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León-Maldonado L, Hernández-Ramírez RU, Torres-Ibarra L, Spiegelman D, Sheth SS, Lazcano E, Cadena-Fiscal JD, Salmerón J. Factors associated with receiving results and attending colposcopy in patients with positive HPV screens in Mexico City. Prev Med Rep 2023; 35:102347. [PMID: 37593354 PMCID: PMC10428024 DOI: 10.1016/j.pmedr.2023.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/23/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
We identified patient and healthcare system factors related to receipt of screening results and attendance to colposcopy among patients with positive screening results in a cervical cancer screening program in Mexico City, Mexico. We analyzed data from 1,351 patients with high-risk human papillomavirus (HPV)-positive results from two screening demonstration studies conducted between 2017 and 2018. Factors associated with receipt of screening results and with adherence to a colposcopy appointment were identified using multivariable logistic regression. Participants had a median age of 40 years (IQR = 32-48), 60% had less than high school education, and 74% had a previous Pap screening in the last 5 years. Fifty-five percent of participants retrieved their screening results at the healthcare facility (HCF) without any reminder. Providing an email address for contact information, attending a HCF with family medicine, and receiving care from experienced nurses were associated with greater adherence to obtaining screening test results. Fifty-seven percent of participants attended their first scheduled colposcopy appointment. Providing a phone number improved adherence to colposcopy, whereas longer travel times between the HCF and the colposcopy clinic was associated with a decrease in colposcopy adherence. Having a Pap test in the last 5 years was positively associated with better compliance with both outcomes. Securing contact information may help to overcome barriers to future follow-up. Additional research is necessary on strategies for obtaining screening test results and scheduling appointments, which may help address barriers to access, such as limited staff availability, distance from the clinic, and travel costs.
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Affiliation(s)
- Leith León-Maldonado
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Raúl U. Hernández-Ramírez
- Department of Biostatistics, Center for Methods in Implementation and Prevention Science (CMIPS), Yale School of Public Health (YSPH), New Haven, CT, USA
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Donna Spiegelman
- Department of Biostatistics, Center for Methods in Implementation and Prevention Science (CMIPS), Yale School of Public Health (YSPH), New Haven, CT, USA
| | - Sangini S. Sheth
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine (YSM), New Haven, CT, USA
| | - Eduardo Lazcano
- Dirección General, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - José D. Cadena-Fiscal
- Jurisdicción Sanitaria Tlalpan, Servicios de Salud de la Ciudad de México, México City, Mexico
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico
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Hu SY, Zhao XL, Zhao FH, Wei LH, Zhou Q, Niyazi M, Liu JH, Wang CY, Li LY, Cheng XD, Duan XZ, Sauvaget C, Qiao YL, Sankaranarayanan R. Implementation of visual inspection with acetic acid and Lugol's iodine for cervical cancer screening in rural China. Int J Gynaecol Obstet 2023; 160:571-578. [PMID: 35871356 DOI: 10.1002/ijgo.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/08/2022] [Accepted: 07/20/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To address the value of visual inspection where HPV-based screening is not yet available, we evaluated the real-world effectiveness of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) as a primary screening method for cervical cancer in rural China. METHODS A total of 206 133 women aged 30-59 years received two rounds of VIA/VILI screening for cervical cancer in 2006-2010. Women with positive screening results underwent colposcopy and direct biopsy, and were treated if cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was diagnosed. Clinical effectiveness of VIA/VILI was evaluated by process and outcome measures. RESULTS The VIA/VILI positivity rate, biopsy rate and detection rate of CIN2+ in the second round were significantly lower than in the first round. The 2-year cumulative detection rate of CIN2+ varied from 0.53% to 0.90% among the four cohorts initiated in 2006, 2007, 2008, and 2009. The first round of screening detected 60%-83% of CIN2, 70%-86% of CIN3, and 88%-100% of cervical cancer. Over 92% of CIN2+ were found at the early stage. CONCLUSION Multiple rounds of visual inspection with continuous training and quality assurance could act as a temporary substitutional screening method for cervical cancer in resource-restricted settings.
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Affiliation(s)
- Shang-Ying Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Lian Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang-Hui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Hui Wei
- Peking University People's Hospital, Beijing, China
| | - Qi Zhou
- Chongqing University Cancer Hospital, Chongqing, China
| | - Mayinuer Niyazi
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Ji-Hong Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Chun-Yan Wang
- Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China
| | - Long-Yu Li
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Xiao-Dong Cheng
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Catherine Sauvaget
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - You-Lin Qiao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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3
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Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, Ndlovu P, Zondi N, Zungu N, Varghese C, Hunting G, Parham G, Simelela P, Moyo S. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health 2022; 22:486. [PMID: 36461001 PMCID: PMC9716693 DOI: 10.1186/s12905-022-02043-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. DESIGN This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. SETTING We included studies conducted in LMICs published in English between 2010 and 2020. PARTICIPANTS We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. RESULTS Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. CONCLUSION A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women's health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.
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Affiliation(s)
- Z. Petersen
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - A. Jaca
- grid.415021.30000 0000 9155 0024Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - T. G. Ginindza
- grid.16463.360000 0001 0723 4123Public Health Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa ,Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), Durban, South Africa
| | - G. Maseko
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - S. Takatshana
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - P. Ndlovu
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - N. Zondi
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - N. Zungu
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa ,grid.16463.360000 0001 0723 4123Public Health Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - C. Varghese
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - G. Hunting
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - G. Parham
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - P. Simelela
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - S. Moyo
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa ,grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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5
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Nuranna L, Lubis DN, Arozal W, Purbadi S, Barinda AJ, Purwoto G, Rustamadji P, Putra AD, Utami TW, Kekalih A. Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue. Front Pharmacol 2022; 13:880333. [PMID: 35668953 PMCID: PMC9164303 DOI: 10.3389/fphar.2022.880333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Early detection and treatment of cervical intraepithelial neoplasia (CIN) through a “see and treat” approach is a pillar of cervical cancer prevention programs in developing countries such as Indonesia. One of the major challenges faced is the limited N2O or CO2 gas supply for cryotherapy. Thus, an alternative therapeutic method such as trichloroacetic acid (TCA) topical application is needed as an alternative solution. The effectiveness of this therapy will depend on its destructive effect on eliminating the whole lesion in CIN.Objective: To estimate the extent of damage in the normal cervical tissue after a single topical application of 85% TCA solution.Design and Methods: This research was an intervention study carried out by applying ±5 ml of 85% TCA solution into the cervix of 40 patients scheduled for total hysterectomy for indications other than cervical pathology 24 h before surgery. The extent of tissue destruction was determined microscopically using histopathological specimens. The study protocol is registered at www.clinicaltrial.gov (ID NCT04911075).Results: In the final analysis, 39 subjects were included. The necrotic area was detected at the superficial layer, accompanied by the full epithelial erosion thickness. In addition, there were also fibrotic areas resembling burned tissue in the stroma. The mean depth of destruction was 1.16 ± 0.01 mm in the anterior lip and 1.01 ± 0.06 mm in the posterior lip. There was no significant depth difference between the anterior and posterior lips (p ≥0.05). Moreover, the 85% TCA topical application was tolerable, as represented by the fact that the vast majority (82.1%) of participants experienced pain with a visual analog scale score of <4.Conclusion: Single dose of TCA 85% in topical solution was able to destroy the normal cervical tissue with a deeper mean depth than the mean depth of CIN III in squamous epithelium.
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Affiliation(s)
- Laila Nuranna
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Dolly N. Lubis
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Wawaimuli Arozal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- *Correspondence: Wawaimuli Arozal,
| | - Sigit Purbadi
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Agian Jeffilano Barinda
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Gatot Purwoto
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Primariadewi Rustamadji
- Department of Pathology and Anatomy, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Andi D. Putra
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Tofan W. Utami
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Aria Kekalih
- Community Medicine Department, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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6
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Karisani N, Aminimoghaddam S, Kashanian M, Baradaran HR, Moradi Y. Diagnostic accuracy for alternative cervical cancer screening strategies: A systematic review and meta-analysis. Health Care Women Int 2022; 45:323-362. [PMID: 35084291 DOI: 10.1080/07399332.2021.1998059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/21/2021] [Indexed: 12/26/2022]
Abstract
We performed a systematic review and meta-analysis to evaluate the accuracy of screening cervical cancer tests as alternative standalone methods. The combined estimates of sensitivity of visual inspection with acetic acid, visual inspection with lugol's iodine, conventional pap smear, liquid-based cytology, High risk HPV testing by clinician, High risk HPV testing by self- sampling, cervicography were 64%, 80%, 55%, 70%, 70% and 67% respectively; the combine values of specificity of these screening strategies were 88%, 88%, 96%, 59%, 94%, and 95% respectively. Our findings draw attention to an attractive opinion to facilitate the collection of specimens for DNA HPV by patients in settings where they don't have access to a regular screening programs.
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Affiliation(s)
- Narmin Karisani
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Soheila Aminimoghaddam
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Maryam Kashanian
- Gynecologist Oncologist, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Parra SG, López-Orellana LM, Molina Duque AR, Carns JL, Schwarz RA, Smith CA, Ortiz Silvestre M, Diaz Bazan S, Escobar PA, Felix JC, Ramalingam P, Castle PE, Cremer ML, Maza M, Schmeler KM, Richards-Kortum RR. Cervical cancer prevention in El Salvador: A prospective evaluation of screening and triage strategies incorporating high-resolution microendoscopy to detect cervical precancer. Int J Cancer 2021; 148:2571-2578. [PMID: 33368249 PMCID: PMC10568648 DOI: 10.1002/ijc.33454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 01/28/2023]
Abstract
Cervical cancer remains a leading cause of cancer death for women in low- and middle-income countries. The goal of our study was to evaluate screening and triage strategies, including high-resolution microendoscopy (HRME), to detect cervical abnormalities concerning for precancer at the point of care. Women (n = 1824) were enrolled at the Instituto de Cáncer de El Salvador. All underwent screening by both human papillomavirus (HPV) testing using careHPV and visual inspection with acetic acid (VIA). Screen-positives, along with 10% of screen-negatives, were invited to return for a follow-up examination that included triage with VIA, colposcopy and HRME imaging. Biopsies were taken of any abnormalities identified. If no abnormalities were identified, then the worst scoring site by HRME was biopsied. The sensitivities of HPV testing and VIA to screen for cervical intraepithelial neoplasia Grade 2 or more severe diagnoses (CIN2+) were 82.1% and 75% (P = .77), while the specificities were 90.4% and 80.9% (P < .001), respectively. The sensitivities of VIA, colposcopy and HRME as triage tests for CIN2+ were 82.1%, 82.1% and 71.4%, respectively (P ≥ .38). HRME had a significantly higher specificity (66.7%) than VIA (51.9%) (P < .001) and colposcopy (53.3%) (P < .001). When evaluating different theoretical screening and triage strategies, screening with HPV testing followed by triage with HRME would result in more women receiving appropriate care (97%) compared to screening with VIA (75%) or HPV alone (90%). Our findings demonstrate that screening with HPV is superior to VIA, and that triage with HRME imaging increases the specificity of detecting CIN2+ at the point of care in a low-resource setting.
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Affiliation(s)
- Sonia G Parra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Jennifer L Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Chelsey A Smith
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Pablo A Escobar
- Liga Contra el Cáncer de El Salvador, San Salvador, El Salvador
| | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Preetha Ramalingam
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Miriam L Cremer
- Basic Health International, San Salvador, El Salvador
- Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mauricio Maza
- Basic Health International, San Salvador, El Salvador
| | - Kathleen M Schmeler
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Kakani P, Kojima N, Banda BA, Lewis S, Suri R, Chibwana F, Chivwara M, Sullivan L, Chimombo M, Sigauke H, Tymchuk C, Kahn D. Increasing cervical cancer screening at a non-government medical center in Lilongwe, Malawi. Int J STD AIDS 2021; 32:933-939. [PMID: 33910402 DOI: 10.1177/09564624211007260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malawi has the highest incidence of and mortality rate due to cervical cancer in the world. This is largely because of inadequate screening and high rates of human immunodeficiency virus (HIV) infection, which greatly increases cervical cancer risk. We describe the implementation of a quality improvement program to increase use of cervical cancer screening at a non-government medical center in Lilongwe, Malawi. The intervention, developed and launched from March to August 2017, aimed to promote education among patients and clinicians about the importance of cervical cancer screening and improve accessibility of screening information within medical records. Visual inspection with acetic acid (VIA) was used to screen for cervical cancer. Women with a positive VIA were offered treatment using thermocoagulation. The number of VIA screenings conducted in 2016 (pre-intervention), 2017 (intervention), and 2018 (post-intervention) was 125, 234 and 456, respectively. Of the 815 women screened during this period, 36 (4.4%) had a VIA-positive result and 12 (1.5%) had suspect cancer. Of the VIA-positive women, 13 (36.1%) received same-day treatment with thermocoagulation. An interrupted time series regression revealed that there was a sustained increase in monthly screenings between the pre- and post-intervention period (β = 30.84; p = 0.006; 95% CI 9.72-51.97), suggesting that the intervention likely was effective in increasing cervical cancer screening. Our results demonstrate that focusing on developing sustainable solutions and improving system processes, without additional equipment or funding, significantly increased the number of women screened and should be considered in other settings to enhance cervical cancer prevention services.
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Affiliation(s)
- Preeti Kakani
- 12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Noah Kojima
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Samuel Lewis
- 12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rajat Suri
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Lauren Sullivan
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Chris Tymchuk
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel Kahn
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
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9
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Vasudevan L, Stinnett S, Mizelle C, Melgar K, Makarushka C, Pieters M, Sanchez LER, Jeronimo J, Huchko MJ, Proeschold-Bell RJ. Barriers to the uptake of cervical cancer services and attitudes towards adopting new interventions in Peru. Prev Med Rep 2020; 20:101212. [PMID: 33224718 PMCID: PMC7666342 DOI: 10.1016/j.pmedr.2020.101212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/20/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Cervical cancer is the leading cause of mortality in women of reproductive age in Peru. Increasing knowledge and awareness may promote cervical cancer screening uptake. Mitigating financial barriers may increase treatment rates among diagnosed women. Participants reported high willingness to adopt new cervical cancer interventions.
Cervical cancer mortality is high among Peruvian women of reproductive age. Understanding barriers and facilitators of cervical cancer screening and treatment could facilitate development of contextually-relevant interventions to reduce cervical cancer incidence and mortality. From April to October 2019, we conducted a cross-sectional survey with 22 medical personnel and administrative staff from Liga Contra el Cancer, in Lima, Peru. The survey included structured and open-ended questions about participants’ roles in cervical cancer prevention and treatment, perceptions of women’s barriers and facilitators for getting screened and/or treated for cervical cancer, as well as attitudes towards adopting new cervical cancer interventions. For structured questions, the frequency of responses for each question was calculated. For responses to open-ended questions, content analysis was used to summarize common themes. Our data suggest that the relative importance and nature of barriers that Peruvian women face are different for cervical cancer screening compared to treatment. In particular, participants mentioned financial concerns as the primary barrier to treatment and a lack of knowledge or awareness of human papillomavirus and/or cervical cancer as the primary barrier to screening uptake among women. Participants reported high willingness to adopt new interventions or strategies related to cervical cancer. Building greater awareness about benefits of cervical cancer screening among women, and reducing financial and geographic barriers to treatment may help improve screening rates, decrease late-stage diagnosis and reduce mortality in women who have a pre-cancer diagnosis, respectively. Further studies are needed to generalize study findings to settings other than Lima, Peru.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Sandra Stinnett
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | | | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | | | | | - Megan J Huchko
- Duke Global Health Institute, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
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Obol JH, Harrison R, Lin S, Obwolo MJ, Richmond R. Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy. BMC Public Health 2020; 20:1396. [PMID: 32928155 PMCID: PMC7488649 DOI: 10.1186/s12889-020-09482-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Uganda has one of the highest burdens of cervical cancer globally. In 2010 the Ugandan Ministry of Health launched the Strategic Plan for Cervical Cancer Prevention and Control with the hope of developing cervical cancer policy in Uganda. This study explored the beliefs of senior key informants in Uganda about cervical cancer prevention, the control programme, and the relevance of cervical cancer policy. Methods We conducted 15 key informant interviews with participants from six organisations across Northern and Central Uganda. Participants were drawn from district local government health departments, St. Mary’s Hospital Lacor, Uganda Nurses and Midwifery Council, non-governmental organisations (NGOs) and Ministry of Health in Kampala, Uganda. The interview recordings were transcribed and analysed using thematic analysis. Results Seven themes emerged relating to the cervical cancer prevention and control programmes in Uganda: (1) policy frameworks for cervical cancer, (2) operationalising cervical cancer prevention and control, (3) financial allocation and alignment, (4) human resources and capability, (5) essential supplies and vaccines, (6) administrative data and resource distribution, and (7) cervical cancer services. Conclusions The key informants perceive that the lack of a cervical cancer policy in Uganda is hindering cervical cancer prevention and control programmes. Therefore, the Ministry of Health and stakeholders need to work together in coming up with an effective policy framework that will accelerate efforts towards cervical cancer prevention and control in Uganda.
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Affiliation(s)
- James Henry Obol
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia. .,Gulu University, Faculty of Medicine, P. O Box 166, Gulu, Uganda.
| | - Reema Harrison
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
| | - Sophia Lin
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
| | | | - Robyn Richmond
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
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11
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Barrett BW, Paz-Soldan VA, Mendoza-Cervantes D, Sánchez GM, Córdova López JJ, Gravitt PE, Rositch AF. Understanding Geospatial Factors Associated With Cervical Cancer Screening Uptake in Amazonian Peruvian Women. JCO Glob Oncol 2020; 6:1237-1247. [PMID: 32755481 PMCID: PMC7456312 DOI: 10.1200/go.20.00096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Cervical cancer (CC) is the most common and second-most deadly cancer among Peruvian women. Access to services is strongly associated with CC screening uptake. This study investigated geospatial features contributing to utilization of screening. We used geolocated data and screening information from a Knowledge, Attitudes, and Practice (KAP) survey implemented in Iquitos, Peru in 2017. MATERIALS AND METHODS The KAP collected cross-sectional CC screening history from 619 female interviewees age 18-65 years within 5 communities of varying urbanization levels. We used spatial statistics to determine if screened households tended to cluster together or cluster around facilities offering screening in greater numbers than expected, given the underlying population density. RESULTS On the basis of K-functions, screened households displayed greater clustering among each other as compared with clustering among unscreened households. Neighborhood-level factors, such as outreach, communication, or socioeconomic condition, may be functioning to generate pockets of screened households. Cross K-functions showed that screened households are generally located closer to health facilities than unscreened households. The significance of facility access is apparent and demonstrates that travel and time barriers to seeking health services must be addressed. CONCLUSION This study highlights the importance of considering geospatial features when determining factors associated with CC screening uptake. Given the observed clustering of screened households, neighborhood-level dynamics should be further studied to understand how they may be influencing screening rates. In addition, results demonstrate that accessibility issues must be carefully considered when designing an effective cancer screening program that includes screening, follow-up, and treatment.
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Affiliation(s)
- Benjamin W Barrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Valerie A Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Graciela Meza Sánchez
- Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | | | - Patti E Gravitt
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Banerjee D, Mandal R, Mandal A, Ghosh I, Mittal S, Muwonge R, Lucas E, Basu P. A Prospective Randomized Trial to Compare Safety, Acceptability and Efficacy of Thermal Ablation and Cryotherapy in a Screen and Treat Setting. Asian Pac J Cancer Prev 2020; 21:1391-1398. [PMID: 32458647 PMCID: PMC7541890 DOI: 10.31557/apjcp.2020.21.5.1391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The prospective randomized study aimed to compare the safety, acceptability and efficacy of thermal ablation (TA) to that of cryotherapy in screen and treat setting. METHODS The participants were recruited prospectively in a community-based screening clinic in India. Women positive on visual inspection with acetic acid (VIA) test and/or Human Papillomavirus (HPV) test were assessed for eligibility for ablative treatment. Total 286 eligible women were randomized to receive either cryotherapy (N=150) or TA (N=136) performed by health workers. Colposcopy and cervical biopsy were performed on all, prior to treatment. Post-treatment follow-up was after one year with colposcopy and biopsy. RESULTS Both the treatment methods had high acceptability. Significantly higher proportion of women treated by cryotherapy reported pain compared to women treated by TA, though intensity was mild in vast majority of them. Approximately 30% of women in both arms had histologic abnormalities, mainly CIN 1, and among those who attended follow-up 74.1% and 81.0% didn't have any CIN after cryotherapy and TA respectively. CONCLUSION TA is as acceptable and safe as cryotherapy in screen and treat setting. TA has the logistic advantages for the low-resourced settings as the machines are more portable, do not require costly refrigerant gas and battery-driven models are available. The cure rates for CIN 1+ lesions in our study were comparable between cryotherapy and TA.
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Affiliation(s)
| | - Ranajit Mandal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
| | - Amit Mandal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
| | - Ishita Ghosh
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
| | - Srabani Mittal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
| | | | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France.
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France.
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Dykens JA, Smith JS, Demment M, Marshall E, Schuh T, Peters K, Irwin T, McIntosh S, Sy A, Dye T. Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review. Cancer Causes Control 2020; 31:417-429. [PMID: 32185604 PMCID: PMC7105425 DOI: 10.1007/s10552-020-01290-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. METHODS We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. RESULTS Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demand-side (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. CONCLUSIONS The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.
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Affiliation(s)
- J Andrew Dykens
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
| | - Jennifer S Smith
- University of North Carolina School of Public Health, Chapel Hill, NC, USA
| | - Margaret Demment
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY, USA
| | - E Marshall
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Tina Schuh
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Karen Peters
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Tracy Irwin
- University of Washington Department of Obstetrics and Gynecology, Seattle, WA, USA
| | - Scott McIntosh
- University of Rochester Department of Public Health Sciences, Rochester, NY, USA
| | - Angela Sy
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | - Timothy Dye
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY, USA
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Lee H, Mtengezo JT, Kim D, Makin MS, Kang Y, Malata A, Fitzpatrick J. Exploring Complicity of Cervical Cancer Screening in Malawi: The Interplay of Behavioral, Cultural, and Societal Influences. Asia Pac J Oncol Nurs 2020; 7:18-27. [PMID: 31879680 PMCID: PMC6927154 DOI: 10.4103/apjon.apjon_48_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Cervical cancer is preventable, and early diagnosis is possible using low-cost technologies, but a scant number of women receive cancer screening in Malawi. This study aims to identify facilitators and barriers that influence the uptakes of cervical cancer screening behavior in Malawi. METHODS A rapid ethnographic approach with the goal of optimizing planning for a future intervention study was utilized. Data were collected from three focus groups and seven individual interviews with adults in their communities, stakeholders, and health-care providers. RESULTS Three categories (sociocultural influences, access to the health-care system, and individual factors) have emerged as facilitators or barriers to cervical cancer screening among Malawian women. The findings also showed that cervical cancer screening behavior is situated socially through cultural and health-care services of a given community. CONCLUSIONS Cancer screenings are only sought when illness symptoms persist or worsen. Awareness and knowledge of cervical cancer and cervical cancer screening is low among both health-care providers and the general population. Health-care systems are donor driven and focus on a single disease, health-care access is the greatest challenge to cervical cancer screening, and health-care providers are not adequately prepared to work for rapid increase in the prevalence of cervical cancer. Integrating cervical cancer screening into the existing health-care system is sustainable way forward, and nurses prepared to handle cervical cancer management can play an essential role to promote cervical cancer screening in a health resource-constrained setting.
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Affiliation(s)
- Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | | | - Deogwoon Kim
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Mary Sue Makin
- College of Nursing, Daeyang University, Lilongwe, Malawi
| | - Younhee Kang
- College of Nursing, Ewha Womans University, Seoul, Korea
| | | | - Joyce Fitzpatrick
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Abstract
BACKGROUND Cervical cancer remains one of the leading causes of cancer for women in medically underserved areas. This is in part due to a lack of trained clinicians to provide the necessary diagnosis and treatment of precancerous lesions to prevent cervical cancer. Increasing medical provider knowledge and skills is important for the early detection and prevention of cervical precancer and cancer in medically underserved areas of the United States and globally. METHOD LUCIA is a low-cost, universal cervical cancer instructional apparatus that can be used to teach and practice a variety of essential skills for cervical cancer screening, diagnosis, and treatment, including: visual inspection with acetic acid, Pap and human papillomavirus DNA specimen collection, colposcopy, endocervical curettage, cervical biopsy, cryotherapy, and loop electrosurgical excision procedure. EXPERIENCE LUCIA was used to provide hands-on training in six courses held in Texas (n=3), El Salvador (n=1), and Mozambique, Africa (n=2). Standardized provider evaluations were administered at three of these courses and resulted in mean scores of 4.12/5 for usefulness, 4.46/5 for skill improvement, and 4.43/5 for ease of skill evaluation. CONCLUSION LUCIA provides dynamic, real-time feedback that allows trainees to learn and practice important skills related to cervical cancer prevention while simulating a patient exam.
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Rahman R, Clark MD, Collins Z, Traore F, Dioukhane EM, Thiam H, Ndiaye Y, De Jesus EL, Danfakha N, Peters KE, Komarek T, Linn AM, Linn PE, Wallner KE, Charles M, Hasnain M, Peterson CE, Dykens JA. Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review. Glob Health Action 2019; 12:1587894. [PMID: 30938248 PMCID: PMC6450494 DOI: 10.1080/16549716.2019.1587894] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low- and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges. Objective: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque’s Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership’s approach to shaping Senegal’s regional cervical cancer screening policy. Methods: The systematic review search strategy comprised two complementary sub-searches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance. Results: Our findings identified specific demand-side (clients and community) and supply-side (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand- and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature. Conclusions: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.
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Affiliation(s)
- R Rahman
- a University of Toledo College of Medicine and Life Sciences , Toledo , OH , USA
| | - M D Clark
- b Library of the Health Sciences , University Library, University of Illinois at Chicago , Chicago , IL , USA.,c Department of Medical Education, College of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - Z Collins
- d Department of Family Medicine, Institute for Health Research and Policy , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - F Traore
- e Region medical de Kedougou , Bureau de la santé de la reproduction, prevention transmission mere enfant du VIH-SIDA , Kedougou , Senegal
| | | | - H Thiam
- g Region medical de Kedougou , Bureau régional de la formation, de la supervision et de la recherche , Kedougou , Senegal
| | - Y Ndiaye
- h Département de Recherche , Sénégal Ministère de la Santé et l'Action Sociale , Dakar , Sénégal
| | - E L De Jesus
- i School of Public Health (SPH) , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | | | - K E Peters
- k School of Public Health, Division of Community Health Sciences, Illinois Prevention Research Center, Institute for Health Research and Policy , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - T Komarek
- l Uniformed Services University , Bethesda , MD , USA
| | - A M Linn
- m School of Public Health, Center for Communications Programs , Johns Hopkins University , Baltimore , MD , USA
| | - P E Linn
- n Logistics Management Institute , Tysons , VA , USA
| | - K E Wallner
- o Elizabeth Glaser Pediatric AIDS Foundation , Washington , DC , USA
| | - M Charles
- p Department of Internal Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - M Hasnain
- q Department of Family Medicine , University of Illinois at Chicago College of Medicine , Chicago , IL , USA
| | - C E Peterson
- r School of Public Health, Division of Epidemiology & Biostatistics, UI Cancer Center , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - J A Dykens
- s Department of Family Medicine, Center for Global Health, Institute for Health Research and Policy, Cancer Center , University of Illinois at Chicago (UIC) , Chicago , IL , USA
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Black E, Hyslop F, Richmond R. Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Womens Health 2019; 19:108. [PMID: 31399092 PMCID: PMC6688246 DOI: 10.1186/s12905-019-0809-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/02/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Uganda has one of the highest age-standardized incidence rates of cervical cancer in the world. The proportion of Ugandan women screened for cervical cancer is low. To evaluate barriers and facilitators to accessing cervical cancer screening, we performed a systematic review of reported views of Ugandan women and healthcare workers. The aim of this review is to inform development of cervical cancer screening promotional and educational programs to increase screening uptake and improve timely diagnosis for women with symptoms of cervical cancer. METHODS Fourteen studies that included the views of 4386 women and 350 healthcare workers published between 2006 and 2019 were included. Data were abstracted by two reviewers and findings collated by study characteristics, study quality, and barriers and facilitators. RESULTS Nineteen barriers and twenty-one facilitators were identified. Study settings included all districts of Uganda, and the quality of included studies was variable. The most frequently reported barriers were embarrassment, fear of the screening procedure or outcome, residing in a remote or rural area, and limited resources / health infrastructure. The most frequent facilitator was having a recommendation to attend screening. CONCLUSION Understanding the barriers and facilitators to cervical cancer screening encountered by Ugandan women can guide efforts to increase screening rates in this population. Additional studies with improved validity and reliability are needed to produce reliable data so that efforts to remove barriers and enhance facilitators are well informed.
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Affiliation(s)
- Eleanor Black
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, NSW 2052 Australia
| | - Fran Hyslop
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, NSW 2052 Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, NSW 2052 Australia
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Black E, Hyslop F, Richmond R. Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Womens Health 2019. [PMID: 31399092 DOI: 10.1186/s12905‐019‐0809‐z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uganda has one of the highest age-standardized incidence rates of cervical cancer in the world. The proportion of Ugandan women screened for cervical cancer is low. To evaluate barriers and facilitators to accessing cervical cancer screening, we performed a systematic review of reported views of Ugandan women and healthcare workers. The aim of this review is to inform development of cervical cancer screening promotional and educational programs to increase screening uptake and improve timely diagnosis for women with symptoms of cervical cancer. METHODS Fourteen studies that included the views of 4386 women and 350 healthcare workers published between 2006 and 2019 were included. Data were abstracted by two reviewers and findings collated by study characteristics, study quality, and barriers and facilitators. RESULTS Nineteen barriers and twenty-one facilitators were identified. Study settings included all districts of Uganda, and the quality of included studies was variable. The most frequently reported barriers were embarrassment, fear of the screening procedure or outcome, residing in a remote or rural area, and limited resources / health infrastructure. The most frequent facilitator was having a recommendation to attend screening. CONCLUSION Understanding the barriers and facilitators to cervical cancer screening encountered by Ugandan women can guide efforts to increase screening rates in this population. Additional studies with improved validity and reliability are needed to produce reliable data so that efforts to remove barriers and enhance facilitators are well informed.
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Affiliation(s)
- Eleanor Black
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, NSW, 2052, Australia
| | - Fran Hyslop
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, NSW, 2052, Australia.
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, NSW, 2052, Australia
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Umukoro C, Makinde O. Perspectives of visual inspection of the cervix with acetic acid as an alternative to Pap smear test as a preventive measure of cervical cancer among female nurses in University College Hospital, Ibadan, Nigeria. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_10_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pham T, Bui L, Kim G, Hoang D, Tran T, Hoang M. Cancers in Vietnam-Burden and Control Efforts: A Narrative Scoping Review. Cancer Control 2019; 26:1073274819863802. [PMID: 31319695 PMCID: PMC6643189 DOI: 10.1177/1073274819863802] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 01/19/2023] Open
Abstract
Although the burden of cancer is rapidly growing in Vietnam, there was no up-to-date review that describes cancer burden and control in Vietnam throughout the literature. By identifying various risk factors, means of prevention, and methods for early detection, this review seeks to systematically summarize the evidence for the future planning and management of cancer occurrence in Vietnam. Additionally, this report aims to identify improvements which are necessary for the treatment and palliative care of patients with cancer in Vietnam. We employed a hybrid approach including both a scoping review and narrative synthesis for this study. Information was identified, extracted, and charted from various sources, which include international and domestically published studies, in addition to gray literature. Our results illustrate that the burden of cancer in Vietnam has tripled in the past 30 years, and this situation could be partly explained by the growing prevalence of both old and new risk factors. Besides hepatitis B virus, various other important risk factors such as human papilloma virus, tobacco usage, physical inactivity, and improper diets are still not under control in Vietnam. There is presently a lack of national cancer screening programs, and the capacity of cancer care services could not maintain pace with the demands of a rapidly increasing Vietnamese population. Overall, policy frameworks for cancer control in Vietnam are in place, but there is still a lack of proper financing and governing models necessary to support a sustainable program. In conclusion, Cancer and its associated consequences are both persistent and emerging problems in Vietnam, and the results of cancer control programs are limited. A comprehensive and evidence-based approach toward the prevention and treatment of cancer should be the future direction for Vietnam.
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Affiliation(s)
- Tung Pham
- Department of Physiology, Hanoi Medical University, Hanoi,
Vietnam
- Center for Population Health Science, Hanoi University of Public
Health, Hanoi, Vietnam
| | - Linh Bui
- Center for Population Health Science, Hanoi University of Public
Health, Hanoi, Vietnam
| | - Giang Kim
- Department of Health Education, Hanoi Medical University, Hanoi,
Vietnam
| | - Dong Hoang
- Vietnam National Cancer Institute, National Cancer Hospital, Hanoi,
Vietnam
| | - Thuan Tran
- Vietnam National Cancer Institute, National Cancer Hospital, Hanoi,
Vietnam
| | - Minh Hoang
- Department of Health Economics, Hanoi University of Public Health,
Hanoi, Vietnam
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Wanyenze RK, Bwanika JB, Beyeza-Kashesya J, Mugerwa S, Arinaitwe J, Matovu JKB, Gwokyalya V, Kasozi D, Bukenya J, Makumbi F. Uptake and correlates of cervical cancer screening among HIV-infected women attending HIV care in Uganda. Glob Health Action 2018; 10:1380361. [PMID: 29035163 PMCID: PMC5678455 DOI: 10.1080/16549716.2017.1380361] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Human immunodeficiency virus (HIV)-infected women are at high risk of cervical cancer. Objective: This study assessed uptake and correlates of cervical screening among HIV-infected women in care in Uganda. Methods: A nationally representative cross-sectional survey of HIV-infected women in care was conducted from August to November 2016. Structured interviews were conducted with 5198 women aged 15–49 years, from 245 HIV clinics. Knowledge and uptake of cervical screening and human papillomavirus (HPV) vaccination were determined. Correlates of cervical screening were assessed with modified Poisson regression to obtain prevalence ratios (PRs) using Stata version 12.0. Results: Overall, 94.0% (n = 4858) had ever heard of cervical screening and 66% (n = 3732) knew a screening site. However, 47.4% (n = 2302) did not know the schedule for screening and 50% (n = 2409) did not know the symptoms of cervical cancer. One-third (33.7%; n = 1719) rated their risk of cervical cancer as low. Uptake of screening was 30.3% (n = 1561). Women who had never been screened cited lack of information (29.6%; n = 1059) and no time (25.5%; n = 913) as the main reasons. Increased likelihood of screening was associated with receipt of HIV care at a level II health center [adj. PR 1.89, 95% confidence interval (CI) 1.29–2.76] and private facilities (adj. PR 1.68, 95% CI 1.16–3.21), knowledge of cervical screening (adj. PR 2.19, 95% CI 1.78–2.70), where to go for screening (adj. PR 6.47, 95% CI 3.69–11.36), and low perception of risk (adj. PR 1.52, 95% CI 1.14–2.03). HPV vaccination was 2%. Conclusions: Cervical screening and HPV vaccination uptake were very low among HIV-infected women in care in Uganda. Improved knowledge of cervical screening schedules and sites, and addressing fears and risk perception may increase uptake of cervical screening in this vulnerable population.
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Affiliation(s)
- Rhoda K Wanyenze
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - John Baptist Bwanika
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
| | - Jolly Beyeza-Kashesya
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
| | - Shaban Mugerwa
- c AIDS Control Program, Ministry of Health , Kampala , Uganda
| | - Jim Arinaitwe
- d Global Fund Focal Coordination Office, Ministry of Health , Kampala , Uganda
| | - Joseph K B Matovu
- e Department of Community Health, Makerere University School of Public Health , Kampala , Uganda
| | - Violet Gwokyalya
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Dickson Kasozi
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Justine Bukenya
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Fred Makumbi
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
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22
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Ouedraogo Y, Furlane G, Fruhauf T, Badolo O, Bonkoungou M, Pleah T, Lankoande J, Bicaba I, Bazant ES. Expanding the Single-Visit Approach for Cervical Cancer Prevention: Successes and Lessons From Burkina Faso. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:288-298. [PMID: 29959272 PMCID: PMC6024624 DOI: 10.9745/ghsp-d-17-00326] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/09/2018] [Indexed: 01/13/2023]
Abstract
The single-visit approach was implemented with strong attention to systems in 14 health facilities. In the 2 largest facilities, nearly 14,000 women screened for cervical cancer over 4 years. Of approximately 9% who screened positive, about 66% received same-day cryotherapy. Attention is needed to ensure local technicians can repair cryotherapy equipment, supplies are consistently in stock, and user fees are not prohibitive to accessing care. Background: Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality among women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical cancer prevention (CECAP) services in Burkina Faso were limited to temporary screening campaigns. Program Description: Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity. Methods: Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy. Results: Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions. Conclusions: Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.
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Affiliation(s)
| | | | | | | | | | | | - Jean Lankoande
- Société de Gynécologues et Obstétriciens du Burkina, Ouagadougou, Burkina Faso
| | - Isabelle Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou, Burkina Faso
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23
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Mesafint Z, Berhane Y, Desalegn D. Health Seeking Behavior of Patients Diagnosed with Cervical Cancer in Addis Ababa, Ethiopia. Ethiop J Health Sci 2018; 28:111-116. [PMID: 29983508 PMCID: PMC6016345 DOI: 10.4314/ejhs.v28i2.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cervical cancer is increasingly recognized as one of the public health problems among women in developing countries. Most women with cervical cancer are seen in the health care system late with advanced stage of cancer. This study aims to explore the care seeking behavior of women with cervical cancer. METHODS A qualitative study was conducted to explore the health seeking behavior of women with cervical cancer for patients who were admitted with cervical cancer in Tikur Anbessa Hospital. In-depth interviews were conducted with purposively selected participants. Interviews were transcribed verbatim and then translated into English and analyzed using a content analysis approach. The study period was from October 2013 to April 2014. RESULTS The study found that women diagnosed with cervical cancer lack prior awareness about cervical cancer and availability of screening services. Moreover, decision making to seek medical care up on experiencing early symptoms seems to be delayed. Women reported the first symptom was unusual vaginal bleeding that forces them to seek care. The bleeding could be profound and accompanied by offensive odor. Fear of stigmatization could make women reluctant to seek timely care. Once treatment is started most women found it shockingly expensive. CONCLUSION Women lack general awareness about the nature and symptoms of cervical cancer. All health services providers serving women need to sensitize women to seek timely screening services and timely treatment services if cervical cancer is confirmed.
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Affiliation(s)
- Zinaw Mesafint
- Tikur Anbessa Specialized Hospital, Addis Ababa University
| | | | - Dawit Desalegn
- Tikur Anbessa Specialized Hospital, Addis Ababa University
- Addis Continental Institute of Public Health
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24
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Li M, Nyabigambo A, Navvuga P, Nuwamanya E, Nuwasiima A, Kaganda P, Asiimwe FT, Vodicka E, Mugisha NM, Mukose A, Kwesiga DK, Lubinga SJ, Garrison LP, Babigumira JB. Acceptability of cervical cancer screening using visual inspection among women attending a childhood immunization clinic in Uganda. PAPILLOMAVIRUS RESEARCH 2017; 4:17-21. [PMID: 29179864 PMCID: PMC5883247 DOI: 10.1016/j.pvr.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/05/2017] [Accepted: 06/05/2017] [Indexed: 12/04/2022]
Abstract
Objective To evaluate the acceptability and performance of cervical cancer (CC) screening using visual inspection with acetic acid (VIA) integrated into a rural immunization clinic in Uganda. Methods/materials We conducted a cross-sectional pilot study in rural Uganda. We explored associations between women's characteristics and acceptance of VIA testing. We collected samples for Papanicolaou (Pap) smear testing in a random subset of women and used results from this test as a comparator for assessing VIA performance. Results We enrolled 625 women of whom 571 (91.4%) accepted and 54 (8.6%) refused CC screening. In the univariate model, age (Odds Ratio (OR)=1.10; p-value<0.001) and employment status (OR 2.00; p-value=0.019) were significantly associated with acceptance of VIA screening. In the multivariate model, no characteristic was independently associated with acceptance of VIA screening after adjusting for other factors. Compared to reference Pap smear, CC screening with VIA had a sensitivity of 50% and a specificity of 97.7%. Conclusions CC screening with VIA is highly acceptable in the setting of rural immunization clinics in Uganda. Studies to assess which screening method would be the most effective and cost-effective are needed before stakeholders can consider adopting screening programs at scale.
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Affiliation(s)
- Meng Li
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA; Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Agnes Nyabigambo
- Department of Community Health and Behavioral Sciences, School of Public Health,Makerere University, Kampala, Uganda
| | | | | | | | | | | | - Elisabeth Vodicka
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA; Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Noleb M Mugisha
- Comprehensive Community Cancer Program, Uganda Cancer Institute, Kampala, Uganda
| | - Aggrey Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Doris K Kwesiga
- Department of Health Policy, Planning and Management, School of Public Health,Makerere University, Kampala, Uganda
| | - Solomon J Lubinga
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA; Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Louis P Garrison
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA; Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Joseph B Babigumira
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA; Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
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25
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Castle PE, Murokora D, Perez C, Alvarez M, Quek SC, Campbell C. Treatment of cervical intraepithelial lesions. Int J Gynaecol Obstet 2017; 138 Suppl 1:20-25. [PMID: 28691333 DOI: 10.1002/ijgo.12191] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Precancerous cervical lesions precede the development of invasive cervical cancer by 10-20 years, making cervical cancer preventable if these lesions are detected and effectively treated. Treatment has evolved in the last few decades and now includes ablative options that can be performed in lower-resource settings where surgical excision is not feasible or routinely available. Gas-based cryotherapy, which freezes cervical tissue to induce localized necrosis, is the most commonly used ablative treatment. However, its implementation in low-resource settings is difficult because the refrigerant gas can be difficult to procure and transport, and is expensive. New cryotherapy devices that do not require an external supply of gas appear promising. Thermal coagulation, which burns cervical tissue to induce necrosis, has become more widely available in the last few years owing to its portability and the feasibility of using battery-powered devices. These two ablative treatments successfully eradicate 75%-85% of high-grade cervical lesions and have minor adverse effects.
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Affiliation(s)
| | - Dan Murokora
- Uganda Women's Health Initiative, Kampala, Uganda
| | | | - Manuel Alvarez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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26
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Turiho AK, Okello ES, Muhwezi WW, Katahoire AR. Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability of HPV vaccination: a qualitative study. BMC Res Notes 2017; 10:431. [PMID: 28854964 PMCID: PMC5577844 DOI: 10.1186/s13104-017-2749-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination has been perceived in diverse ways some of which encourage its uptake while others could potentially deter its acceptability. This study explored community member’s perceptions about HPV vaccination in Ibanda district and the implications of the perceptions for acceptability of HPV vaccination. The study was conducted following initial vaccination of adolescent schoolgirls in the district between 2008 and 2011. Methods This qualitative study employed focus group discussions (FGDs) and key informant interviews (KIIs). FGDs were conducted with schoolgirls and parents/guardians and KIIs were conducted with school teachers, health workers and community leaders. Transcripts from the FGDs and KIIs were coded and analyzed thematically using ATLAS.ti (v. 6). Results The HPV vaccination was understood to safely prevent cervical cancer, which was perceived to be a severe incurable disease. Vaccinations were perceived as protection against diseases like measles and polio that were known to kill children. These were major motivations for girls’ and parents’ acceptance of HPV vaccination. Parents’ increased awareness that HPV is sexually transmitted encouraged their support for vaccination of their adolescent daughters against HPV. There were reports however of some initial fears and misconceptions about HPV vaccination especially during its introduction. These initially discouraged some parents and girls but over the years with no major side effects reported, girls reported that they were willing to recommend the vaccination to others and parents also reported their willingness to get their daughters vaccinated without fear. Health workers and teachers interviewed however explained that, some concerns stilled lingered in the communities. Conclusions The perceived benefits and safety of HPV vaccination enhanced girls’ and parents’ acceptability of HPV vaccination. The initial rumors, fears and concerns about HPV vaccination that reportedly discouraged some girls and parents, seemed to have waned with time giving way to more favourable perceptions regarding HPV vaccination although the study still found that a few concerns still lingered on and these have implications for HPV vaccination acceptability.
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27
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Basu P, Meheus F, Chami Y, Hariprasad R, Zhao F, Sankaranarayanan R. Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings. Int J Gynaecol Obstet 2017; 138 Suppl 1:26-32. [PMID: 28691336 DOI: 10.1002/ijgo.12183] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Filip Meheus
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Youssef Chami
- Lalla Salma Foundation for Cancer Prevention and Treatment, Rabat, Morocco
| | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research (ICMR), Noida, India
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
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28
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Ndejjo R, Mukama T, Kiguli J, Musoke D. Knowledge, facilitators and barriers to cervical cancer screening among women in Uganda: a qualitative study. BMJ Open 2017; 7:e016282. [PMID: 28606908 PMCID: PMC5541520 DOI: 10.1136/bmjopen-2017-016282] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore community knowledge, facilitators and barriers to cervical cancer screening among women in rural Uganda so as to generate data to inform interventions. DESIGN A qualitative study using focus group discussions and key informant interviews. SETTING Discussions and interviews carried out in the community within two districts in Eastern Uganda. PARTICIPANTS Ten (10) focus group discussions with 119 screening-eligible women aged between 25 and 49 years and 11 key informant interviews with healthcare providers and administrators. RESULTS Study participants' knowledge about cervical cancer causes, signs and symptoms, testing methods and prevention was poor. Many participants attributed the cause of cervical cancer to use of contraception while key informants said that some believed it was due to witchcraft. Perceptions towards cervical cancer and screening were majorly positive with many participants stating that they were at risk of getting cervical cancer. The facilitators to accessing cervical cancer screening were: experiencing signs and symptoms of cervical cancer, family history of the disease and awareness of the disease/screening service. Lack of knowledge about cervical cancer and screening, health system challenges, fear of test outcome and consequences and financial constraints were barriers to cervical cancer screening. CONCLUSION Whereas perceptions towards cervical cancer and screening were positive, knowledge of study participants on cervical cancer was poor. To improve cervical cancer screening, effort should be focused on reducing identified barriers and enhancing facilitators.
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Affiliation(s)
- Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Trasias Mukama
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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29
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Price JT, Asgary R. Implementation and feasibility of an adapted two-stage visual inspection with acetic acid/cryotherapy-based cervical cancer screening programme for HIV-infected women in Addis Ababa, Ethiopia. Eur J Cancer Care (Engl) 2017; 25:526-7. [PMID: 27121898 DOI: 10.1111/ecc.12480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J T Price
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - R Asgary
- Department of Medicine, New York University School of Medicine, New York, NY, USA.
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30
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Cremer M, Paul P, Bergman K, Haas M, Maza M, Zevallos A, Ossandon M, Garai JD, Winkler JL. A Non-Gas-Based Cryotherapy System for the Treatment of Cervical Intraepithelial Neoplasia: A Mixed-Methods Approach for Initial Development and Testing. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:57-64. [PMID: 28351879 PMCID: PMC5478229 DOI: 10.9745/ghsp-d-16-00270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022]
Abstract
A non–gas-based treatment device for early cervical cancer treatment, adapted for use in low-resource settings to improve ease of use, portability, and durability, performed similarly to a standard gas-based cryotherapy device in small-scale testing. A large randomized clinical trial is currently underway for further assessment. Background: Gas-based cryotherapy is the most widely used treatment strategy for cervical intraepithelial neoplasia (CIN) in low-resource settings, but reliance on gas presents challenges in low- and middle-income countries (LMICs). Our team adapted the original CryoPen Cryosurgical System, a cryotherapy device that does not require compressed gas and is powered by electricity, for use in LMICs. Methods: A mixed-methods approach was used involving both qualitative and quantitative methods. First, we used a user-centered design approach to identify priority features of the adapted device. U.S.-based and global potential users of the adapted CryoPen participated in discussion groups and a card sorting activity to rank 7 features of the adapted CryoPen: cost, durability, efficacy and safety, maintenance, no need for electricity, patient throughput, and portability. Mean and median rankings, overall rankings, and summary rankings by discussion group were generated. In addition, results of several quantitative tests were analyzed including bench testing to determine tip temperature and heat extraction capabilities; a pathology review of CIN grade 3 cases (N=107) to determine target depth of necrosis needed to achieve high efficacy; and a pilot study (N=5) investigating depth of necrosis achieved with the adapted device to assess efficacy. Results: Discussion groups revealed 4 priority themes for device development in addition to the need to ensure high efficacy and safety and low cost: improved portability, durability, ease of use, and potential for cure. Adaptions to the original CryoPen system included a single-core, single-tip model; rugged carrying case; custom circuit to allow car battery charging; and sterilization by high-level disinfection. In bench testing, there were no significant differences in tip temperature or heat extraction capability between the adapted CryoPen and the standard cryotherapy device. In 80% of the cases in the pilot study, the adapted CryoPen achieved the target depth of necrosis 3.5 mm established in the pathology review. Conclusion: The LMIC-adapted CryoPen overcomes barriers to standard gas-based cryotherapy by eliminating dependency on gas, increasing portability, and ensuring consistent freeze temperatures. Further testing and evaluation of the adapted CryoPen will be pursued to assess scalability and potential impact of this device in decreasing the cervical cancer burden in LMICs.
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Affiliation(s)
- Miriam Cremer
- Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA. .,Basic Health International, New York, NY, USA, and San Salvador, El Salvador
| | - Proma Paul
- Basic Health International, New York, NY, USA, and San Salvador, El Salvador.,University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Katie Bergman
- Basic Health International, New York, NY, USA, and San Salvador, El Salvador
| | - Michael Haas
- CryoPen, Inc., Covington, LA, USA.,Department of Family Medicine, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Mauricio Maza
- Basic Health International, New York, NY, USA, and San Salvador, El Salvador
| | - Albert Zevallos
- Department of Gynecology, National Institute for Neoplastic Diseases, Lima, Peru
| | - Miguel Ossandon
- National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA
| | - Jillian D Garai
- Basic Health International, New York, NY, USA, and San Salvador, El Salvador
| | - Jennifer L Winkler
- Basic Health International, New York, NY, USA, and San Salvador, El Salvador.,Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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31
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Novikova T. Optical techniques for cervical neoplasia detection. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2017; 8:1844-1862. [PMID: 29046833 PMCID: PMC5629403 DOI: 10.3762/bjnano.8.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 05/04/2023]
Abstract
This paper provides an overview of the current research in the field of optical techniques for cervical neoplasia detection and covers a wide range of the existing and emerging technologies. Using colposcopy, a visual inspection of the uterine cervix with a colposcope (a binocular microscope with 3- to 15-fold magnification), has proven to be an efficient approach for the detection of invasive cancer. Nevertheless, the development of a reliable and cost-effective technique for the identification of precancerous lesions, confined to the epithelium (cervical intraepithelial neoplasia) still remains a challenging problem. It is known that even at early stages the neoplastic transformations of cervical tissue induce complex changes and modify both structural and biochemical properties of tissues. The different methods, including spectroscopic (diffuse reflectance spectroscopy, induced fluorescence and autofluorescence spectroscopy, Raman spectroscopy) and imaging techniques (confocal microscopy, optical coherence tomography, Mueller matrix imaging polarimetry, photoacoustic imaging), probe different tissue properties that may serve as optical biomarkers for diagnosis. Both the advantages and drawbacks of these techniques for the diagnosis of cervical precancerous lesions are discussed and compared.
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Affiliation(s)
- Tatiana Novikova
- LPICM, CNRS, Ecole polytechnique, University Paris Saclay, Palaiseau, France
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32
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Hasahya OT, Berggren V, Sematimba D, Nabirye RC, Kumakech E. Beliefs, perceptions and health-seeking behaviours in relation to cervical cancer: a qualitative study among women in Uganda following completion of an HPV vaccination campaign. Glob Health Action 2016; 9:29336. [PMID: 26895145 PMCID: PMC4759844 DOI: 10.3402/gha.v9.29336] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 01/12/2023] Open
Abstract
Background Cervical cancer remains a leading cause of morbidity and mortality in Uganda. Despite earlier information campaigns to introduce human papilloma virus (HPV) vaccination, which also targeted cervical cancer, misinterpretation and misunderstanding of the subject remain high. Women in Uganda present with cervical cancer at an advanced stage due to poor health-seeking behaviours, with an associated high mortality rate. This project explored beliefs, attitudes, perceptions, and health-seeking behaviours in relation to cervical cancer among women in Uganda after an HPV vaccination project had been rolled out. Design A qualitative study design was used, with six focus group discussions (FGDs) that included 36 women, aged 25–49 years, with no previous history of cervical cancer symptoms or diagnosis. The women were interviewed in February and March 2013. The transcribed data was analysed using content analysis. Results Three themes emerged: feeling unprotected and unsafe, misbelief and wondering about cervical cancer, and fear of the testing procedure. Participating women had heard of cervical cancer but preferred to wait to access cervical cancer screening until symptom debut. Conclusions There are still barriers to cervical cancer screening among women in Uganda, where there is a need for culture-specific, sensitive information and interventions to address the issues of improving the cervical cancer screening uptake among these women. Societal context needs to be taken into account when implementing community-based health education.
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Affiliation(s)
- Olivia Topister Hasahya
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Gynecological, Breast and Sarcoma Cancer, Department of Oncology, Karolinska University Hospital, Solna, Sweden;
| | - Vanja Berggren
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Faculty of Health Sciences, Lund University, Lund, Sweden
| | - Douglas Sematimba
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Edward Kumakech
- Makerere University College of Health Sciences, Kampala, Uganda
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Pan XF, Zhao ZM, Sun J, Chen F, Wen QL, Liu K, Song GQ, Zhang JJ, Wen Y, Fu CJ, Yang CX. Acceptability and correlates of primary and secondary prevention of cervical cancer among medical students in southwest China: implications for cancer education. PLoS One 2014; 9:e110353. [PMID: 25360743 PMCID: PMC4215919 DOI: 10.1371/journal.pone.0110353] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/14/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand knowledge about, and acceptability of, cervical cancer screening and HPV vaccines among medical students; and to explore potential factors that influence their acceptability in China. METHODS We conducted a survey among medical students at six universities across southwest China using a 58-item questionnaire regarding knowledge and perceptions of HPV, cervical cancer, and HPV vaccines. RESULTS We surveyed 1878 medical students with a mean age of 20.8 years (standard deviation: 1.3 years). Of these, 48.8% and 80.1% believed cervical cancer can be prevented by HPV vaccines and screening respectively, while 60.2% and 71.2% would like to receive or recommend HPV vaccines and screening. 35.4% thought HPV vaccines ought to be given to adolescents aged 13-18 years. 32% stated that women should start to undergo screening from the age of 25. 49.2% felt that women should receive screening every year. Concern about side effects (38.3% and 39.8%), and inadequate information (42.4% and 35.0%) were the most cited barriers to receiving or recommending HPV vaccination and cervical cancer screening. Females were more likely to accept HPV vaccines (OR, 1.86; 95% CI: 1.47-2.35) or cervical cancer screening (OR, 3.69; 95% CI: 2.88-4.74). Students with a higher level of related knowledge were much more willing to receive or recommend vaccines (P<0.001) or screening (P<0.001). Students who showed negative or uncertain attitudes towards premarital sex were less likely to accept either HPV vaccines (OR, 0.67; 95% CI: 0.47-0.96), or screening (OR, 0.68; 0.47-0.10). Non-clinical students showed lower acceptability of cervical screening compared to students in clinical medicine (OR, 0.74; 95% CI: 0.56-0.96). CONCLUSIONS The acceptability of HPV vaccines and cervical cancer screening is relatively low among medical students in southwest China. Measures should be taken to improve knowledge about cervical cancer and awareness of HPV vaccines and screening among medical students at university.
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Affiliation(s)
- Xiong-Fei Pan
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China
| | - Zhi-Mei Zhao
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China
| | - Jing Sun
- Department of Pathology, Development and Regeneration Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, China
| | - Feng Chen
- Department of Preventive Healthcare and Hospital Infection Control, Deyang People's Hospital, Deyang, China
| | - Qing-Lian Wen
- Department of Oncology, the Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Kang Liu
- Institute of Tissue Engineering and Stem Cells, The Second Clinical Hospital of North Sichuan Medical College, Nanchong, China
| | - Gui-Qin Song
- Department of Biology, North Sichuan Medical University, Nanchong, China
| | - Jing-Jing Zhang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Ying Wen
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China
| | - Chun-Jing Fu
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Chun-Xia Yang
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China
- * E-mail:
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Bosu WK. Learning lessons from operational research in infectious diseases: can the same model be used for noncommunicable diseases in developing countries? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2014; 5:469-82. [PMID: 25506254 PMCID: PMC4259801 DOI: 10.2147/amep.s47412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
About three-quarters of global deaths from noncommunicable diseases (NCDs) occur in developing countries. Nearly a third of these deaths occur before the age of 60 years. These deaths are projected to increase, fueled by such factors as urbanization, nutrition transition, lifestyle changes, and aging. Despite this burden, there is a paucity of research on NCDs, due to the higher priority given to infectious disease research. Less than 10% of research on cardiovascular diseases comes from developing countries. This paper assesses what lessons from operational research on infectious diseases could be applied to NCDs. The lessons are drawn from the priority setting for research, integration of research into programs and routine service delivery, the use of routine data, rapid-assessment survey methods, modeling, chemoprophylaxis, and the translational process of findings into policy and practice. With the lines between infectious diseases and NCDs becoming blurred, it is justifiable to integrate the programs for the two disease groups wherever possible, eg, screening for diabetes in tuberculosis. Applying these lessons will require increased political will, research capacity, ownership, use of local expertise, and research funding.
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Affiliation(s)
- William K Bosu
- Department of Epidemics and Disease Control, West African Health Organisation, Bobo-Dioulasso, Burkina Faso
- Correspondence: William K Bosu, Department of Epidemics and Disease Control, West African Health Organisation, 175 Ouzzein Coulibaly Avenue, Bobo-Dioulasso 01 BP 153, Burkina Faso, Email
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