1
|
Adsul P, de Cortina SH, Pramathesh R, Jayakrishna P, Srinivas V, Nethan ST, Dhanasekaran K, Hariprasad R, Madhivanan P. Asking physicians how best to implement cervical cancer prevention services in India: A qualitative study from Mysore. PLOS Glob Public Health 2022; 2:e0000570. [PMID: 36962451 PMCID: PMC10021426 DOI: 10.1371/journal.pgph.0000570] [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] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Cervical cancer is the second most common cancer among Indian women. Screening is an effective prevention strategy, but achieving high screening rates depend upon identifying barriers at multiple levels of healthcare delivery. There is limited research on understanding the perspectives of providers who deliver cancer prevention services. The objective of this study was to explore physician perspectives on cervical cancer prevention, barriers to effective implementation, and strategies to overcome these barriers in India. Guided by the "Multilevel influences on the Cancer Care Continuum" theoretical framework, we conducted semi-structured interviews with physicians in Mysore, India. From November 2015- January 2016, we interviewed 15 (50.0%) primary care physicians, seven (23.3%) obstetrician/gynecologists, six (20.0%) oncologists, and two (6.7%) pathologists. We analyzed interview transcripts in Dedoose using a grounded theory approach. Approximately two-thirds (n = 19, 63.3%) of the participants worked in the public sector. Only seven (23.3%) physicians provided cervical cancer screening, none of them primary care physicians. Physicians discussed the need for community-level, culturally-tailored education to improve health literacy and reduce stigma surrounding cancer and gynecologic health. They described limited organizational capacity in the public sector to provide cancer prevention services, and emphasized the need for further training before they could perform cervical cancer screening. Physicians recommend an integrated strategy for cervical cancer prevention at multiple levels of uptake and delivery with specific efforts focused on culturally-tailored stigma-reducing education, community-level approaches utilizing India's community health workers, and providing physician training and continuing education in cancer prevention.
Collapse
Affiliation(s)
- Prajakta Adsul
- Public Health Research Institute of India, Mysore, India
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Sasha Herbst de Cortina
- Public Health Research Institute of India, Mysore, India
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
- School of Medicine, University of California Irvine, Irvine, California, United States of America
| | | | | | | | - Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India
| | - Kavitha Dhanasekaran
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India
- Health Promotion Sciences Department, Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
2
|
Aggarwal S, Ju D, Allen AM, Rose LA, Gill KP, Shen SA, Temko JE, Chang I, Faraj J, Brabender DE, Herbst de Cortina S, Marik-Reis O, Mehta MC. Regional differences in vision health: findings from Mwanza, Tanzania. Int Health 2019; 10:457-465. [PMID: 30016443 DOI: 10.1093/inthealth/ihy046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background Visual impairment in developing countries has both social and economic impact on individuals and communities. Understanding the subjective visual functioning of populations will allow for local policymakers to identify the need for optometric or ophthalmic services in their communities. Methods The authors surveyed 644 adult patients in Mwanza, Tanzania at three clinics (Buzuruga, Mwananchi and Kisesa) using a modified Visual Functioning Questionnaire 25. Responses were categorized into General health, General vision, Ocular pain, Near activities, Distance activities, Social function, Mental health, Role difficulties, Color vision, Peripheral vision and Dependency. Results Patients at Buzuruga reported the lowest scores on most subscales. Of 100 employed patients, 37% claimed to have at least some difficulty in performing job duties due to their eyesight. At Kisesa, 146 (246/221) patients (66.1%) had never had an eye exam, compared with 134/227 (59.0%) at Buzuruga and 69/173 (39.9%) at Mwananchi (p<0.01). Common reasons for not seeing an eye doctor were the perceived expense and lack of vision problems. Conclusions Due to regional differences in visual functioning in Mwanza, a national effort for vision health cannot be entirely successful without addressing the individualized needs of local communities. Reducing the cost of vision care appointments may expand vision health care utilization in Mwanza.
Collapse
Affiliation(s)
- Sahil Aggarwal
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - David Ju
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Angela M Allen
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Laura A Rose
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Karam P Gill
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - S Aricia Shen
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Jamie E Temko
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Irene Chang
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Jessica Faraj
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Danielle E Brabender
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | | | - Olivia Marik-Reis
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Mitul C Mehta
- Gavin Herbert Eye Institute, University of California, 850 Health Sciences Road, Irvine, CA, USA
| |
Collapse
|
3
|
Allan-Blitz LT, Vargas SK, Konda KA, Herbst de Cortina S, Cáceres CF, Klausner JD. Field evaluation of a smartphone-based electronic reader of rapid dual HIV and syphilis point-of-care immunoassays. Sex Transm Infect 2018; 94:589-593. [PMID: 30126946 DOI: 10.1136/sextrans-2017-053511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/14/2018] [Accepted: 07/20/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Electronic (E) devices read and quantify lateral flow-based rapid tests, providing a novel approach to assay interpretation. We evaluated the performance of one E-reader for two dual HIV and syphilis immunoassays. METHODS We enrolled men who have sex with men and transgender women >18 years of age seeking medical services at an STD clinic in Lima, Peru, between October 2016 and April 2017. Venous blood was tested using two dual HIV and syphilis antibody immunoassays (SD BIOLINE HIV/Syphilis Duo, Republic of Korea, and First Response HIV 1+2/Syphilis Combo, India). Reference testing included a fourth-generation ELISA for HIV antibodies and use of the Treponema pallidum particle agglutination assay for syphilis antibodies. Trained clinic staff visually inspected the immunoassay results, after which the immunoassays were read by the HRDR-200 E-reader (Cellmic, USA), an optomechanical smartphone attachment. We calculated the concordance of the E-reader with visual inspection, as well as the sensitivity of both rapid immunoassays, in detecting HIV and T. pallidum antibodies. RESULTS On reference testing of 283 participant specimens, 34% had HIV antibodies and 46% had T. pallidum antibodies. Using First Response, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for T . pallidum and 97% (95% CI 95% to 99%) for HIV antibodies. Using SD BIOLINE, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for T. pallidum and 99% (95% CI 98% to 99%) for HIV antibodies. For both immunoassays, the sensitivity for HIV antibodies was 98% (95% CI 93% to 100%) and the sensitivity for T. pallidum antibodies was 81% (95% CI 73% to 87%). CONCLUSIONS E-reader results correlated well with visual inspection. The sensitivities of both rapid assays were comparable with past reports. Further evaluation of the E-reader is warranted to investigate its utility in data collection, monitoring and documentation of immunoassay results.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Silver K Vargas
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelika A Konda
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sasha Herbst de Cortina
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Carlos F Cáceres
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeffrey D Klausner
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| |
Collapse
|
4
|
Herbst de Cortina S, Arora G, Wells T, Hoffman RM. Evaluation of a Structured Predeparture Orientation at the David Geffen School of Medicine's Global Health Education Programs. Am J Trop Med Hyg 2016; 94:563-7. [PMID: 26755562 DOI: 10.4269/ajtmh.15-0553] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/14/2015] [Indexed: 11/07/2022] Open
Abstract
Given the lack of a standardized approach to medical student global health predeparture preparation, we evaluated an in-person, interactive predeparture orientation (PDO) at the University of California Los Angeles (UCLA) to understand program strengths, weaknesses, and areas for improvement. We administered anonymous surveys to assess the structure and content of the PDO and also surveyed a subset of students after travel on the utility of the PDO. We used Fisher's exact test to evaluate the association between prior global health experience and satisfaction with the PDO. One hundred and five students attended the PDO between 2010 and 2014 and completed the survey. One hundred and four students (99.0%) reported learning new information. Major strengths included faculty mentorship (N = 38, 19.7%), opportunities to interact with the UCLA global health community (N = 34, 17.6%), and sharing global health experiences (N = 32, 16.6%). Of students surveyed after their elective, 94.4% (N = 51) agreed or strongly agreed that the PDO provided effective preparation. Students with prior global health experience found the PDO to be as useful as students without experience (92.7% versus 94.4%, P = 1.0). On the basis of these findings, we believe that a well-composed PDO is beneficial for students participating in global health experiences and recommend further comparative studies of PDO content and delivery.
Collapse
Affiliation(s)
- Sasha Herbst de Cortina
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| | - Gitanjli Arora
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| | - Traci Wells
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| | - Risa M Hoffman
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| |
Collapse
|