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Debellut F, Gamage D, Kumar S, Wickramasinghe S, Ruwanpathirana T, Kariyawasam M, Perera CS, Ginige S, Cooray N, Pecenka C, Slavkovsky R, Scott LaMontagne D, Mvundura M. Human papillomavirus (HPV) vaccination program in Sri Lanka: Ongoing costs and operational context of a routinized program. Vaccine X 2024; 17:100456. [PMID: 38379668 PMCID: PMC10877402 DOI: 10.1016/j.jvacx.2024.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Existing evidence on the cost of human papillomavirus (HPV) vaccination programs has focused on pilot and demonstration projects or initial introductions, which resulted in a perceived high cost. We aimed to study the ongoing cost and operational context of an established HPV vaccination program in Sri Lanka. We conducted a retrospective operational research and microcosting study focusing on 2019. We collected data from 30 divisional health units, 10 districts, and the central level. We then evaluated financial and economic costs, reported by level of the health system, program activity, cost types, and per dose delivered. In 2019, Sri Lanka delivered a total of 314,815 doses of HPV vaccine. In our study sample, 95 % of the HPV vaccination sessions took place at schools, with peaks of delivery in February-March and September-October. The weighted mean financial cost per dose delivered was $0.27 (95 % confidence interval [CI]: $0.15-$0.39) and the economic cost per dose was $3.88 (95 % CI: $2.67-$5.10), excluding the cost of vaccines and supplies. Most of the cost was borne by the divisional health unit level. Service delivery and social mobilization were major contributors to overall costs at the divisional health unit level, and vaccine collection or distribution and storage were the most costly activities at the district and central levels. Cost drivers included the opportunity cost of health worker and non-health worker time at the divisional health unit level and capital costs for vehicles and equipment, along with fuel, maintenance, and energy, at the district and central levels. This study provides new evidence on the cost and cost drivers of a routinized HPV vaccination program. Results can be used for financial planning purposes in Sri Lanka and may inform other countries as they consider use of HPV vaccines.
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Affiliation(s)
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
| | - Rose Slavkovsky
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
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Aldaba JG, Llave CL, Uy MEV, Tejano KP, Aquino MRC, Antonio P Catalig M, Sy ADR, Valverde HA, Mooney J, Slavkovsky R. The cost of human papillomavirus vaccination delivery at the administrative and health facility levels in the Philippines. Vaccine X 2024; 17:100459. [PMID: 38420134 PMCID: PMC10900773 DOI: 10.1016/j.jvacx.2024.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/19/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Background The World Health Organization has recommended the inclusion of human papillomavirus (HPV) vaccines in national immunization programs to address the global problem of cervical cancer. In the Philippines, HPV vaccination was introduced in a phased approach in 2015. This study seeks to estimate the cost of delivery of the HPV vaccination program and its operational context in the Philippines. Methods This was a retrospective, cross-sectional micro-costing study focused on ongoing HPV vaccination delivery and its operational context across all levels of the health system. Using structured questionnaires and data collection from secondary sources, the weighted mean financial and economic costs and costs per dose at the national, subnational, and health facility levels were estimated. Results The weighted mean financial and economic costs per dose of the HPV vaccination program aggregated across all levels of the health system were $US3.72and $29.74, respectively. Activities contributing most significantly to costs were service delivery and vaccine collection or distribution and storage at the health facility and administrative levels, respectively. The opportunity costs for health worker and non-health worker time accounted for 77% of the economic cost per dose. Conclusion The total weighted mean financial and economic costs of HPV delivery are within range of those reported in other countries. Costing studies can help identify cost drivers with local operational context to help inform policymakers and program managers in budgeting and planning interventions to improve program implementation.
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Affiliation(s)
- Josephine G Aldaba
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Cecilia L Llave
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Ma Esterlita V Uy
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Kim Patrick Tejano
- Disease Prevention and Control Bureau, Department of Health, Manila, Philippines
| | - Ma Romina C Aquino
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Migel Antonio P Catalig
- Department of Physical Sciences and Mathematics, College of Arts and Sciences, University of the Philippines Manila, Philippines
| | - Alvin Duke R Sy
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Philippines
| | - Haidee A Valverde
- Institute of Health Policy and Development Studies, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Jessica Mooney
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Rose Slavkovsky
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
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Slavkovsky R, Callen E, Pecenka C, Mvundura M. Costs of human papillomavirus vaccine delivery in low- and middle-income countries: A systematic review. Vaccine 2024; 42:1200-1210. [PMID: 38302338 PMCID: PMC10911079 DOI: 10.1016/j.vaccine.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
Vaccines to protect against human papillomavirus (HPV) infection are recommended for all adolescents by the World Health Organization (WHO) and are primarily delivered in school-based settings. This systematic review aims to summarize the available evidence on the cost of HPV vaccine delivery in low- and middle-income countries (LMICs). This updated evidence is eminent given recent global efforts to revitalize HPV vaccine delivery following the COVID-19 pandemic and can be used to inform planning for program sustainability. We carried out a systematic review of published literature reporting the costs of HPV vaccine delivery in LMICs published between 2005 and 2023. Eligibility criteria were developed using the Population, Intervention, Comparator, Outcome (PICO) framework, and studies that reported primary costing data and unit costs of HPV vaccine delivery were included. From the included studies, we extracted data such as phase of HPV vaccine implementation when costing was done, delivery strategy, and unit costs. Unit costs were converted into 2022 US$ for comparability. All included studies underwent critical appraisal using an adapted framework including Consolidated Health Economics Evaluation Reporting Standards criteria, the WHO-led consensus statement on vaccine delivery costing, and other frameworks. Our research identified 226 records, of which 15 met our inclusion criteria. Most studies (64 %) were carried out in African countries and during HPV vaccine pilots or demonstrations (60 %). Vaccine delivery cost ranged from $0.31 to $24.07 per dose for financial costs and $1.48 to $48.70 per dose for economic costs. The critical appraisal showed that most studies did not describe the uncertainty of reported delivery cost. Our systematic review evidence suggests that HPV vaccine delivery costs vary widely depending on country and stage of implementation when costing was done. Areas for further research include costing when programs are beyond the introduction phase and in LMICs outside of Africa.
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Affiliation(s)
- Rose Slavkovsky
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA.
| | - Emily Callen
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Mercy Mvundura
- Medical Devices and Health Technologies, PATH, Seattle, WA, USA
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Sultana R, Slavkovsky R, Ullah MR, Tasnim Z, Sultana S, Khan S, Shirin T, Haque S, Hossen MT, Islam MM, Khanom JA, Haque A, Nazneen A, Rimi NA, Hossain K, Islam MT, Hasan S, Yazdany MS, Ahsan MS, Mehedi K, Marfin AA, Letson GW, Pecenka C, Nguyen ALT. Cost of Acute and Sequelae Care for Japanese Encephalitis Patients, Bangladesh, 2011-2021. Emerg Infect Dis 2023; 29:2488-2497. [PMID: 37987586 PMCID: PMC10683813 DOI: 10.3201/eid2912.230594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from the societal perspective, we recruited patients with laboratory-confirmed JE from the past 10 years of JE surveillance in Bangladesh and categorized them as acute care, initial sequalae, and long-term sequelae patients. Among 157 patients, we categorized 55 as acute, 65 as initial sequelae (53 as both categories), and 90 as long-term sequelae. The average (median) societal cost of an acute JE episode was US $929 ($909), of initial sequelae US $75 ($33), and of long-term sequelae US $47 ($14). Most families perceived the effect of JE on their well-being to be extreme and had sustained debt for JE expenses. Our data about the high cost of JE can be used by decision makers in Bangladesh.
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Mvundura M, Slavkovsky R, Debellut F, Naddumba T, Bayeh A, Ndiaye C, Anena J, Vodicka E, Diop A, Gamage D, Musanabaganwa C, Tatkan G, Driwale A, Zelalem M, Badiane O, Ginige S, Hamilton E, Sibomana H, Lakew Y, Uwinkindi F, Dhufera A, Ampeire I, Kumar S, Lamontagne DS. Cost and operational context for national human papillomavirus (HPV) vaccine delivery in six low- and middle-income countries. Vaccine 2023; 41:7435-7443. [PMID: 37949752 DOI: 10.1016/j.vaccine.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION There are concerns from immunization program planners about high delivery costs for human papillomavirus (HPV) vaccine. Most prior research evaluated costs of HPV vaccine delivery during demonstration projects or at introduction, showing relatively high costs, which may not reflect the costs beyond the pilot or introduction years. This study sought to understand the operational context and estimate delivery costs for HPV vaccine in six national programs, beyond their introduction years. METHODS Operational research and microcosting methods were used to retrospectively collect primary data on HPV vaccination program activities in Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda. Data were collected from the national level and a sample of subnational administrative offices and health facilities. Operational data collected were tabulated as percentages and frequencies. Financial costs (monetary outlays) and economic costs (financial plus opportunity costs) were estimated, as was the cost per HPV vaccine dose delivered. Costing was done from the health system perspective and reported in 2019 United States dollars (US$). RESULTS Across the study countries, between 53 % and 99 % of HPV vaccination sessions were conducted in schools. Differences were observed in intensity and frequency with which program activities were conducted and resources used. Mean annual economic costs at health facilities in each country ranged from $1,207 to $3,190, while at the national level these ranged from $7,657 to $304,278. Mean annual HPV vaccine doses delivered per health facility in each country ranged from 162 to 761. Mean financial costs per dose per study country ranged from $0.27 to $3.32, while the economic cost per dose ranged from $3.09 to $17.20. CONCLUSION HPV vaccine delivery costs were lower than at introduction in some study countries. There were differences in the activities carried out for HPV vaccine delivery and the number of doses delivered, impacting the cost estimates.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ganesh Tatkan
- Ministry of Health, Primary Health Care, Georgetown, Guyana
| | - Alfred Driwale
- Uganda National Expanded Programme on Immunization, Kampala, Uganda
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Nguyen ALT, Slavkovsky R, Phan HT, Nguyen HTT, Vannachone S, Le DH, Dubot-Pérès A, Vongsouvath M, Dinh ST, Marfin AA, Letson GW, Vu HM, Tham DC, Mayxay M, Ashley EA, Pham TQ, Pecenka C. Estimating the cost of illness of acute Japanese encephalitis and sequelae care in Vietnam and Laos: A cross-sectional study. PLOS Glob Public Health 2023; 3:e0001873. [PMID: 37310946 PMCID: PMC10263309 DOI: 10.1371/journal.pgph.0001873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Japanese encephalitis (JE) is a leading cause of acute encephalitis syndrome and resulting neurological disability in Asia and the Western Pacific. This study aims to estimate the cost of acute care, initial rehabilitation and sequelae care, in Vietnam and Laos. METHODOLOGY We conducted a cross-sectional retrospective study using a micro-costing approach from the health system and household perspectives. Out-of-pocket direct medical and non-medical costs, indirect costs, and family impact were reported by patients and/or caregivers. Hospitalization costs were extracted from hospital charts. Acute costs covered expenditures from pre-hospital to follow-up visits while sequelae care costs were estimated from expenditures in the last 90 days. All costs are in 2021 US dollars. PRINCIPAL FINDINGS 242 patients in two major sentinel sites in the North and South of Vietnam and 65 patients in a central hospital in Vientiane, Laos, with laboratory-confirmed JE were recruited regardless of age, sex, and ethnicity. In Vietnam, the mean total cost was $3,371 per acute JE episode (median $2,071, standard error [SE] $464) while annual costs were $404 for initial sequelae care (median $0, SE $220) and $320 for long-term sequelae care (median $0, SE $108). In Laos, the mean hospitalization costs in acute stage were $2,005 (median $1,698, SE $279) and the mean annual costs were $2,317 (median $0, SE $2,233) for initial sequelae care and $89 (median $0, SE $57) for long-term sequelae care. In both countries, most patients did not seek care for their sequelae. Families perceived extreme impact from JE and 20% to 30% of households still had sustained debts years after acute JE. CONCLUSIONS JE patients and families in Vietnam and Laos suffer extreme medical, economic, and social hardship. This has policy implications for improving JE prevention in these two JE-endemic countries.
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Affiliation(s)
| | | | - Hai Thanh Phan
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Souphaphone Vannachone
- Lao-Oxford University-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Dang Hai Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Audrey Dubot-Pérès
- Lao-Oxford University-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), Marseille, France
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Manivanh Vongsouvath
- Lao-Oxford University-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Son Thai Dinh
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | | | | | | | - Mayfong Mayxay
- Lao-Oxford University-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People’s Democratic Republic
| | - Elizabeth A. Ashley
- Lao-Oxford University-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thai Quang Pham
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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Sandoval M, Holme F, Lobo S, Slavkovsky R, Thomson KA, Jeronimo J, Figueroa J, De Sanjose S. Age patterns of human papillomavirus infection as primary screening test for cervical cancer and subsequent triage with visual inspection in Honduras. Salud Publica Mex 2020; 62:487-493. [DOI: 10.21149/10979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/05/2020] [Indexed: 11/06/2022] Open
Abstract
Objective. To evaluate age patterns in human papillomavirus (HPV) prevalence and visual inspection with acetic acid (VIA) positivity among women participating in cervical cancer screening in Honduras. Materials and methods. Data on the HPV status (careHPV) and subsequent VIA in HPV-positive women were retrieved from three provinces within the Public Health Sector. Results. Between 2015 and 2018, 60 883 women aged 15-85 years were screened. HPV was detected in 15%, with variation by age, peaking at 20-24 years (27.8%) decreasing to 16% at 30-49 years. Differences in point age– specific HPV prevalence were observed between provinces, but with similar age pattern. VIA was positive in 24.5% of the women aged 30-44 years. Conclusions. The age pattern of the HPV prevalence supports starting HPV testing at age 30+. The low positivity of VIA in ages close to menopause suggest underdetection of cervical lesions in this age group.
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Holme F, Jeronimo J, Maldonado F, Camel C, Sandoval M, Martinez-Granera B, Montenegro M, Figueroa J, Slavkovsky R, Thomson KA, de Sanjose S. Introduction of HPV testing for cervical cancer screening in Central America: The Scale-Up project. Prev Med 2020; 135:106076. [PMID: 32247010 PMCID: PMC7218710 DOI: 10.1016/j.ypmed.2020.106076] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/30/2020] [Accepted: 03/28/2020] [Indexed: 01/02/2023]
Abstract
The Scale-Up project introduced vaginal self-sampling and low-cost human papillomavirus (HPV) testing as the primary approach for cervical cancer screening in selected public health centers in Guatemala, Honduras, and Nicaragua. We evaluate the country-specific accomplishments in screening: target-coverage, triage, and treatment. Between 2015 and 2018, cervical cancer screening was offered to women at least 30 years of age. Triage of HPV-positive women was based on visual inspection with acetic acid or Pap. Aggregated data included total women screened, use of self-sampling, age, time elapsed since last screening, HPV results, triage tests, triage results, and treatment. A total of 231,741 women were screened for HPV, representing 85.8% of the target populations within the project. HPV positivity was lower in Guatemala (12.4%) compared to Honduras and Nicaragua (14.5% and 14.2%, respectively, p < 0.05). A follow-up triage test was completed for 84.2%, 85.8%, and 50.1% of HPV-positive women in Guatemala, Nicaragua, and Honduras, respectively. Of those with a positive triage test, 84.7%, 67.1%, and 58.8% were treated in Guatemala, Nicaragua, and Honduras, respectively. First-time screening was highest in Nicaragua (55.8%) where self-sampling was also widely used (97.1%). The Scale-Up project demonstrated that large-scale cervical cancer screening and treatment intervention in a high-burden, low-resource setting can be achieved. Self-sampling and ablative treatment were key to the project's achievements. Data monitoring, loss to follow-up, and triage methods of screen- positive women remain critical to full success.
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Affiliation(s)
| | | | | | - Claudia Camel
- Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Manuel Sandoval
- Asociación Hondureña de Planificación de Familia, Tegucigalpa, Honduras.
| | | | - Mirna Montenegro
- Instancia por la Salud y el Desarrollo de las Mujeres, Guatemala City, Guatemala
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Holme F, Maldonado F, Martinez-Granera OB, Rodriguez JM, Almendarez J, Slavkovsky R, Bansil P, Thomson KA, Jeronimo J, de Sanjose S. HPV-based cervical cancer screening in Nicaragua: from testing to treatment. BMC Public Health 2020; 20:495. [PMID: 32295562 PMCID: PMC7161152 DOI: 10.1186/s12889-020-08601-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. METHODS We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self- vs. provider-collected sampling. RESULTS Forty-four thousand six hundred thirty-five women were screened with HPV testing; 96.6% of women used self-sampling. Six thousand seven hundred seventy-six women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04-0.08, p < 0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29. CONCLUSIONS Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of self-sampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.
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Affiliation(s)
- Francesca Holme
- PATH, Department of Sexual & Reproductive Health, 2201 Westlake Ave., Suite 200, Seattle, WA, 98101, USA.
| | - Francisco Maldonado
- Movicancer, Rpto. Las Palmas, del Semáforo "El Guanacaste" (Walmart), 200 mts. al Lago, 175 mts. al Este., Casa, #1108, Managua, Nicaragua
| | - Orlando B Martinez-Granera
- Movicancer, Rpto. Las Palmas, del Semáforo "El Guanacaste" (Walmart), 200 mts. al Lago, 175 mts. al Este., Casa, #1108, Managua, Nicaragua
| | - Jose Maria Rodriguez
- Movicancer, Rpto. Las Palmas, del Semáforo "El Guanacaste" (Walmart), 200 mts. al Lago, 175 mts. al Este., Casa, #1108, Managua, Nicaragua
| | - Juan Almendarez
- Movicancer, Rpto. Las Palmas, del Semáforo "El Guanacaste" (Walmart), 200 mts. al Lago, 175 mts. al Este., Casa, #1108, Managua, Nicaragua
| | - Rose Slavkovsky
- PATH, Department of Sexual & Reproductive Health, 2201 Westlake Ave., Suite 200, Seattle, WA, 98101, USA
| | - Pooja Bansil
- PATH, Department of Sexual & Reproductive Health, 2201 Westlake Ave., Suite 200, Seattle, WA, 98101, USA
| | - Kerry A Thomson
- PATH, Department of Sexual & Reproductive Health, 2201 Westlake Ave., Suite 200, Seattle, WA, 98101, USA
| | | | - Silvia de Sanjose
- PATH, Department of Sexual & Reproductive Health, 2201 Westlake Ave., Suite 200, Seattle, WA, 98101, USA
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Sandoval M, Slavkovsky R, Bansil P, Jeronimo J, Lim J, Figueroa J, de Sanjose S. Acceptability and safety of thermal ablation for the treatment of precancerous cervical lesions in Honduras. Trop Med Int Health 2019; 24:1391-1399. [PMID: 31622526 PMCID: PMC6916631 DOI: 10.1111/tmi.13315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To evaluate the acceptability and safety of thermal ablation (TA) for the treatment of precancerous cervical lesions in women in Honduras. Methods Human papillomavirus (HPV) and visual inspection with acetic acid (VIA) screen‐positive eligible women received TA. After treatment, women rated the level of pain experienced during treatment using the Wong‐Baker FACES® pain‐rating scale from 0 to 10. Short‐term safety outcomes that could require medical attention were assessed one month after treatment. Results A total of 319 women received TA treatment. The average pain rating was 2.5 (95% CI: 2.3–2.8), and 85% rated their pain levels as less than 6. No significant differences in low (below 6) or high (6 and above) pain were found by age or number of biopsies performed, but there was a significant difference by the number of TA applications (P < 0.01). When asked if they would recommend this treatment, all women said they would. At the one‐month follow‐up visit, the most common reported discomforts were bleeding (10%) and cramping (8.4%); 11 women reported severe lower abdominal pain, and none required medical attention. Conclusions TA is safe and acceptable to patients as a treatment option for precancerous cervical lesions in low‐resource settings.
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Affiliation(s)
- Manuel Sandoval
- Asociación Hondureña de Planificación de Familia, Tegucigalpa, Honduras
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Jeronimo J, Holme F, Slavkovsky R, Camel C. Corrigendum to "Implementation of HPV testing in Latin America" [J. Clin. Virol. 76, S1 (2016) S69-S73]. J Clin Virol 2017; 95:12. [PMID: 28830013 DOI: 10.1016/j.jcv.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Claudia Camel
- Instancia por la Salud y el Desarrollo de las Mujeres, EdificioValsari, 7mo Nivel, Oficina 702, 6 Calle1-36, Zona 10, Guatemala City, Guatemala
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Holme F, Slavkovsky R, Jeronimo J. Public-Private Partnerships for the Development of New Devices for Screening and Treatment of Cervical Precancer for Emerging Economies. J Glob Oncol 2016. [DOI: 10.1200/jgo.2016.004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract 74 PATH is a nonprofit organization involved in the development of new technologies for screening and treatment of precancerous lesions of the uterine cervix for the last 25 years. PATH had private-public partnerships with four private companies for the design, development, improvement, and/or field validation of two new technologies for screening (careHPV and OncoE6 Cervical Test) and two devices for treatment (CryoPen and the Liger Thermal Coagulator). This experience allows us to identify some commonalities among those companies: they all had the technical or scientific background for developing or improving the technologies needed, they were committed to creating technologies suitable for emerging economies, and their knowledge or presence in low-resource countries was limited. The characteristics of our collaboration with the private companies varied depending on the initial status of the technology. Two of the companies already had marketed technologies that required adaptation for suitability in low-resource settings, and the role of PATH was to support the planning and modification of the technology, bench and field testing of the prototypes, and/or clinical validation of the product. Meanwhile, the other two companies had the technological capacity and expertise for developing the required technologies, but they did not have a working prototype; therefore, the role of PATH involved supporting the design and development of the new technology, as well as the required bench testing and validations. The financial support required was variable; in some cases PATH provided technical support for developing a “proof of concept” prototype, which later extended to financial support from PATH or other organizations. In other cases, the complexity of the initial work required financial support to start the development of that “proof of concept.” In conclusion, public-private partnerships are very effective for the development of new, affordable, and suitable technologies for screening and treatment of cervical precancer in emerging economies. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Francesca Holme Travel, Accommodations, Expenses: Qiagen Rose Slavkovsky No relationship to disclose Jose Jeronimo No relationship to disclose
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Affiliation(s)
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- Francesca Holme, Rose Slavkovsky, and Jose Jeronimo, PATH
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Bouchalova K, Svoboda M, Kharaishvili G, Vrbkova J, Slavkovsky R, Bouchal J, Navratil J, Koudelakova V, Trojanec R, Cwiertka K, Hajduch M, Kolar Z. 265 BCL11A gene status and prediction of survival in triple negative breast cancer (TNBC) treated with anthracycline-based adjuvantchemotherapy. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Slavkovsky R, Kohlerova R, Jiroutova A, Hajzlerova M, Sobotka L, Cermakova E, Kanta J. Effects of hyaluronan and iodine on wound contraction and granulation tissue formation in rat skin wounds. Clin Exp Dermatol 2010; 35:373-9. [DOI: 10.1111/j.1365-2230.2009.03559.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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