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Bretelle F, Loubière S, Desbriere R, Loundou A, Blanc J, Heckenroth H, Schmitz T, Benachi A, Haddad B, Mauviel F, Danoy X, Mares P, Chenni N, Ménard JP, Cocallemen JF, Slim N, Sénat MV, Chauleur C, Bohec C, Kayem G, Trastour C, Bongain A, Rozenberg P, Serazin V, Fenollar F. Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth: The AuTop Randomized Clinical Trial. JAMA Pediatr 2023; 177:894-902. [PMID: 37459059 PMCID: PMC10352927 DOI: 10.1001/jamapediatrics.2023.2250] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023]
Abstract
Importance Bacterial vaginosis (BV) is a well-known risk factor for preterm birth. Molecular diagnosis of BV is now available. Its impact in the screening and treatment of BV during pregnancy on preterm births has not been evaluated to date. Objective To evaluate the clinical and economic effects of point-of-care quantitative real-time polymerase chain reaction screen and treat for BV in low-risk pregnant women on preterm birth. Design, Setting, and Participants The AuTop trial was a prospective, multicenter, parallel, individually randomized, open-label, superiority trial conducted in 19 French perinatal centers between March 9, 2015, and December 18, 2017. Low-risk pregnant women before 20 weeks' gestation without previous preterm births or late miscarriages were enrolled. Data were analyzed from October 2021 to November 2022. Interventions Participants were randomized 1:1 to BV screen and treat using self-collected vaginal swabs (n = 3333) or usual care (n = 3338). BV was defined as Atopobium vaginae (Fannyhessea vaginae) load of 108 copies/mL or greater and/or Gardnerella vaginalis load of 109 copies/mL or greater, using point-of-care quantitative real-time polymerase chain reaction assays. The control group received usual care with no screening of BV. Main Outcomes and Measures Overall rate of preterm birth before 37 weeks' gestation and total costs were calculated in both groups. Secondary outcomes were related to treatment success as well as maternal and neonate health. Post hoc subgroup analyses were conducted. Results Among 6671 randomized women (mean [SD] age, 30.6 [5.0] years; mean [SD] gestational age, 15.5 [2.8] weeks), the intention-to-treat analysis of the primary clinical and economic outcomes showed no evidence of a reduction in the rate of preterm birth and total costs with the screen and treat strategy compared with usual care. The rate of preterm birth was 3.8% (127 of 3333) in the screen and treat group and 4.6% (153 of 3338) in the control group (risk ratio [RR], 0.83; 95% CI, 0.66-1.05; P = .12). On average, the cost of the intervention was €203.6 (US $218.0) per participant, and the total average cost was €3344.3 (US $3580.5) in the screen and treat group vs €3272.9 (US $3504.1) in the control group, with no significant differences being observed. In the subgroup of nulliparous women (n = 3438), screen and treat was significantly more effective than usual care (RR, 0.62; 95% CI, 0.45-0.84; P for interaction = .003), whereas no statistical difference was found in multiparous (RR, 1.30; 95% CI, 0.90-1.87). Conclusion and Relevance In this clinical trial of pregnant women at low risk of preterm birth, molecular screening and treatment for BV based on A vaginae (F vaginae) and/or G vaginalis quantification did not significantly reduce preterm birth rates. Post hoc analysis suggests a benefit of screen and treat in low-risk nulliparous women, warranting further evaluation in this group. Trial Registration ClinicalTrials.gov Identifier: NCT02288832.
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Affiliation(s)
- Florence Bretelle
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
- Aix-Marseille Univ, IRD, Assistance Publique–Hopitaux de Marseille, UMRD-258 Microbes, Evolution, Phylogenie and Infection (MEPHI), Marseille, France
| | - Sandrine Loubière
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Fondation Hopital Saint Joseph, Marseille, France
| | - Anderson Loundou
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Julie Blanc
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Obstetrics and Gynecology, Hopital Nord, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Hélène Heckenroth
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, Assistance Publique–Hôpitaux de Paris Hôpital Robert Debré, Université Paris Cité, Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, DMU Santé des Femmes et des nouveau-nés Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Clamart, France
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Université Paris Saclay, Clamart, France
| | - Bassam Haddad
- Centre Hospitalier de Créteil, Créteil, France
- Department of Obstetrics and Gynecology, Institut Mondor de Recherche Biomedicale, Université Paris Est Creteil, Centre Hospitalier Creteil, Creteil, France
| | - Franck Mauviel
- Department of Obstetrics and Gynecology, Centre hospitalier de Toulon sainte Musse, Toulon, France
| | - Xavier Danoy
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aix en Provence, Centre hospitalier de Pertuis, Aix en Provence, France
| | - Pierre Mares
- Departement of Obstetrics and Gynecology, Centre hospitalier universitaire de Nimes, Nimes, France
| | - Nawal Chenni
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aubagne, Aubagne, France
| | - Jean-Pierre Ménard
- Direction de la Protection Maternelle et Infantile et de la Promotion de la Santé, Conseil départemental du Val-de-Marne, Créteil, France
| | - Jean-François Cocallemen
- Departement de recherche clinique, Hopital Nord, Assistance hôpitaux de Marseille, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | | | - Marie Victoire Sénat
- Departement Gynécologie Obstétrique, Centre hospitalier Universitaire du Kremlin Bicetre, Kremlin Bicetre, France
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
| | - Céline Chauleur
- Service de Gynécologie-obstétrique, CHU de Saint Etienne, INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne, France
| | | | - Gilles Kayem
- Service de Gynécologie Obstétrique de l’hôpital Trousseau, Université Pierre et Marie Curie, INSERM U1153, Paris, France
| | - Cynthia Trastour
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - André Bongain
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - Patrick Rozenberg
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
- American Hospital of Paris, Neuilly-sur-Seine, France
| | - Valerie Serazin
- Service de Biologie Médicale, CHI de Poissy-Saint-Germain-en-Laye, Poissy, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Institut national de la recherche agronomique, Biologie de la Reproduction, Environnement, Epigénétique et Développement, Paris, France
| | - Florence Fenollar
- Department of Infectious Diseases, Hopital de la Timone, Assistance Publique–Hopitaux de Marseille, IHU-Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut recherche et développement, Assistance Publique–Hopitaux de Marseille, SSA, Vecteurs – Infections Tropicales et Méditeranéennes, Marseille, France
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Kundrod KA, Jeronimo J, Vetter B, Maza M, Murenzi G, Phoolcharoen N, Castle PE. Toward 70% cervical cancer screening coverage: Technical challenges and opportunities to increase access to human papillomavirus (HPV) testing. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001982. [PMID: 37585432 PMCID: PMC10431663 DOI: 10.1371/journal.pgph.0001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The World Health Organization (WHO) has called for the elimination of cervical cancer as a public health problem. Cervical cancer screening through human papillomavirus (HPV) testing is a core component of the strategy for elimination, with a set target of screening 70% of women twice in their lifetimes. In this review, we discuss technical barriers and opportunities to increase HPV screening globally.
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Affiliation(s)
- Kathryn A. Kundrod
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Beatrice Vetter
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Violence and Injury Prevention, Pan American Health Organization, Washington, DC, United States of America
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development Rwanda and Rwanda Military Hospital, Kigali, Rwanda
| | - Natacha Phoolcharoen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, United States of America
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Winer RL, Lin J, Anderson ML, Tiro JA, Meenan RT, Hansen K, Gao H, Sparks A, Greene DN, Kilgore-Martin S, Green BB, Buist DSM. Design of a pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake in a U.S. healthcare system: The STEP trial. Contemp Clin Trials 2022; 122:106960. [PMID: 36241145 PMCID: PMC10164445 DOI: 10.1016/j.cct.2022.106960] [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: 07/29/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Mailing HPV self-sampling kits to overdue individuals increases cervical cancer screening adherence; offering self-sampling to previously adherent individuals has not been evaluated in the U.S. Given heterogeneity of the U.S. health system and population, data are needed to optimize how HPV self-sampling is offered to individuals who are overdue, due after successful past screening, or have an unknown screening history. METHODS STEP is a pragmatic randomized controlled trial set within a U.S. integrated healthcare delivery system, designed to compare different outreach approaches for offering HPV self-sampling in populations defined by prior screening behavior (previously-adherent, overdue, or unknown screening history). Over 14 months, eligible individuals were identified through electronic medical record (EMR) data and randomized to Usual Care (UC), Education (UC + educational materials about cervical cancer screening), Direct-Mail (UC + Education + a mailed self-sampling kit) or Opt-In (UC + Education + option to request a kit), depending on screening history. The primary objective is to compare screening completion by outreach approach and screening history. Secondary objectives include evaluating incremental cost-effectiveness of outreach approaches, and identifying patient preference for, and satisfaction with, HPV self-screening, and barriers to abnormal results follow-up (measured through interviews and focus groups). CONCLUSIONS The trial was designed to generate data that U.S. health systems can use to inform primary HPV screening implementation strategies that incorporate HPV self-sampling options to improve screening access, adherence, and patient satisfaction. The objective of this report is to describe the rationale and design of this pragmatic trial.
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Affiliation(s)
- Rachel L Winer
- Department of Epidemiology, University of Washington, Box 351619, 3980 15th Ave NE, Seattle, WA 98195, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - John Lin
- Department of Epidemiology, University of Washington, Box 351619, 3980 15th Ave NE, Seattle, WA 98195, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Jasmin A Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Kristina Hansen
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Angela Sparks
- Washington Permanente Medical Group, 320 Westlake Ave N #100, Seattle, WA 98109, USA.
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific St, NW120, Seattle, WA 98195, USA; Kaiser Foundation Health Plan of Washington Laboratory, Box 34944, Seattle, WA 98124, USA.
| | - Sony Kilgore-Martin
- Washington Permanente Medical Group, 320 Westlake Ave N #100, Seattle, WA 98109, USA.
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Washington Permanente Medical Group, 320 Westlake Ave N #100, Seattle, WA 98109, USA; Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA.
| | - Diana S M Buist
- Department of Epidemiology, University of Washington, Box 351619, 3980 15th Ave NE, Seattle, WA 98195, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Surriabre P, Allende G, Prado M, Cáceres L, Bellot D, Torrico A, Ustariz K, Rojas S, Barriga J, Calle P, Villarroel L, Yañez RM, Baay M, Rodriguez P, Fontaine V. Self-sampling for human papillomavirus DNA detection: a preliminary study of compliance and feasibility in BOLIVIA. BMC Womens Health 2017; 17:135. [PMID: 29273032 PMCID: PMC5741906 DOI: 10.1186/s12905-017-0490-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 11/30/2017] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Cervical cancer incidence and mortality rates in Bolivia are among the highest in Latin America. This investigation aims to evaluate the possibility of using simple devices, e.g. a cotton swab and a glass slide, for self-sampling in order to detect human papillomavirus (HPV) DNA by PCR in cervico-vaginal cells. METHODS In the first phase of our study we evaluated the use of a glass slide as a transport medium for cervical cells. A physician took paired-cervical samples from 235 women. One sample was transported in Easyfix® solution and the other sample was smeared over a glass slide. Both were further analyzed and compared for human DNA recovery and HPV detection. A kappa value was determined to evaluate the agreement between the HPV DNA detection rates. In the second phase of the study, 222 women from the urban, peri-urban and rural regions of Cochabamba were requested to perform self-sampling using the following devices: a cotton swab combined with a glass slide, and a vaginal tampon. Women gave their opinion about the self-sampling technique. Finally, the agreement for high risk-HPV detection between self- and physician-collected samples was performed in 201 samples in order to evaluate the self-sampling technique. RESULTS Firstly, the comparison between Easyfix® solution and the glass slide to transport clinical samples gave a good agreement for HPV DNA detection (κ = 0.71, 95% CI 0.60-0.81). Secondly, self-sampling, especially with cotton swab combined with glass slide, would generally be preferred over clinician sampling for a screening program based on HPV detection. Finally, we showed a good agreement between self- and physician collected samples for high risk-HPV detection (κ = 0.71, 95% CI 0.55-0.88). CONCLUSIONS Simple devices such as a cotton swab and a glass slide can be used to perform self-sampling and HPV DNA detection. Furthermore, most Bolivian women preferred self-sampling over clinician-sampling for cervical cancer screening.
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Affiliation(s)
- Pedro Surriabre
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles, Brussels, Belgium
| | - Gustavo Allende
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles, Brussels, Belgium
| | - Marcela Prado
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Leyddy Cáceres
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Diego Bellot
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Andrea Torrico
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Karina Ustariz
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Shirley Rojas
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Jaime Barriga
- Hospital Materno Infantil Germán Urquidi, Servicio de Ginecología, Cochabamba, Bolivia
| | - Pamela Calle
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Ligia Villarroel
- Marie Stopes International, Servicio de Ginecología, Cochabamba, Bolivia
| | - Rosse Mary Yañez
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Marc Baay
- Laboratory of Cancer Research and Clinical Oncology, University of Antwerpen, Wilrijk, Belgium
| | - Patricia Rodriguez
- Laboratorio de Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Véronique Fontaine
- Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles, Brussels, Belgium
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Winer RL, Tiro JA, Miglioretti DL, Thayer C, Beatty T, Lin J, Gao H, Kimbel K, Buist DSM. Rationale and design of the HOME trial: A pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake and effectiveness in a U.S. healthcare system. Contemp Clin Trials 2017; 64:77-87. [PMID: 29113956 DOI: 10.1016/j.cct.2017.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/23/2017] [Accepted: 11/01/2017] [Indexed: 01/14/2023]
Abstract
Women who delay or do not attend Papanicolaou (Pap) screening are at increased risk for cervical cancer. Trials in countries with organized screening programs have demonstrated that mailing high-risk (hr) human papillomavirus (HPV) self-sampling kits to under-screened women increases participation, but U.S. data are lacking. HOME is a pragmatic randomized controlled trial set within a U.S. integrated healthcare delivery system to compare two programmatic approaches for increasing cervical cancer screening uptake and effectiveness in under-screened women (>3.4years since last Pap) aged 30-64years: 1) usual care (annual patient reminders and ad hoc outreach by clinics) and 2) usual care plus mailed hrHPV self-screening kits. Over 2.5years, eligible women were identified through electronic medical record (EMR) data and randomized 1:1 to the intervention or control arm. Women in the intervention arm were mailed kits with pre-paid envelopes to return samples to the central clinical laboratory for hrHPV testing. Results were documented in the EMR to notify women's primary care providers of appropriate follow-up. Primary outcomes are detection and treatment of cervical neoplasia. Secondary outcomes are cervical cancer screening uptake, abnormal screening results, and women's experiences and attitudes towards hrHPV self-sampling and follow-up of hrHPV-positive results (measured through surveys and interviews). The trial was designed to evaluate whether a programmatic strategy incorporating hrHPV self-sampling is effective in promoting adherence to the complete screening process (including follow-up of abnormal screening results and treatment). The objective of this report is to describe the rationale and design of this pragmatic trial.
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Affiliation(s)
- Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Division of Biostatistics, University of California Davis, Med Sci 1C, Room 145, One Shields Avenue, Davis, CA 95616, USA.
| | - Chris Thayer
- Kaiser Permanente Washington, 2715 Naches Ave SW, PO Box 9010, Renton, WA 98057, USA.
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - John Lin
- Department of Pathology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA.
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Vassilakos P, Catarino R, Bougel S, Munoz M, Benski C, Meyer-Hamme U, Jinoro J, Heriniainasolo JL, Petignat P. Use of swabs for dry collection of self-samples to detect human papillomavirus among Malagasy women. Infect Agent Cancer 2016; 11:13. [PMID: 26989433 PMCID: PMC4794859 DOI: 10.1186/s13027-016-0059-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/15/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Most women in developing countries have never attended cervical screening programmes and often little information exists on type-specific human papillomavirus (HPV) prevalence among these populations. Self-sampling for HPV testing (self-HPV) using a dry swab may be useful for establishing a screening program and evaluating HPV prevalence. Our aim was to evaluate self-HPV using a dry swab stored at room temperature. METHODS This community-based study in Madagascar consisted of 449 women aged 30-65. Eligible women were provided a dry swab to perform self-HPV. HPV analysis was accomplished by two different real-time PCR tests using the same extracted DNA from the samples. RESULTS Overall, 52 (11.6 %) specimens were invalid for HPV detection. The delay between sampling and laboratory processing of DNA extraction considerably increased invalid results. Overall HPV prevalence of 14 hrHPV types detected by the two PCR tests was found to be 38.2 % (n = 152). Distribution of 19 hrHPV and 9 low-risk HPV (lrHPV) types revealed most frequently 53 and 68 among hrHPV and HPV 54, HPV 70 and HPV 42 among lrHPV. Agreement between the two PCR methods for any of the 14 high-risk HPV (hrHPV) strains detected was 89.9 % (kappa = 0.77, 95 % CI: 0.71-0.84). In 385 (85.7 %) samples the DNA load of ß-globin demonstrated a signal with medium or high level copies. Conversely, in 28 (60.9 %) invalid samples the signal was undetectable. The HPV-DNA load signal was predominantly of intermediate level (58.5 %, n = 218). CONCLUSIONS Self-HPV using a dry swab stored at room temperature could be a useful method for HPV screening and for conducting population-based surveys on HPV prevalence in resource-poor settings.
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Affiliation(s)
- Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva, Switzerland
| | - Rosa Catarino
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland
| | | | - Maria Munoz
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva, Switzerland
| | - Caroline Benski
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland ; Saint Damien Healthcare Centre, Ambanja, Madagascar
| | - Ulrike Meyer-Hamme
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland
| | | | | | - Patrick Petignat
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland
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Cervical carcinoma in the European Union: an update on disease burden, screening program state of activation, and coverage as of March 2014. Int J Gynecol Cancer 2015; 25:474-83. [PMID: 25695550 DOI: 10.1097/igc.0000000000000374] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Cervical cancer (CC) is defined as a disease of disparity. This is due to marked differences in CC incidence and mortality between developed and developing countries. As a continent, Europe is no exception. This study examines the state of activation of CC screening in the European Union as of March 2014, reviews CC incidence and mortality data, and highlights the initiatives adopted to extend program coverage to nonresponders. METHODS The present study is based on the most recent data available from PubMed-indexed journals, the Web sites of the health ministries of each member state, and the Web sites of national cancer observatories; failing these sources, information was sought in scientific journals published in the local language. RESULTS In 2003, the European Council recommended that priority be given to organized screening program activation. Nonetheless, a number of European Union member states still lack population-based organized screening programs, and few have implemented programs directed at disadvantaged populations. CONCLUSIONS Several investigations have demonstrated that the women at higher CC risk are unscreened and underscreened ones. Since then, several member states have made significant efforts to set up effective prevention programs by adopting international quality standards and centralizing screening organization and result evaluation. Several developed countries and some new central-eastern European member states have poorly organized prevention programs that result in poor women's health. Diagnosis of CC is emotionally traumatic, but it is highly preventable. When CC is found early, it is highly treatable and associated with long survival and good quality of life.
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Othman NH, Mohamad Zaki FH. Self-collection tools for routine cervical cancer screening: a review. Asian Pac J Cancer Prev 2015; 15:8563-9. [PMID: 25374168 DOI: 10.7314/apjcp.2014.15.20.8563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sub-optimal participation is a major problem with cervical cancer screening in developing countries which have no organized national screening program. There are various notable factors such as 'embarrassment', 'discomfort' and 'no time' cited by women as they are often also the bread winners for the family. Implementation of self-sampling methods may increase their participation. The aim of this article was to provide a survey of various types of self-sampling tools which are commonly used in collection of cervical cells. We reviewed currently available self-sampling devices and collated the advantages and disadvantages of each in terms of its acceptance and its accuracy in giving desired results. In general, regardless of which device is used, self-sampling for cervical scrapings is highly acceptable to women in most of the studies cited.
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Affiliation(s)
- Nor Hayati Othman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia E-mail :
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Akmatov MK, Mehraj J, Gatzemeier A, Strömpl J, Witte W, Krause G, Pessler F. Serial home-based self-collection of anterior nasal swabs to detect Staphylococcus aureus carriage in a randomized population-based study in Germany. Int J Infect Dis 2014; 25:4-10. [PMID: 24813875 DOI: 10.1016/j.ijid.2014.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Participant-collected serial nasal swabs would be a cost-efficient feature of prospective population-based microbiological studies. We examined the feasibility of serial anterior nasal self-swabbing for Staphylococcus aureus detection in a prospective population-based study in Braunschweig, Germany, and assessed the impact of three interventions on participation and compliance. METHODS Two thousand twenty-six inhabitants were selected randomly from the resident registries and asked to self-collect a nasal swab monthly from July 2012 to January 2013 and return it by mail. The swabs were tested for the presence of S. aureus. Participation and compliance were assessed in four study groups (incremental cash incentive, participation in a lottery, reminder by mail, and control group without incentive or reminder). RESULTS Baseline participation was highest in the cash incentive group (24%; 123/504) and lowest in the reminder group (16%; 83/509). Approximately 90% of the participants in all groups returned the swabs each month, demonstrating high compliance irrespective of the intervention. Laboratory analyses showed that most swabs were usable for bacteriological studies. S. aureus was detected at the expected frequency of 20-27%. CONCLUSIONS Home-based serial nasal self-swabbing proved to be feasible and highly acceptable and promises to be a cost-efficient tool for large-scale prospective population-based studies on bacterial infection or colonization.
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Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
| | - Jaishri Mehraj
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Anja Gatzemeier
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Julia Strömpl
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | | | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Frank Pessler
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
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Wolfrum SG, Koutsky LA, Hughes JP, Feng Q, Xi LF, Shen Z, Winer RL. Evaluation of dry and wet transport of at-home self-collected vaginal swabs for human papillomavirus testing. J Med Microbiol 2012; 61:1538-1545. [PMID: 22899778 DOI: 10.1099/jmm.0.046110-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Our objective was to compare human papillomavirus (HPV) detection in paired self-collected vaginal samples transported by overnight mail in liquid specimen transport medium (STM) (wet) or in dry tubes (dry). Women aged 18-24 years were recruited online to self-collect vaginal swab samples at home for HPV testing and 159 women returned paired wet and dry samples. Dry samples were rehydrated with STM upon arrival at the laboratory. HPV was detected by the Roche Linear Array HPV genotyping test (37 genotypes) and Kappa and McNemar statistics were used to compare wet versus dry samples for detecting HPV. Of the subjects tested in this study, 51 % were HPV-positive (in either sample) and 40 % were positive for high-risk HPV. A total of 216 type-specific infections were detected among the 80 HPV-positive women. Almost perfect agreement was observed between paired samples for detecting any HPV (subject-level positive agreement: 91.9 %, κ: 0.85) or type-specific HPV (positive agreement across types: 90.1 %, κ: 0.90). Similar agreement between sample types was seen when testing for high-risk types and 81.9 % of all type-specific infections were detected in both samples. Among discordant pairs, wet samples were 3.3 times more likely to be positive for type-specific HPV than dry samples (P = 0.02). However, in 63.6 % of wet-positive/dry-negative discordant pairs analysed for viral load, type-specific HPV was either undetectable or detected at a low level (<100 copies) in the wet samples, suggesting that the majority of infections missed by using dry samples are less likely to be clinically relevant. Our results indicate that dry transport is a feasible option for transporting at-home self-collected vaginal samples for HPV DNA testing.
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Affiliation(s)
| | - Laura A Koutsky
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Qinghua Feng
- Department of Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Long Fu Xi
- Department of Pathology, School of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Zhenping Shen
- Department of Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rachel L Winer
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Self-collected vaginal swabs for the quantitative real-time polymerase chain reaction assay of Atopobium vaginae and Gardnerella vaginalis and the diagnosis of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2011; 31:513-8. [PMID: 21789604 DOI: 10.1007/s10096-011-1341-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 07/07/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study was to assess the feasibility of using self-collected vaginal specimens for the quantitative real-time polymerase chain reaction (qPCR) assays of bacterial vaginosis (BV)-associated bacteria versus practitioner-collected swabs. A cross-sectional study included 190 pregnant women enrolled before 20 weeks' gestation from September 2008 to November 2009. Self- and practitioner-collected swabs were taken during the same prenatal visit for each woman, qPCR assays performed for each, and the results compared. The quantification of the human albumin gene was used as an internal control to ensure sampling quality and accurate comparisons. The level of agreement of the qPCR assays for each microorganism was calculated with the Spearman product moment correlation coefficient and the kappa statistic. In all, 370 vaginal samples (185 self- and 185 practitioner-collected swabs) had a narrow range of values for the number of albumin gene copies and a significant correlation coefficient (Spearman's rho = 0.532; p < 0.001). The agreement between both sampling methods was excellent (Spearman's rho was 0.748 for Atopobium vaginae, 0.918 for Lactobacillus species, 0.940 for Gardnerella vaginalis; p < 0.001), especially for high concentrations of A. vaginae (≥10(8) copies/mL; kappa value = 0.973; p < 0.001) and G. vaginalis (≥10(9) copies/mL; kappa value = 0.903; p < 0.001). This study demonstrates the validity and reliability of self- versus practitioner-collected swabs for the molecular quantification of Lactobacillus species, G. vaginalis, and A. vaginae.
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Schmeink CE, Bekkers RLM, Massuger LFAG, Melchers WJG. The potential role of self-sampling for high-risk human papillomavirus detection in cervical cancer screening. Rev Med Virol 2011; 21:139-53. [DOI: 10.1002/rmv.686] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Channa E. Schmeink
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Leon F. A. G. Massuger
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
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Koshiol J, Rotunno M, Gillison ML, Van Doorn LJ, Chaturvedi AK, Tarantini L, Song H, Quint WGV, Struijk L, Goldstein AM, Hildesheim A, Taylor PR, Wacholder S, Bertazzi PA, Landi MT, Caporaso NE. Assessment of human papillomavirus in lung tumor tissue. J Natl Cancer Inst 2011; 103:501-7. [PMID: 21293027 PMCID: PMC3057981 DOI: 10.1093/jnci/djr003] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Lung cancer kills more than 1 million people worldwide each year. Whereas several human papillomavirus (HPV)–associated cancers have been identified, the role of HPV in lung carcinogenesis remains controversial. Methods We selected 450 lung cancer patients from an Italian population–based case–control study, the Environment and Genetics in Lung Cancer Etiology. These patients were selected from those with an adequate number of unstained tissue sections and included all those who had never smoked and a random sample of the remaining patients. We used real-time polymerase chain reaction (PCR) to test specimens from these patients for HPV DNA, specifically for E6 gene sequences from HPV16 and E7 gene sequences from HPV18. We also tested a subset of 92 specimens from all never-smokers and a random selection of smokers for additional HPV types by a PCR-based test for at least 54 mucosal HPV genotypes. DNA was extracted from ethanol- or formalin-fixed paraffin-embedded tumor tissue under strict PCR clean conditions. The prevalence of HPV in tumor tissue was investigated. Results Specimens from 399 of 450 patients had adequate DNA for analysis. Most patients were current (220 patients or 48.9%) smokers, and 92 patients (20.4%) were women. When HPV16 and HPV18 type–specific primers were used, two specimens were positive for HPV16 at low copy number but were negative on additional type-specific HPV16 testing. Neither these specimens nor the others examined for a broad range of HPV types were positive for any HPV type. Conclusions When DNA contamination was avoided and state-of-the-art highly sensitive HPV DNA detection assays were used, we found no evidence that HPV was associated with lung cancer in a representative Western population. Our results provide the strongest evidence to date to rule out a role for HPV in lung carcinogenesis in Western populations.
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Affiliation(s)
- Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7248, USA.
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