- The Department of Ear, Nose and Throat (Ebrahim, Merven, Loock), Tygerberg Academic Hospital, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Amir H Afrogheh
- From the Department of Oral and Maxillofacial Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, University of the Western Cape, Cape Town, South Africa (Dapaah, Hille, Opperman, Afrogheh)
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Spayne J, Hesketh T. Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators. BMJ Open 2021. [PMID: 34475188 DOI: 10.1136/bmjopen‐2021‐052016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.
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Affiliation(s)
- Jacqueline Spayne
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute for Global Health, University College London, London, UK
| | - Therese Hesketh
- Institute for Global Health, University College London, London, UK
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Abstract
BACKGROUND Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.
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Affiliation(s)
- Jacqueline Spayne
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute for Global Health, University College London, London, UK
| | - Therese Hesketh
- Institute for Global Health, University College London, London, UK
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Abidi S, Labani S, Singh A, Asthana S, Ajmera P. Economic evaluation of human papillomavirus vaccination in the Global South: a systematic review. Int J Public Health 2020; 65:1097-1111. [PMID: 32712694 DOI: 10.1007/s00038-020-01431-1] [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: 01/30/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Many reviews have been conducted on the economic evaluation of the HPV vaccine in global north countries. But there is a dearth of such reviews in the Global South countries. Hence, this systematic review aims to summarize studies done in these countries. METHODS Four databases PubMed, Embase, Cochrane Library, and Google Scholar from 2009 to 2019 were searched for economic evaluations on HPV vaccination in the Global South countries. PRISMA guidelines were followed to include full-text articles. 40 original articles were shortlisted for full-text review. RESULTS Studies had varied models, assumptions, and results according to different scenarios. Most studies concluded HPV vaccination to be cost-effective under varied scenarios and vaccine cost was the most influential parameter affecting the sensitivity analyses, consequently incremental cost-effectiveness ratio. A wide range in the cost-effectiveness ratio was observed in the included studies due to different study settings, populations, and inconsistencies in modeling practices (variations in methodological approaches). CONCLUSIONS This review suggests the introduction of HPV vaccination alone or in combination with screening according to different countries. The price of the vaccine should be economical and funds for the vaccine should be provided by public sector firms.
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Affiliation(s)
- Saba Abidi
- Delhi Pharmaceutical Sciences and Research University, New Delhi, India.
| | - Satyanarayana Labani
- Indian Council of Medical Research - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Aastha Singh
- Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Smita Asthana
- Indian Council of Medical Research - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Puneeta Ajmera
- Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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12
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Sah SK, González JV, Shrestha S, Adhikari A, Manandhar KD, Yadav SB, Stein DA, Gupta BP, Picconi MA. Human papillomavirus genotype distribution in cervical cancer biopsies from Nepalese women. Infect Agent Cancer 2018; 13:4. [PMID: 29375654 PMCID: PMC5773015 DOI: 10.1186/s13027-018-0176-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/11/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is the leading cause of morbidity and mortality from cancer in Nepalese women. Nearly all cases of CC are caused by infection with certain genotypes of human papillomavirus (HPV). Data on HPV genotype distribution in Nepalese CC patients is sparse. We aimed to determine the distribution of HPV genotypes in biopsies of CC tissue from Nepalese women. METHODS This study examined 248 archived paraffin-embedded tissue specimens from CC cases from patients of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal. DNA was extracted from the biopsies and HPV detection performed by PCR. HPV genotyping was then carried out by a reverse line hybridization technique capable of identifying 36 distinct HPV genotypes. RESULTS Most of the samples were from tumors that had been designated by hospital pathologists as squamous cell carcinoma (77.6%). 165 of the 248 samples contained DNA of sufficient quality for rigorous PCR testing. All the analyzable specimens were positive for HPV. The most common HPV genotypes, in decreasing order of frequency were 16, 18, 45, 33, 52, 56 and 31; most were found as single infections (94.5%). Together, HPV types 16, 18, and 45 were found in 92% of the tumor samples. CONCLUSION This study strengthens the knowledge-base of HPV genotype distribution in CC cases in Nepal. Hopefully, this information will be useful to the medical community and public health policy-makers in generating improved HPV-surveillance, -prevention and -treatment strategies in Nepal.
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Affiliation(s)
- Sunil Kumar Sah
- B. P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan Nepal
| | - Joaquin V. González
- Oncogenic Viruses Laboratory, National Institute of Infectious Diseases-ANLIS “Dr. Malbrán”, Av. Velez Sarsfield 563, C1282AFF Buenos Aires, Argentina
- National and Regional HPV Reference Laboratory, National Institute of Infectious Diseases-ANLIS “Dr. Malbrán”, Av. Velez Sarsfield 563, C1282AFF Buenos Aires, Argentina
| | - Sadina Shrestha
- B. P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan Nepal
| | - Anurag Adhikari
- Kathmandu Research Institute for Biological Sciences, Lalitpur, Nepal
| | - Krishna Das Manandhar
- Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Shyam Babu Yadav
- Department of Health Service, Ministry of Health, Government of Nepal, Kathmandu, Nepal
| | - David A. Stein
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Birendra Prasad Gupta
- Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - María Alejandra Picconi
- Oncogenic Viruses Laboratory, National Institute of Infectious Diseases-ANLIS “Dr. Malbrán”, Av. Velez Sarsfield 563, C1282AFF Buenos Aires, Argentina
- National and Regional HPV Reference Laboratory, National Institute of Infectious Diseases-ANLIS “Dr. Malbrán”, Av. Velez Sarsfield 563, C1282AFF Buenos Aires, Argentina
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Tran BX, Than PTQ, Doan TTN, Nguyen HLT, Thi Mai H, Nguyen THT, Le HT, Latkin CA, Zhang MWB, Ho RCM. Knowledge, attitude, and practice on and willingness to pay for human papillomavirus vaccine: a cross-sectional study in Hanoi, Vietnam. Patient Prefer Adherence 2018; 12:945-954. [PMID: 29881260 PMCID: PMC5985800 DOI: 10.2147/ppa.s165357] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite its effectiveness in preventing human papillomavirus (HPV) infection, the rate of uptake of the HPV vaccine is low in Vietnam. This study aimed to investigate barriers related to knowledge-attitude-practice (KAP) about the HPV vaccine and willingness to pay (WTP) for the vaccine among those using services in an urban vaccination clinic in Hanoi, Vietnam. MATERIALS AND METHODS A cross-sectional study was conducted in a vaccination clinic of the Institute for Preventive Medicine and Public Health in Hanoi, Vietnam, from March to April 2016. KAP on the HPV vaccine was collected using a structured questionnaire. Double-bounded dichotomous-choice questions with open-ended questions were used to examine the WTP of respondents. Interval regression and stepwise logistic models were used to identify factors associated with WTP and the average amount that people would be willing to pay for the vaccine. RESULTS Of 492 vaccination service users, 67.9%, 94.6%, and 12.3% of respondents were aware of the best age for HPV vaccination, its benefits, and the target group for vaccination, respectively. While the majority believed that the HPV vaccine was safe (92.8%) and effective (90.8%), and desired to be vaccinated (71.1%), only 31.8% of users were vaccinated. Most of the respondents were willing to pay for the HPV vaccine (86.6%), and willing to pay an average amount of US$49.3. Those aged 20-29 years and earning more than 22 million VND/month (very rich) were more likely to pay for the HPV vaccine than people aged <20 years and earning <7 million VND/month. Users who had attained more than a high-school education and heard about the HPV vaccine from doctors, nurses, or other health professionals tended to be willing to pay for the vaccine at a lower price than individuals with below secondary-level education and who had not heard about the vaccine from these health professionals. CONCLUSION Sexual health education and financial assistance should be imparted alongside the HPV vaccination program.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Correspondence: Bach Xuan Tran, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA, Tel +84 888 288 399, Email
| | - Phung Tat Quoc Than
- Department of Health Sciences, College of Health and Human Development, California State University, Northridge CA, USA
| | - Tien Thuy Ngoc Doan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Hue Thi Mai
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Melvyn WB Zhang
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore
| | - Roger CM Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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