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Gutiérrez F, Padilla S, García-Abellán J, Gutiérrez-Ortiz de la Tabla A, Ledesma C, Masiá M. Cancer screening in people with HIV: Implementation in clinical practice and barriers perceived by medical specialists in Spain. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00013-3. [PMID: 38262880 DOI: 10.1016/j.eimce.2024.01.007] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain. METHODS A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort. RESULTS 106 questionnaires were received from 12 different Spanish Autonomous Communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the CPGs recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the Infectious Diseases/HIV Services in the screening programmes was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different Autonomous Communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the CPGs. CONCLUSIONS There are barriers and opportunities to expand cancer screening programmes in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate CPGs screening recommendations among medical specialists.
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Affiliation(s)
- Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Sergio Padilla
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier García-Abellán
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Christian Ledesma
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Mar Masiá
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Kazmerski TM, Stransky OM, Lavage DR, Hughan KS, Jain R, Ladores SL, Stalvey MS, Tangpricha V, Taylor-Cousar JL, West NE, Sawicki GS. Clinician perspectives and practices related to sexual and reproductive care provision for males with cystic fibrosis. J Cyst Fibros 2023:S1569-1993(23)01668-5. [PMID: 37953183 DOI: 10.1016/j.jcf.2023.10.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Males with cystic fibrosis (MwCF) have unique sexual and reproductive health (SRH) concerns. This study investigates multidisciplinary CF clinician perspectives related to SRH for MwCF in the current era of CF care. METHODS We surveyed multidisciplinary clinicians exploring attitudes, practices, and preferences toward male CF SRH care. We compared responses across groups by population served (pediatric vs. adult vs. both pediatric and adult MwCF) using chi square/Fisher's exact tests. RESULTS A total of 297 clinicians completed the survey (41 % pediatric, 36 % adult, 23 % both; 27 % physicians, 24 % social workers, 11 % nurses, 41 % other). Nearly all (98 %) believed the CF team had a role in SRH care with 75 % believing they should be primarily responsible. Pediatric clinicians were less likely to deem SRH topics important and less likely to report annual discussions compared to adult colleagues (all p<0.05). Pediatric clinicians reported less comfort in their SRH knowledge than adult colleagues (p<0.001) and in their ability to provide SRH care (p<0.05). Common barriers endorsed by respondents included lack of SRH knowledge (75 %) and presence of family/partners in exam room (64 %). A majority rated SRH screening tools (91 %), partnerships with SRH specialists (90 %), clinician training (83 %), and management algorithms (83 %) as potential facilitators. CONCLUSION Multidisciplinary CF clinicians perceive SRH for MwCF as important but report suboptimal SRH discussions. Pediatric clinicians report significantly less comfort and skill in discussing and managing male SRH. Identified barriers and facilitators should be used to improve SRH care for MwCF.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States.
| | - Olivia M Stransky
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States; UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave. Pittsburgh, PA, 15224, United States.
| | - Danielle R Lavage
- Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States; Department of Anesthesia and Perioperative Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Kara S Hughan
- Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States.
| | - Raksha Jain
- University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX 75390-8558, United States.
| | - Sigrid L Ladores
- School of Nursing, The University of Alabama at Birmingham, 1720 S. 2nd Ave., NB485-A, Birmingham, AL 35294, United States.
| | | | - Vin Tangpricha
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle Atlanta, 30322, United States.
| | | | - Natalie E West
- The Johns Hopkins University, 1830 Building 5th Floor Pulmonary, Baltimore, MD 21287, United States.
| | - Gregory S Sawicki
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, United States.
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Atukunda A, Deogratius MA, Arinaitwe E, Orishaba P, Kamya MR, Nankabirwa JI. Do clinicians in areas of declining malaria transmission adhere to malaria diagnosis guidelines? A cross-sectional study from Kampala, Uganda. Malar J 2021; 20:187. [PMID: 33858434 PMCID: PMC8051068 DOI: 10.1186/s12936-021-03729-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 11/24/2020] [Accepted: 04/08/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Uganda's clinical management guidelines recommend a malaria laboratory test in all patients presenting with fever (history of fever or an axillary temperature ≥ 37.5 °C), and only those with a positive test receive anti-malarial treatment. However, the current practice in areas with declining malaria transmission remains unknown. This study assessed the clinicians' diagnostic practices, the factors associated with recommending a test, and the risk of missing a malaria case when a test is not recommended in patients presenting with fever in Kampala, an area of declining malaria transmission in Uganda. METHODS Between January and March 2020, 383 participants aged ≥ 12 years and presenting to Kisenyi Health Centre IV in Kampala district with fever were enrolled in the study. A questionnaire was administered during exit interviews, routine diagnostic practices were recorded from participant clinical notes, and a research blood slide was obtained for later reading. RESULTS Of the enrolled participants, 356 (93%) had a malaria diagnostic test recommended by the clinician. Factors associated with increasing prevalence of having a test recommended included; history of overnight travel (adjusted prevalence ratio [aPR] 1.07, 95% confidence interval [CI] 1.02-1.13, p = 0.011), being married (aPR = 1.07, 95% CI 1.01-1.13, p = 0.022), and having tertiary education (aPR = 1.09 95% CI 1.01-1.17, p = 0.031). Among the 27 participants where a malaria diagnostic test was not recommended, 4 (14.8%) had a positive study smear. CONCLUSION Despite having significant declines in malaria transmission in Kampala in the last decade, clinicians at the study health facility highly adhered to the clinical management guidelines, recommending a malaria test in almost all patients presenting with fever. However, a significant proportion of malaria cases was missed when a test was not recommended. These results highlight the importance of laboratory testing for malaria in all patients who present with fevers and live in endemic settings even when the transmission has significantly declined.
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Affiliation(s)
- Angella Atukunda
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Science, P.O Box 7072, Kampala, Uganda.
| | - Mwaka Amos Deogratius
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Science, P.O Box 7072, Kampala, Uganda
| | - Emmanuel Arinaitwe
- Infectious Disease Research Collaboration, Plot 2C Nakasero Hill Road, P.O Box 7475, Kampala, Uganda
| | - Philip Orishaba
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Science, P.O. Box 7072, Kampala, Uganda
| | - Moses R Kamya
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Science, P.O Box 7072, Kampala, Uganda.,Infectious Disease Research Collaboration, Plot 2C Nakasero Hill Road, P.O Box 7475, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Science, P.O Box 7072, Kampala, Uganda.,Infectious Disease Research Collaboration, Plot 2C Nakasero Hill Road, P.O Box 7475, Kampala, Uganda
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