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Evina Bolo S, Kenfack B, Wisniak A, Tankeu G, Yakam V, Moukam A, Sormani J, Stoll B, Vassilakos P, Petignat P. Factors influencing cervical cancer re-screening in a semi-rural health district of Cameroon: a cohort study. BMC Womens Health 2024; 24:76. [PMID: 38281960 PMCID: PMC10822157 DOI: 10.1186/s12905-024-02917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Screening participation at recommended intervals is a crucial component of cervical cancer prevention effectiveness. However, little is known regarding the rate of re-screening in a Sub-Saharan context. This study aimed to estimate the re-screening rate of women in a semi-rural after an initial HPV-based screening and identify factors that influence adherence. METHODS This cohort study at the Annex Regional Hospital of Dschang enrolled women screened for cervical cancer over 5 years ago and due for re-screening. Women who initially tested HPV-positive (n = 132) and a random sample of HPV-negative women (n = 220) participated in a telephone survey between October 2021 and March 2022 to assess re-screening participation and reasons. Sociodemographic factors were collected, and associations with rescreening were evaluated. RESULTS A total of 352 participants aged under 50 years (mean age 37.4 years) were contacted, and 203 (58.0%) completed the survey. The proportion of women who complied with the screening recommendation was 34.0% (95% CI 27.5% - 40.5%), The weighted re-screening proportion was 28.4%. Age, marital status, education level, type of employment, and place of residence were not associated with the rate of re-screening. Main reported barriers to re-screening were lack of information (39.0%), forgetfulness (39.0%), and impression of being in good health (30.0%). Women who remembered the recommended screening interval were 2 to 3 times more likely to undergo re-screening (aOR (adjusted odds ratio) = 2.3 [1.2-4.4], p = 0.013). Human papilloma virus- positive status at the initial screening was also associated with the re-screening((aOR) (95% CI): 3.4 (1.8-6.5). CONCLUSION Following an initial Human Papilloma Virus-based screening campaign in the West Region of Cameroon, one third of women adhered to re-screening within the recommended timeframe. Existing screening strategies would benefit from developing better information approaches to reinforce the importance of repeated cervical cancer screening.
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Affiliation(s)
- Sophie Evina Bolo
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon.
- Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
- Department of Obstetrics, Gynaecology and Maternal Health, University of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - Gilles Tankeu
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
- Global Research Agency, Dschang, Cameroon
| | - Virginie Yakam
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
| | - Alida Moukam
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jessica Sormani
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
- HES-SO University of Applied Sciences and Arts Western, Delémont, Switzerland
| | - Beat Stoll
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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Qu X, Xu C, Yang W, Li Q, Tu S, Gao C. KLF5 inhibits the migration and invasion in cervical cancer cell lines by regulating SNAI1. Cancer Biomark 2024; 39:231-243. [PMID: 38217587 PMCID: PMC11191462 DOI: 10.3233/cbm-230175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/21/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Epithelial-mesenchymal transition (EMT) is an important biological process by which malignant tumor cells to acquire migration and invasion abilities. This study explored the role of KLF5 in the EMT process of in cervical cancer cell lines. OBJECTIVE Krüpple-like factor 5 (KLF5) is a basic transcriptional factor that plays a key role in cell-cycle arrest and inhibition of apoptosis. However, the molecular mechanism by which KLF5 mediates the biological functions of cervical cancer cell lines has not been elucidated. Here, we focus on the potential function of ELF5 in regulating the EMT process in in vitro model of cervical cancer cell lines. METHOD Western-blot and real-time quantitative PCR were used to detect the expression of EMT-related genes in HeLa cells. MTT assays, cell scratch and Transwell assays were used to assess HeLa cells proliferation and invasion capability. Using the bioinformatics tool JASPAR, we identified a high-scoring KLF5-like binding sequence in the SNAI1 gene promoter. Luciferase reporter assays was used to detect transcriptional activity for different SNAI1 promoter truncates. RESULT After overexpressing the KLF5 gene in HeLa cells, KLF5 not only significantly inhibited the invasion and migration of HeLa cells, but also increased the expression of E-cadherin and decreased the expression of N-cadherin and MMP9. In addition, the mRNA expression of upstream regulators of E-cadherin, such as SNAI1, SLUG, ZEB1/2 and TWIST1 was also decreased. Furthermore, KLF5 inhibiting the expression of the SNAI1 gene via binding its promoter region, and the EMT of Hela cells was promoted after overexpression of the SNAI1 gene. CONCLUSION These results indicate that KLF5 can downregulate the EMT process of HeLa cells by decreasing the expression of the SNAI1 gene, thereby inhibiting the migration and invasion of HeLa cervical cancer cells.
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Affiliation(s)
- Xinjian Qu
- Institute of Marine Drugs, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
- Guangxi Key Laboratory of Marine Drugs, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Chang Xu
- Institute of Marine Drugs, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
- Guangxi Key Laboratory of Marine Drugs, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Wenbo Yang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, Liaoning, China
| | - Qianqian Li
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, Liaoning, China
| | - Simei Tu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, Liaoning, China
| | - Chenghai Gao
- Institute of Marine Drugs, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
- Guangxi Key Laboratory of Marine Drugs, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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Morse RM, Brown J, Gage JC, Prieto BA, Jurczuk M, Matos A, Vásquez Vásquez J, Reátegui RR, Meza-Sanchez G, Córdova LAD, Gravitt PE, Tracy JK, Paz-Soldan VA. "Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program. BMC Public Health 2023; 23:2396. [PMID: 38042779 PMCID: PMC10693157 DOI: 10.1186/s12889-023-17324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. METHODS This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. RESULTS We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. CONCLUSIONS Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Julia C Gage
- Center for Global Health, National Cancer Institute, Bethesda, MD, USA
| | - Bryn A Prieto
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Magdalena Jurczuk
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrea Matos
- Dirección de Prevención y Control de Cancer (DPCAN) of Peruvian Ministry of Health, Lima, Peru
| | | | | | | | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Kathleen Tracy
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
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Morse RM, Brown J, Gage JC, Prieto BA, Jurczuk M, Matos A, Vásquez JV, Reátegui RR, Meza-Sanchez G, Córdova LAD, Gravitt PE, Tracy JK, Paz-Soldan VA. "Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program. RESEARCH SQUARE 2023:rs.3.rs-3256535. [PMID: 37790338 PMCID: PMC10543436 DOI: 10.21203/rs.3.rs-3256535/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Cervical cancer is preventable with vaccination and early detection and treatment programs. However, in order for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | | | - Julia C Gage
- Center for Global Health, National Cancer Institute
| | - Bryn A Prieto
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | - Magdalena Jurczuk
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | - Andrea Matos
- Dirección de Prevención y Control de Cancer (DPCAN) of Peruvian Ministry of Health
| | | | | | | | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - J Kathleen Tracy
- Department of Medicine, University of Vermont College of Medicine
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
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Mwamba M, Lombe DC, Msadabwe S, Bond V, Simwinga M, Sentoogo Ssemata A, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. A Narrative Synthesis of Literature on the Barriers to Timely Diagnosis and Treatment of Cancer in Sub-Saharan Africa. Clin Oncol (R Coll Radiol) 2023; 35:e537-e548. [PMID: 37302880 DOI: 10.1016/j.clon.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Poor cancer survival outcomes in sub-Saharan Africa (SSA) have been linked to delays in diagnosis and treatment. Here we present a detailed overview of the qualitative literature evaluating the barriers to receiving timely diagnosis and treatment of cancer in SSA. The PubMed, EMBASE, CINAHL, PsycINFO databases were searched to identify qualitative studies reporting on barriers to timely diagnosis of cancer in SSA published between 1995 and 2020. A systematic review methodology was applied, including quality assessment and narrative data synthesis. We identified 39 studies, of which 24 focused on breast or cervical cancer. Only one study focused on prostate cancer and one on lung cancer. When exploring factors contributing to delays, six key themes emerged from the data. The first theme was health service barriers, which included: (i) inadequate numbers of trained specialists; (ii) limited knowledge of cancer among healthcare providers; (iii) poor co-ordination of care; (iv) inadequately resourced health facilities; (v) negative attitudes of healthcare providers towards patients; (vi) high cost of diagnostic and treatment services. The second key theme was patient preference for complementary and alternative medicine; the third was the limited understanding of cancer among the population. The fourth barrier was a patient's personal and family obligations; the fifth was the perceived impact of cancer and its treatment on sexuality, body image and relationships. Finally, the sixth was the stigma and discrimination faced by patients following a diagnosis of cancer. In conclusion, health system, patient level and societal factors all influence the likelihood of timely diagnosis and treatment for cancer in SSA. The results provide a focus for targeting health system interventions, particular with regards to awareness and understanding of cancer in the region.
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Affiliation(s)
- M Mwamba
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
| | - D C Lombe
- Regional Cancer Treatment Services MidCentral District Health Board, New Zealand
| | - S Msadabwe
- Cancer Diseases Hospital, Lusaka, Zambia
| | - V Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia; London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - M Simwinga
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - A Sentoogo Ssemata
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - R Muhumuza
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - J Seeley
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - A D Mwaka
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - A Aggarwal
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK; Institute of Cancer Policy, King's College London, London, UK
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Knettel B, Minja L, Msoka E, Tarimo C, Katiti V, Pan W, Mwobobia J, Juhlin E, Knippler E, Watt M, Suneja G, Kimani S, Abouelella D, Mmbaga B, Osazuwa-Peters N. Culturally-informed adaptation and psychometric properties of the Cataldo Cancer Stigma Scale in Northern Tanzania. J Psychosoc Oncol 2023; 42:286-298. [PMID: 37534869 PMCID: PMC10837313 DOI: 10.1080/07347332.2023.2241458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Cancer-related stigma impacts patients' emotional health, care engagement, and cancer outcomes, but few measures of cancer stigma exist. We culturally adapted and assessed psychometric properties of the Cataldo Cancer Stigma Scale (CCSS) in Tanzania. METHODS We administered the CCSS short version (21 items), plus 12 locally-derived items, to 146 adult cancer patients. We conducted exploratory factor analysis, examined internal consistency/reliability, and assessed convergent validity with relevant measures. RESULTS We identified a 17-item cancer stigma scale with strong psychometric properties and four subscales: enacted stigma, shame and blame, internalized stigma, and disclosure concerns. Stigma was rare except for disclosure concerns. Stigma was positively associated with depression and anxiety and negatively associated with social support, quality of life, and illness acceptance. CONCLUSIONS The scale provides valid, culturally-informed measurement of cancer stigma in Tanzania. Future studies should assess associations with care engagement, which will inform interventions to reduce stigma and improve outcomes.
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Affiliation(s)
- Brandon Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Elizabeth Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre Cancer Care Centre, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Judith Mwobobia
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Erika Juhlin
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Melissa Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Stephen Kimani
- Department of Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - Dina Abouelella
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nosayaba Osazuwa-Peters
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
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Mittal A, Neibart SS, Kulkarni A, Anderson T, Hudson SV, Beer NL, Einstein MH, Kohler RE. Barriers and facilitators to effective cervical cancer screening in Belize: a qualitative analysis. Cancer Causes Control 2023:10.1007/s10552-023-01703-0. [PMID: 37165111 DOI: 10.1007/s10552-023-01703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Belize has among the highest cervical cancer incidence and mortality rates of Latin American and Caribbean countries. This study evaluates the perspectives of key stakeholders for cervical cancer screening in Belize and identifies the barriers and facilitators for providing equitable access to prevention services. METHODS Semi-structured interviews discussing cervical cancer screening were conducted with key stakeholders across the six districts of Belize in 2018. Interviews were transcribed, coded, and analyzed thematically; themes were organized by levels of the social-ecological model. RESULTS We conducted 47 interviews with health care providers (45%), administrators (17%), government officials (25%), and other stakeholders (13%). Majority (78%) of interviews were from the public sector. Perceived barriers to cervical cancer screening were identified across multiple levels: (1) Individual Patient: potential delays in Pap smear results and fear of a cancer diagnosis; (2) Provider: competing clinician responsibilities; (3) Organizational: insufficient space and training; (4) Community: reduced accessibility in rural areas; and (5) Policy: equipment and staffing budget limitations. The main facilitators we identified included the following: (1) at the Community level: resource-sharing between public and private sectors and dedicated rural outreach personnel; (2) at the Policy level: free public screening services and the establishment of population-based screening. CONCLUSION Despite free, publicly available cervical cancer screening in Belize, complex barriers affect access and completion of management when abnormal screening tests are identified. Provider workload, education outreach, and additional funding for training and facilities are potential areas for strengthening this program and increasing detection and management for cervical cancer control.
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Affiliation(s)
- Avni Mittal
- Department of Obstetrics and Reproductive Health and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Shane S Neibart
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Taylor Anderson
- University of Queensland Ochsner Clinical School, Brisbane, QLD, Australia
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Mark H Einstein
- Department of Obstetrics and Reproductive Health and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Racquel E Kohler
- Department of Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health , Piscataway, NJ, USA
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Sharma K, Machalek DA, Toh ZQ, Amenu D, Muchengeti M, Ndlovu AK, Mremi A, Mchome B, Vallely AJ, Denny L, Rees H, Garland SM. No woman left behind: achieving cervical cancer elimination among women living with HIV. Lancet HIV 2023:S2352-3018(23)00082-6. [PMID: 37182539 DOI: 10.1016/s2352-3018(23)00082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
Cervical cancer is the fourth most common malignancy in women of reproductive age globally. The burden of this disease is highest in low-income and middle-income countries, especially among women living with HIV. In 2018, WHO launched a global strategy to accelerate cervical cancer elimination through rapid scale-up of prophylactic vaccination, cervical screening, and treatment of precancers and cancers. This initiative was key in raising a call for action to address the stark global disparities in cervical cancer burden. However, achieving elimination of cervical cancer among women with HIV requires consideration of biological and social issues affecting this population. This Position Paper shows specific challenges and uncertainties on the way to cervical cancer elimination for women living with HIV and highlights the scarcity of evidence for the effect of interventions in this population. We argue that reaching equity of outcomes for women with HIV will require substantial advances in approaches to HPV vaccination and improved understanding of the long-term effectiveness of HPV vaccines in settings with high HIV burden cervical cancer, just as HIV, is affected by social and structural factors such as poverty, stigma, and gender discrimination, that place the elimination strategy at risk. Global efforts must, therefore, be galvanised to ensure women living with HIV have optimised interventions, given their substantial risk of this preventable malignancy.
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Affiliation(s)
- Kirthana Sharma
- Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, USA.
| | - Dorothy A Machalek
- Global Health Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Zheng Q Toh
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Demisew Amenu
- Department of Obstetrics and Gynaecology, Jimma University, Jimma, Ethiopia
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; South African Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Andrew K Ndlovu
- School of Allied Health Professions Department of Medical Laboratory Sciences, University of Botswana, Gaborone, Botswana
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Bariki Mchome
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Andrew J Vallely
- Global Health Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lynette Denny
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Gynaecologic Cancer Research Centre, Cape Town, South Africa
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
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9
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Tshabalala G, Blanchard C, Mmoledi K, Malope D, O'Neil DS, Norris SA, Joffe M, Dietrich JJ. A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001826. [PMID: 37159437 PMCID: PMC10168575 DOI: 10.1371/journal.pgph.0001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.
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Affiliation(s)
- Gugulethu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charmaine Blanchard
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Palliative Care, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keletso Mmoledi
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Palliative Care, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Desiree Malope
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Daniel S O'Neil
- Yale Cancer Center, Department of Medicine, Yale School of Medicine, Yale University, New Haven, United States of America
| | - Shane A Norris
- South African Medical Research Council Common Epithelial Cancer Research Centre, Tygerberg, South Africa
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Yale Cancer Center, Department of Medicine, Yale School of Medicine, Yale University, New Haven, United States of America
| | - Janan Janine Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa; and African Social Sciences Unit of Research and Evaluation (ASSURE), division of Wits Health Consortium, Johannesburg, South Africa
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Zibako P, Hlongwa M, Tsikai N, Manyame S, Ginindza TG. Mapping Evidence on Management of Cervical Cancer in Sub-Saharan Africa: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159207. [PMID: 35954564 PMCID: PMC9367747 DOI: 10.3390/ijerph19159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
Cervical cancer (CC) is the most common viral infection of the reproductive tract and in Sub-Saharan Africa (SSA), its morbidity and mortality rates are high. The aim of this review was to map evidence on CC management in SSA. The scoping review was conducted in accordance with Arksey and O’Malley’s scoping review framework. The review included studies on different aspects of CC management. The review was also done following the steps and guidelines outlined in the PRISMA-Extension for Scoping Reviews (PRISMA-ScR) checklist. The following databases were searched: PubMed, EBSCOhost, Scopus and Cochrane Database of Systematic Review. A total of 1121 studies were retrieved and 49 which were eligible for data extraction were included in the review. The studies were classifiable in 5 groups: 14 (28.57%) were on barriers to CC screening, 10 (20.41%) on factors associated with late-stage presentation at diagnosis, 11 (22.45%) on status of radiotherapy, 4 (8.20%) on status of chemotherapy and 10 (20.41%) on factors associated with high HPV coverage. High HPV vaccine coverage can be achieved using the class school-based strategy with opt-out consent form process. Barriers to CC screening uptake included lack of knowledge and awareness and unavailability of screening services. The reasons for late-stage presentation at diagnosis were unavailability of screening services, delaying whilst using complementary and alternative medicines and poor referral systems. The challenges in chemotherapy included unavailability and affordability, low survival rates, treatment interruption due to stock-outs as well as late presentation. Major challenges on radiotherapy were unavailability of radiotherapy, treatment interruption due to financial constraints, and machine breakdown and low quality of life. A gap in understanding the status of CC management in SSA has been revealed by the study implying that, without full knowledge of the extent of CC management, the challenges and opportunities, it will be difficult to reduce infection, improve treatment and palliative care. Research projects assessing knowledge, attitude and practice of those in immediate care of girls at vaccination age, situational analysis with health professionals and views of patients themselves is important to guide CC management practice.
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Affiliation(s)
- Petmore Zibako
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa; (M.H.); (T.G.G.)
- Correspondence:
| | - Mbuzeleni Hlongwa
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa; (M.H.); (T.G.G.)
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Nomsa Tsikai
- College of Health Sciences, University of Zimbabwe, MT Pleasant, Harare P.O. Box MP167, Zimbabwe; (N.T.); (S.M.)
| | - Sarah Manyame
- College of Health Sciences, University of Zimbabwe, MT Pleasant, Harare P.O. Box MP167, Zimbabwe; (N.T.); (S.M.)
| | - Themba G. Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa; (M.H.); (T.G.G.)
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
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Gerstl S, Lee L, Nesbitt RC, Mambula C, Sugianto H, Phiri T, Kachingwe J, Llosa AE. Cervical cancer screening coverage and its related knowledge in southern Malawi. BMC Public Health 2022; 22:295. [PMID: 35164716 PMCID: PMC8842862 DOI: 10.1186/s12889-022-12547-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world’s highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened. Methods A population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status. Results The percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC. Conclusion Most of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.
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Affiliation(s)
- Sibylle Gerstl
- Epicentre / Médecins Sans Frontières (MSF), Paris, France.
| | - Lawrence Lee
- Epicentre / Médecins Sans Frontières (MSF), Paris, France
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Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The Effect of Peer-Led Navigation Approach as a Form of Task Shifting in Promoting Cervical Cancer Screening Knowledge, Intention, and Practices Among Urban Women in Tanzania: A Randomized Controlled Trial. Cancer Control 2022; 29:10732748221089480. [PMID: 35666651 PMCID: PMC9174555 DOI: 10.1177/10732748221089480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Even though the government's priorities in preventing cervical cancer are implemented in urban areas, the screening rate remains unsatisfactory at 6%, compared to 70% recommended by the world health organization. The ongoing public health education has not resulted in sufficient screening rates. The study aims to assess peer-led navigation (PLNav) in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania. Since PLNav is the form of task shifting, it involves delegating cervical-cancer-related tasks from healthcare professionals to community health workers (CHWs). METHODS It is a community-based randomized controlled trial conducted in Dar es Salaam in Tanzania March-Sept 2020. The PLNav involved the CHWs delivering health education, counselling and navigation assistance to community women (COMW). The CHWs help women who have never undergone cervical cancer screening (CCS) and those who have undergone CCS but with a precancerous cervical lesion to overcome screening barriers. The data related to PLNav were analyzed by descriptive statistics, an independent-samples t-test, repeated measures ANOVA and linear regression. RESULTS The repeated measures ANOVA across time showed that PLNav intervention on mean knowledge score changes was statistically significant in the intervention group compared with the control group's usual care, [F (1, 43) = 56.9, P < .001]. At the six-month follow-up, 32 (72.7%) out of 44 participants from the intervention group had screened for cervical cancer, and only one participant (2.3%) from the control group screened. The PLNav intervention on CCS uptake changes was statistically significant in the intervention group compared with usual care in the control group [F (1, 43) = 100.4, P < .001]. The effect of time on CCS uptake in the intervention and control groups was statistically significant [F (1.64, 70.62) = 73.4, P < .001]. CONCLUSION Peer-led navigation (PLNav) was effective in promoting cervical cancer screening knowledge, intention, and uptake.
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Affiliation(s)
- Joanes Faustine Mboineki
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,12636School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.,School of Nursing and Public Health, The University of Dodoma, Tanzania
| | - Panpan Wang
- 12636School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Kamala Dhakal
- 12636School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Mikiyas Amare Getu
- 12636School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Changying Chen
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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13
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Peterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA. Stigma and cervical cancer prevention: A scoping review of the U.S. literature. Prev Med 2021; 153:106849. [PMID: 34662598 DOI: 10.1016/j.ypmed.2021.106849] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior-either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.
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Affiliation(s)
- Caryn E Peterson
- School of Public Health, University of Illinois at Chicago, USA.
| | - Abigail Silva
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, USA
| | | | | | - Elise Z Hu
- University of Illinois College of Medicine, USA
| | | | | | - Ian G Jasenof
- University of Illinois Health, Mile Square Health Center, USA
| | - Sage J Kim
- School of Public Health, University of Illinois at Chicago, USA
| | - J Andrew Dykens
- University of Illinois College of Medicine, USA; Department of Family Medicine, College of Medicine, Center for Global Health, USA
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Li Y, Chen S, Xu M, Liu J. Effect of crisis intervention nursing on perioperative psychological state and self-efficacy of patients undergoing laparoscopic radical hysterectomy. Am J Transl Res 2021; 13:12988-12995. [PMID: 34956515 PMCID: PMC8661230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/07/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the effect of crisis intervention nursing on perioperative psychological state and self-efficacy of patients with laparoscopic radical hysterectomy. METHOD A total of 151 cervical cancer patients that underwent laparoscopic radical surgery during January 2018 to March 2020 in our hospital were selected as the research objects. The patients were divided into control group (n=73) and observation group (n=78) according to treatment regimen. The control group received conventional nursing measures, and the observation group was treated with crisis intervention nursing in addition to the traditional measures. The changes of psychological state, self-efficacy, psychological crisis, hope degree before and after intervention, and the satisfaction of the two groups with nursing care were compared. RESULTS The scores of HAMA, HAMD, self-efficacy, psychological crisis and hope degree in the two groups were remarkably improved after intervention compared with before intervention (all P<0.05), and the improvement of each index in observation group was obviously superior to that in control group (P<0.05). After intervention, the satisfaction to nursing care in observation group was dramatically higher than that in control group (P<0.05). CONCLUSION The application of crisis intervention nursing on patients with laparoscopic radical hysterectomy is conductive to alleviating the adverse emotions such as anxiety and depression, reducing their sense of psychological crisis, improving the self-efficacy and hope degree of curing disease, as well as the satisfaction rate with the nursing care, which is worthy of clinical application.
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Affiliation(s)
- Yan Li
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Sisi Chen
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Mengjie Xu
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Jiao Liu
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
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Mpata PC, Nkosi ZZ. Experiences of cervical cancer screening in HIV-positive women in Zimbabwe. Curationis 2021; 44:e1-e7. [PMID: 34797107 PMCID: PMC8603067 DOI: 10.4102/curationis.v44i1.2184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/29/2021] [Accepted: 06/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background The primary purpose of screening is to detect individuals in danger of cervical cancer so as to prevent further progression of the disease. Cervical cancer remains a global concern, as it ranks as the fourth most commonly diagnosed female malignancy worldwide. It is the commonest female cancer in Zimbabwe. Women living with human immunodeficiency virus (HIV) have a disproportionate risk of invasive cervical cancer, as they are 2–12 times more likely to develop pre-cancerous lesions. As a result of the increased risk, routine screenings are suggested. Few women are screened for cervical cancer in Zimbabwe. Objectives This study aimed at describing the experiences of screening for cervical cancer and motivation behind screening. Method The study employed a qualitative research approach. In-depth one to one interviews and focus group discussions were conducted using interview and focus group guides. The study was conducted at an opportunistic infections clinic in Mpilo Central Hospital. Data analysis was performed by using Giorgi’s descriptive method of data analysis. Results The themes that emerged from data analysis were facilitators to screening for cervical cancer, community awareness of cervical cancer screening, free cervical cancer treatment and more screening centres and integrating cervical cancer screening with HIV care. Conclusion In-depth understanding of the factors that enable women to take part in cervical cancer screening is essential so that these factors can be strengthened to improve uptake of cervical cancer screening services.
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Affiliation(s)
- Patience C Mpata
- School of Nursing and Midwifery, Mpilo Central Hospital, Bulawayo.
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Niyonsenga G, Gishoma D, Sego R, Uwayezu MG, Nikuze B, Fitch M, Igiraneza PC. Connaissances, utilisation et obstacles liés au dépistage du cancer du col utérin dans des hôpitaux de district de Kigali, au Rwanda. Can Oncol Nurs J 2021; 31:275-284. [PMID: 34395830 DOI: 10.5737/23688076313275284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Contexte Dans le monde, le cancer du col utérin arrive au troisième rang des cancers les plus fréquents chez les femmes, mais il passe au deuxième rang en Afrique orientale, où se trouve le Rwanda. Le dépistage périodique est un moyen de prévention efficace. Malgré cela, en Afrique, on estime que le taux de dépistage de ce cancer se situe entre 10 et 70 %. Plusieurs facteurs entravent le dépistage, surtout en Afrique subsaharienne. Au Rwanda, on recense peu d'écrits sur l'utilisation des services de dépistage et les facteurs nuisant au dépistage du cancer du col utérin. Objectif Évaluer les connaissances sur le dépistage du cancer du col utérin qu'ont les femmes fréquentant les hôpitaux de district de Kigali (au Rwanda), recenser l'utilisation de ce service et déterminer les obstacles qui empêchent d'y recourir. Méthodologie Une étude transversale descriptive a été menée, et les données ont été collectées au moyen d'un questionnaire structuré. Des questions nominales de type « oui ou non » ont mis en lumière les connaissances des femmes sur le cancer du col utérin et l'utilisation des services de dépistage. Pour cerner les obstacles au dépistage, nous avons utilisé des questions de type « échelle de Likert ». Ces données ont ensuite fait l'objet d'une analyse statistique descriptive et déductive. La sélection des répondantes s'est faite par échantillonnage aléatoire systématique depuis la base de données des patientes fréquentant les services gynécologiques de trois hôpitaux de district de Kigali (Rwanda). Résultats Au total, 329 femmes ont répondu au sondage. La moitié d'entre elles (n = 165) connaissaient bien le dépistage du cancer du col utérin. Le pourcentage de dépistage se situe à 28,3 %. Nous avons décelé un lien entre l'utilisation du dépistage et une bonne connaissance du sujet (P = 0,000, r = -0,392) ainsi que certains facteurs démographiques (P = 0,000). Parmi les obstacles qui concourent à restreindre l'accès au dépistage, nous avons relevé des obstacles individuels (méconnaissance de l'existence des services de dépistage), géographiques (milieu rural) et liés au système de santé et aux prestataires de soins (campagnes de sensibilisation déficientes, attitudes négatives des prestataires de soins envers les patientes et longs délais d'attente). Conclusion Dans les hôpitaux de district étudiés de Kigali (Rwanda), on constate un faible pourcentage de dépistage du cancer du col utérin causé par plusieurs obstacles. Il est donc fortement recommandé d'engager une campagne d'information permanente sur ce cancer et son dépistage. Enfin, il est crucial que les prestataires de soins qualifiés encouragent les femmes à se soumettre au dépistage, et qu'ils s'efforcent de réduire les obstacles qui s'y rattachent.
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Affiliation(s)
| | - Darius Gishoma
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
| | - Ruth Sego
- Collège des sciences infirmières Rory Meyers, Université de New York, New York, États-Unis et Faculté des sciences infirmières Bloomberg, Université de Toronto, Canada
| | - Marie Goretti Uwayezu
- École de sciences infirmières et pratique sage-femme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
| | - Bellancille Nikuze
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
| | - Margaret Fitch
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
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Obol JH, Lin S, Obwolo MJ, Harrison R, Richmond R. Provision of cervical cancer prevention services in Northern Uganda: a survey of health workers from rural health centres. BMC Health Serv Res 2021; 21:794. [PMID: 34380470 PMCID: PMC8359606 DOI: 10.1186/s12913-021-06795-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
Background Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan. Methods A cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p-value ≤ 0.05 was considered a significant predictor of outcome. Results We surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13–0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99–9.63, p-=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00–4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22–6.86, p = 0.02). Conclusions This study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90–70–90 targets by 2030 to be on track for cervical cancer elimination. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06795-5.
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Affiliation(s)
- James Henry Obol
- School of Population Health and Community Medicine, University of New South Wales, 2033, Kensington, NSW, Australia. .,Faculty of Medicine, Gulu University, P.O Box 166, Gulu, Uganda.
| | - Sophia Lin
- School of Population Health and Community Medicine, University of New South Wales, 2033, Kensington, NSW, Australia
| | | | - Reema Harrison
- School of Population Health and Community Medicine, University of New South Wales, 2033, Kensington, NSW, Australia
| | - Robyn Richmond
- School of Population Health and Community Medicine, University of New South Wales, 2033, Kensington, NSW, Australia
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Niyonsenga G, Gishoma D, Sego R, Uwayezu MG, Nikuze B, Fitch M, Igiraneza PC. Knowledge, utilization and barriers of cervical cancer screening among women attending selected district hospitals in Kigali - Rwanda. Can Oncol Nurs J 2021; 31:266-274. [PMID: 34395829 DOI: 10.5737/23688076313266274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening. Objective To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda. Methods A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal 'yes' or 'no' questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda. Results Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. Conclusion A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.
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Affiliation(s)
| | - Darius Gishoma
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Ruth Sego
- Rory Meyer's College of Nursing, New York University, New York, USA and the Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Marie Goretti Uwayezu
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Bellancille Nikuze
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Margaret Fitch
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
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Nyagabona SK, Luhar R, Ndumbalo J, Mvungi N, Ngoma M, Meena S, Siu S, Said M, Mwaiselage J, Tarimo E, Buckle G, Selekwa M, Mushi B, Mmbaga EJ, Van Loon K, DeBoer RJ. Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania. Oncologist 2021; 26:e1197-e1204. [PMID: 34041817 PMCID: PMC8265360 DOI: 10.1002/onco.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background In response to the increasing burden of cancer in Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory‐informed implementation strategy to promote guideline‐concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline‐based practice prior to the launch of the TNCTG. Materials and Methods In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline‐concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis. Results Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included capacity and infrastructure, information technology, communication, efficiency, and quality of services provided. Contextual factors external to ORCI included interinstitutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania. Conclusion Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in an effort to improve uptake of the TNCTGs at ORCI. Implications for Practice This study provides an assessment of cancer care delivery systems in a low resource setting from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors that are likely to influence guideline implementation outcomes is the first step of developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent actionable targets that will inform the next phases of our implementation strategy for guideline‐concordant cancer care in Tanzania and comparable settings. Guidelines to improve and standardize oncology care in Tanzania were developed in 2020. This study utilized focus group discussions to assess the barriers and facilitators to guideline implementation at Ocean Road Cancer Institute.
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Affiliation(s)
| | - Rohan Luhar
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | | | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Stephen Meena
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sadiq Siu
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mwamvita Said
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Edith Tarimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Geoffrey Buckle
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia John Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,University of Oslo, Norway
| | - Katherine Van Loon
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Rebecca J DeBoer
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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20
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Henke A, Kluge U, Borde T, Mchome B, Serventi F, Henke O. Tanzanian women´s knowledge about Cervical Cancer and HPV and their prevalence of positive VIA cervical screening results. Data from a Prevention and Awareness Campaign in Northern Tanzania, 2017 - 2019. Glob Health Action 2021; 14:1852780. [PMID: 33371824 PMCID: PMC7782163 DOI: 10.1080/16549716.2020.1852780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: 14.9 million women (≥15 years) in Tanzania are at risk of developing cervical cancer. Limited cancer care facilities, prevention programs and sparse knowledge among community members and healthcare workers contribute to late-stage presentation leading to a high mortality rate. Objective: This study aims to scientifically accompany prevention and awareness campaigns (PrevACamp) in northern Tanzania in its real-world settings to obtain (1) a better understanding about cervical cancer and HPV knowledge amongst female PrevACamp participants and (2) to determine the prevalence of pre-cancerous lesions among women undergoing cervical cancer VIA screening. Method: Cross-sectional survey among PrevACamp attendees in two regions in Northern Tanzania. Two data collections tools were used: Questionnaires and clinical data from VIA screening. Data were collected from October 2017 to March 2019. Results: 2,192 PrevACamp attendees were interviewed and 2,224 received VIA screening. There was significant nescience on cervical cancer regardless of education level, resident status, or number of children as well as nescience on HPV in all age groups, especially in urban areas and misconceptions about cancer. Screening revealed VIA positivity rate of 3.1%. Conclusion: There is an alarming lack of knowledge about cervical cancer and, to a lesser Extent, about HPV among the study participants. Having health insurance influenced the level of knowledge significantly. Outreach programs in rural areas appear to target the population in need of health education. Low positive VIA screening results are paralleled with lower HIV rates among the women. We assume that the high density of primary health care coverage in northern Tanzania contributes to these findings..
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Affiliation(s)
- Antje Henke
- Kilimanjaro Christian Medical Centre, Cancer Care Centre , Moshi, Tanzania
| | - Ulrike Kluge
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin , Berlin, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences , Berlin, Germany
| | - Bariki Mchome
- Department of Gynaecology, Kilimanjaro Christian Medical Centre , Moshi, Tanzania
| | - Furaha Serventi
- Kilimanjaro Christian Medical Centre, Cancer Care Centre , Moshi, Tanzania
| | - Oliver Henke
- Kilimanjaro Christian Medical Centre, Cancer Care Centre , Moshi, Tanzania
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21
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Barriers to Cervical Cancer Screening Among Women Living With HIV in Low- and Middle-Income Countries: A Systematic Review. J Assoc Nurses AIDS Care 2021; 31:497-516. [PMID: 32675646 DOI: 10.1097/jnc.0000000000000194] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Women living with HIV in low-and-middle-income countries (LMICs) are at high risk of developing cervical cancer due to their immunocompromised status. Screening is an imperative prevention measure for early detection and for ultimately reducing high rates of cervical cancer; however, cervical cancer screening uptake among this group remains low. This systematic review aimed to identify barriers to cervical cancer screening among women living with HIV in LMIC. A comprehensive literature search was undertaken, and an analysis of included studies was completed to abstract major themes related to cervical cancer screening barriers for women living with HIV in LMIC. Lack of cervical cancer and cervical cancer screening knowledge among patients was found to be the most prevalent barrier to cervical cancer screening. Our findings highlight a dire need for interventions to increase knowledge and awareness of cervical cancer screening among women living with HIV in LMIC, along with addressing barriers within health care systems.
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Mboineki JF, Wang P, Chen C. Fundamental Elements in Training Patient Navigators and Their Involvement in Promoting Public Cervical Cancer Screening Knowledge and Practices: A Systematic Review. Cancer Control 2021; 28:10732748211026670. [PMID: 34169777 PMCID: PMC8236772 DOI: 10.1177/10732748211026670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/23/2021] [Accepted: 05/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer screening remains unsatisfactory in some regions due to hindrances. This study aims to explore fundamental elements in training patient navigators and their involvement in promoting screening knowledge and practices. METHODS This systematic review study included only English published articles between 2014 and 2019 from PubMed/Medline, EBSCO, Science Direct, and Wiley online library. RESULTS Healthcare professionals trained patient navigators in 3 days regarding screening basics, along with group discussions and role-plays. They delivered effective health education and navigation assistance. CONCLUSION The group education session facilitated by patient navigators, coupled with navigation care, resulted in a high screening rate.
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Affiliation(s)
- Joanes Faustine Mboineki
- First Affiliated Teaching Hospital of Zhengzhou University, Zhengzhou, Henan, China
- School of Nursing, Zhengzhou University, Zhengzhou, China
- College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Panpan Wang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- First Affiliated Teaching Hospital of Zhengzhou University, Zhengzhou, Henan, China
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23
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Rohner E, Mulongo M, Pasipamire T, Oberlin AM, Goeieman B, Williams S, Lubeya MK, Rahangdale L, Chibwesha CJ. Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africa a. Int J Gynaecol Obstet 2020; 152:53-59. [PMID: 33188707 DOI: 10.1002/ijgo.13485] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To map the cervical cancer screening cascade among women living with HIV attending a public-sector cytology screening program in Johannesburg, South Africa. METHODS We conducted a retrospective cohort study of routinely collected clinical data captured in an electronic medical record system. Women (≥18 years) living with HIV with an abnormal Pap result between January 2013 and May 2018 were included. The proportion of women who received follow-up consistent with extant clinical guidelines, stratified by their initial Pap smear result, was examined. RESULTS The study included 2072 women: 1384 (66.8%) with a low-risk Pap result, 681 (32.9%) with a high-risk Pap result, and 7 (0.3%) with suspected cancer. Only 174 (25.6%) women with a high-risk Pap result underwent guideline-indicated management within 18 months. Among women with a low-risk Pap result, 375 (27.1%) received follow-up within 1 year; the cumulative incidence of follow-up increased to 63.1% at 3 years. All women with suspected cancer either received a colposcopic biopsy or were referred for further treatment. CONCLUSION Attrition among South African women living with HIV who attended cervical screening in an urban public-sector program was high. Developing tailored interventions to address bottlenecks in the care cascade and improve cervical screening outcomes will be central to eliminating cervical cancer.
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Affiliation(s)
- Eliane Rohner
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Masangu Mulongo
- Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | - Tafadzwa Pasipamire
- Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Austin M Oberlin
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | | | - Sophie Williams
- Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | - Mwansa K Lubeya
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carla J Chibwesha
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
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24
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Mboineki JF, Wang P, Dhakal K, Getu MA, Millanzi WC, Chen C. Predictors of uptake of cervical cancer screening among women in Urban Tanzania: community-based cross-sectional study. Int J Public Health 2020; 65:1593-1602. [PMID: 33130908 DOI: 10.1007/s00038-020-01515-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The proportion of women screened for cervical cancer in Tanzania remains small at 6-21%. Even though some studies have been conducted to address barriers, the screening uptake remains low, which denotes the presence of unidentified barriers. The main objective of this study is to assess the predictors in the uptake of cervical cancer screening (CCS) among women in Tanzania. METHODS This is a community-based cross-sectional study conducted to obtain quantitative data through validated questionnaires to assess predictors of CCS. RESULTS 1013 (91.8%) of the respondents had not been screened for cervical cancer. Three predictors of CCS were identified in this study; screening intention, health beliefs, and knowledge level. 600 (54.4%) of respondents had no screening intention. 552 (50%) had negative health beliefs, and 585 (53%) had inadequate knowledge of cervical cancer and CCS. Respondents who had no intention to screen were 0.482 (AOR) times less likely to uptake CCS (P = 0.002; 95% CI: 0.305, 0.761). CONCLUSIONS The ongoing community-awareness raising campaigns should be coupled with community knowledge-raising campaign, and there should be an establishing of peer-supporting screening programs in communities.
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Affiliation(s)
- Joanes Faustine Mboineki
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.,Department of Nursing and Midwifery, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Panpan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Kamala Dhakal
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | | | - Walter Cleophance Millanzi
- Department of Nursing and Midwifery, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Changying Chen
- The first affiliated hospital of Zhengzhou University, Jianshe Dong Lu, Zhengzhou, 450000, Henan province, China.
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25
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Barriers and Facilitators of Pap Testing for Women Living With HIV: A Focus Group Study. J Assoc Nurses AIDS Care 2020; 31:190-196. [PMID: 31567730 DOI: 10.1097/jnc.0000000000000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Page CM, Ibrahim S, Park LP, Huchko MJ. Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies. PLoS One 2020; 15:e0235264. [PMID: 32658921 PMCID: PMC7357749 DOI: 10.1371/journal.pone.0235264] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/11/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya. METHODS In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018-2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively. RESULTS Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women's decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment. CONCLUSION Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.
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Affiliation(s)
- Charlotte M. Page
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | | | - Lawrence P. Park
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Megan J. Huchko
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Liu L, Chen Y, Zhang Q, Li C. Silencing of KCNA1 suppresses the cervical cancer development via mitochondria damage. Channels (Austin) 2020; 13:321-330. [PMID: 31354026 PMCID: PMC6682364 DOI: 10.1080/19336950.2019.1648627] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Voltage-gated potassium channel subfamily A member 1 (KCNA1/Kv1.1) is an important component of type A potassium channels, which has been found to be involved in various tumors. This study aimed to identify the role of KCNA1 in cervical cancer and explore the related mechanism. The levels of KCNA1 in cervical cancer tissues and cell lines were examined by Western blot and qPCR. Cell proliferation and invasion were assessed by CCK-8 and transwell assays, respectively. Protein levels of Hedgehog (Hhg), Wnt and Notch were detected by Western blot. The mitochondrial capacity was examined by immunostaining with MitoTracker Red CMXRos. KCNA1 was highly expressed in cervical cancer tissues and cell lines, and correlated with poor prognosis. In addition, depletion of KCNA1 suppressed growth, proliferation, migration and invasion of HeLa cells. Moreover, KCNA1 could regulate the Hhg, Wnt and Notch signaling pathways and cause mitochondrial dysfunction. The present study has demonstrated that KCNA1 is an oncogene excessively expressed in cervical cancer, and promotes tumor progression by regulating the Hhg, Wnt and Notch signaling pathways and the mitochondrial capacity. Therefore, our results provide a theoretical basis for the discovery of novel clinical treatment against cervical cancer.
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Affiliation(s)
- Li Liu
- a Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , China.,b Department of Obstetrics and Gynecology, Wenzhou People's Hospital , Wenzhou , Zhejiang , China
| | - Yumei Chen
- b Department of Obstetrics and Gynecology, Wenzhou People's Hospital , Wenzhou , Zhejiang , China
| | - Qingyuan Zhang
- c Department of Neurology, Wenzhou People's Hospital , Wenzhou , Zhejiang , China
| | - Changzhong Li
- a Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , China
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Yeates K, Erwin E, Mtema Z, Magoti F, Nkumbugwa S, Yuma S, Hopman WM, Ferguson A, Oneko O, Macheku G, Mtei AF, Smith C, Andrews L, West N, Dalton M, Newcomb A, Ginsburg O. Smartphone-Enhanced Training, QA, Monitoring, and Evaluation of a Platform for Secondary Prevention of Cervical Cancer: Opportunities and Challenges to Implementation in Tanzania. JCO Glob Oncol 2020; 6:1114-1123. [PMID: 32692627 PMCID: PMC7392775 DOI: 10.1200/go.20.00124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Until human papillomavirus (HPV)-based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who "graduated" from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.
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Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- New York University School of Global Public Health, New York NY
- Pamoja Tunaweza Women’s Centre, Moshi, Tanzania
| | - Erica Erwin
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Zac Mtema
- SkyConnect Company and Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Frank Magoti
- SkyConnect Company and Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Simoni Nkumbugwa
- SkyConnect Company and Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Safina Yuma
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Wilma M. Hopman
- Kingston General Health Research Institute; Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Olola Oneko
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Agnes Feksi Mtei
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | | | | | - Nicola West
- Pamoja Tunaweza Women’s Centre, Moshi, Tanzania
- Queen’s University, Kingston, Ontario, Canada
| | | | - Ashley Newcomb
- Section for Global Health, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Ophira Ginsburg
- Section for Global Health, Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Perlmutter Cancer Center, New York University Langone Health, New York, NY
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Kasraeian M, Hessami K, Vafaei H, Asadi N, Foroughinia L, Roozmeh S, Bazrfashan K. Patients' self-reported factors influencing cervical cancer screening uptake among HIV-positive women in low- and middle-income countries: An integrative review. Gynecol Oncol Rep 2020; 33:100596. [PMID: 32551354 PMCID: PMC7292910 DOI: 10.1016/j.gore.2020.100596] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/30/2020] [Accepted: 05/29/2020] [Indexed: 01/10/2023] Open
Abstract
This review reveals barriers of cervical cancer screening among HIV-positive women. The uptake of cervical cancer screening among HIV-positive women is very low. We reported personal, social and structural barriers of cervical cancer screening.
Cervical cancer is among the most common causes of cancer-related deaths in low- and middle-income countries (LMICs). Despite the strong evidence regarding cervical cancer screening cost-effectiveness, its utilization remains low especially in high risk populations such as HIV-positive women. The aim of this review was to provide an overview on the patient-reported factors influencing cervical cancer screening uptake among HIV-positive women living in LMICs. We systematically searched EMBASE, PUBMED/MEDLINE and Web of Science databases to identify all quantitative and qualitative studies investigating the patient-reported barriers or facilitators to cervical cancer screening uptake among HIV-positive population from LMICs. A total of 32 studies met the inclusion criteria. A large number of barriers/facilitators were identified and then grouped into three categories of personal, social and structural variables. However, the most common influential factors include knowledge and attitude toward cervical cancer or its screening, embarrassment, fear of cervical cancer screening and test results, patient-healthcare provider relationship, social support, screening costs and time constraints. This review’s findings highlighted the need for multi-level participation of policy makers, health professionals, patients and their families in order to overcome the barriers to uptake of cervical cancer screening among HIV-positive women, who are of special concern in LMICs.
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Affiliation(s)
- Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrfashan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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30
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Mungo C, Ibrahim S, Bukusi EA, Truong HHM, Cohen CR, Huchko M. Scaling up cervical cancer prevention in Western Kenya: Treatment access following a community-based HPV testing approach. Int J Gynaecol Obstet 2020; 152:60-67. [PMID: 32347550 DOI: 10.1002/ijgo.13171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/28/2020] [Accepted: 04/14/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate access to treatment after community-based HPV testing as testing within screen-and-treat programs has the potential to lower mortality from cervical cancer in low-resource settings. METHODS A prospective cohort study was conducted in western Kenya in 2018. Women aged 25-65 years underwent HPV self-testing. HPV-positive women were referred for cryotherapy. Participant data were obtained from questionnaires during screening and treatment. The proportion successfully accessing treatment and variables associated with successful treatment was determined. RESULTS Of the 750 women included, 140 (18.6%) tested positive for HPV. Of them, 135 were notified of their results, of whom 77 (59.2%) sought treatment and 73 (52.1%) received cryotherapy. Women who received treatment had a shorter time from screening to result notification (median 92 days, interquartile range [IQR] 84-104) compared to those who did not (97 days, IQR 89-106; P=0.061). In adjusted analyses, women with a history of cervical cancer screening (odds ratio [OR] 11, 95% confidence interval [CI] 1.42-85.20) and those electing result notification through a home visit (OR 4, 95% CI 1.23-14.17) were significantly more likely to acquire treatment at follow-up. CONCLUSION Linkage to treatment after community-based HPV screening in this population was low, highlighting the need for strategies aimed at strengthening treatment linkage in similar settings.
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Pan X, Cao YM, Liu JH, Ding J, Xie XY, Cao PG. MEG3 Induces Cervical Carcinoma Cells' Apoptosis Through Endoplasmic Reticulum Stress by miR-7-5p/STC1 Axis. Cancer Biother Radiopharm 2020; 36:501-510. [PMID: 32379497 DOI: 10.1089/cbr.2019.3344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Many patients with advanced cervical cancer (CC) have a poor prognosis and their mortality rank the first among women with malignant tumors. It's essential to explore the molecular mechanism of CC in clinical practice. Long noncoding RNA maternally expressed gene 3 (MEG3) has been reported to downregulate in CC tissues. However, the underlying mechanism of MEG3 in CC remains poorly elaborated. The current study aimed to explore the potential mechanism of MEG3 inducing endoplasmic reticulum stress (ERs)-mediated apoptosis of CC cells. Methods: The expression of MEG3 and miR-7-5p in CC tissues and cell lines was verified by quantitative reverse transcription/polymerase chain reaction (qRT-PCR). The vector of MEG3, miR-7-5p inhibitor, and sh-SCT1 were transfected into CC cell lines, and their expression was tested by qRT-PCR. Flow cytometry was used to detect apoptosis, and ERs-related protein expression was performed by Western blot. The regulatory relationship between MEG3/SCT1 and miR-7-5p was validated by Dual luciferase reporter assay. Results: CC tissues and cell lines showed downregulated MEG3 and STC1, and upregulated miR-7-5p. Overexpression of MEG3 or miR-7-5p inhibition induced ERs-triggered apoptosis of CC cells. In addition, sh-STC1 can reverse the effects of overexpressing MEG3 on CC cell apoptosis. In addition, dual luciferase reporter assay revealed that miR-7-5p can directly target to MEG3 and STC1. Conclusion: MEG3, act as a competing endogenous RNA of miR-7-5p, accelerates ERs-mediated apoptosis of CC cells through regulating SCT1 expression.
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Affiliation(s)
- Xi Pan
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Yan-Ming Cao
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Jian-Hao Liu
- School of Pharmaceutical Sciences of Central South University, Changsha, People's Republic of China
| | - Juan Ding
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Xue-Yi Xie
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Pei-Guo Cao
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
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Fokom Domgue J, Futuh B, Ngalla C, Kakute P, Manjuh F, Manga S, Nulah K, Welty E, Schmeler K, Welty T. Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa. Int J Cancer 2019; 147:128-138. [PMID: 31633801 DOI: 10.1002/ijc.32746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Joel Fokom Domgue
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer Center Houston TX
- Department of Obstetrics and GynecologyFaculty of Medicine and Biomedical Sciences, University of Yaoundé Yaoundé Cameroon
| | - Beatrice Futuh
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Calvin Ngalla
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Peter Kakute
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Florence Manjuh
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Simon Manga
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer Center Houston TX
| | - Thomas Welty
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
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33
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Runge AS, Bernstein ME, Lucas AN, Tewari KS. Cervical cancer in Tanzania: A systematic review of current challenges in six domains. Gynecol Oncol Rep 2019; 29:40-47. [PMID: 31309135 PMCID: PMC6606891 DOI: 10.1016/j.gore.2019.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 01/29/2023] Open
Abstract
Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a priority for the Tanzanian government. In this systematic review of 39 peer-reviewed publications that appeared in the PubMed/MEDLINE (NCBI) database from 2013 to 2018, we synthesize the growing body of literature to capture current trends in Tanzania's evolving cervical cancer landscape. Six domains were identified, including risk factors, primary prevention, barriers to screening, treatment, healthcare worker education, and sustainability. In addition to traditional risk factors associated with sexual behavior, acetowhite changes observed during visual inspection of the cervix with acetic acid, lower education, rural setting, and HIV positivity also have a noteworthy clinical impact.
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Affiliation(s)
- Ava S. Runge
- Department of Medical Education, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Megan E. Bernstein
- Department of Medical Education, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Alexa N. Lucas
- Department of Medical Education, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Krishnansu S. Tewari
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California, Irvine Medical Center, Orange, CA, USA
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