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Luckett R, Ramogola-Masire D, Gompers A, Moraka N, Moyo S, Sedabadi L, Tawe L, Kashamba T, Gaborone K, Mathoma A, Noubary F, Kula M, Grover S, Dreyer G, Botha MH, Makhema J, Shapiro R, Hacker MR. Triage of HPV positivity in a high HIV prevalence setting: A prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana. Int J Gynaecol Obstet 2024; 165:507-518. [PMID: 37950533 PMCID: PMC11021160 DOI: 10.1002/ijgo.15225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Guidelines for effective triage following positive primary high-risk human papillomavirus (HPV) screening in low- and middle-income countries with high human immunodeficiency virus (HIV)-prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana. METHODS We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South-East District, Botswana. Non-pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self-samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8-type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+). RESULTS Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8 years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8-type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92-92.85) and women without HIV 85.92% (95% CI: 75.62-93.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39-70.65], women without HIV 44.29% [95% CI: 32.41-56.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15-78.41], women without HIV 45.71% [95% CI: 33.74-58.06]). However, 8-type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06-34.90) and women without HIV 37.06% (95% CI: 32.85-41.41). These results were similar when CIN3+ was used as the outcome. When combining 8-type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18-84.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18-64.84). CONCLUSIONS Eight-type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade-off between sensitivity and specificity with currently available options. CLINICAL TRIALS REGISTRATION This study is registered on Clinicaltrials.gov no. NCT04242823, https://clinicaltrials.gov/ct2/show/NCT04242823.
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Affiliation(s)
- Rebecca Luckett
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
- Harvard Medical School, Boston, USA
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
- Department of Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Sikhulile Moyo
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, USA
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Department of Pathology, University of Botswana, Gaborone, Botswana
| | - Leatile Sedabadi
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Leabaneng Tawe
- Department of Pathology, University of Botswana, Gaborone, Botswana
| | - Thanolo Kashamba
- Department of Pathology, University of Botswana, Gaborone, Botswana
| | | | - Anikie Mathoma
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Farzad Noubary
- Department of Health Sciences, Northeastern University, Boston, USA
| | - Maduke Kula
- National Cervical Cancer Prevention Program, Ministry of Health and Wellness Botswana, Gaborone, Botswana
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Greta Dreyer
- Department of Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Matthys H Botha
- Department of Obstetrics & Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Joseph Makhema
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Roger Shapiro
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
- Harvard T.H. Chan School of Public Health, Boston, USA
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2
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Lepe M. Disparities in cervical cancer screening in the United States. Cancer Cytopathol 2024; 132:205-208. [PMID: 37519242 DOI: 10.1002/cncy.22752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Affiliation(s)
- Marcos Lepe
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Park DH, Haizan I, Ahn MJ, Choi MY, Kim MJ, Choi JH. One-Pot CRISPR-Cas12a-Based Viral DNA Detection via HRP-Enriched Extended ssDNA-Modified Au@Fe 3O 4 Nanoparticles. BIOSENSORS 2024; 14:26. [PMID: 38248403 PMCID: PMC10812942 DOI: 10.3390/bios14010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
In the context of virus outbreaks, the need for early and accurate diagnosis has become increasingly urgent. In addition to being crucial for effective disease control, timely and precise detection of viral infections is also necessary for the implementation of essential public health measures, especially during pandemics. Among these measures, point-of-care testing (POCT) stands out as a powerful approach with the potential to revolutionize the landscape of viral diagnosis. In this study, we developed a one-pot clustered regularly interspaced short palindromic repeats (CRISPR)-Cas12a-based viral DNA detection system tailored for POCT; this method utilizes multi-enzyme-modified Au@Fe3O4 nanoparticles. As an alternative to nucleic acid amplification, our method uses single-stranded DNA elongation to facilitate multi-enzyme modification; this guarantees heightened sensitivity and expedites the diagnostic process. We achieved a satisfactory limit of detection of 0.25 nM, demonstrating the remarkable sensitivity of the method without the need for sophisticated equipment. The incorporation of Au@Fe3O4 magnetic nanoparticles facilitates sample separation, further streamlining the workflow and reinforcing the simplicity of our method. This integrated approach offers a practical solution for sensitive viral DNA detection in POCT scenarios, advancing the field of rapid and accurate diagnostics.
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Affiliation(s)
- Dong Hyeok Park
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
| | - Izzati Haizan
- Department of Bioprocess Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea;
| | - Min Ju Ahn
- Department of Biotechnology, Jeonbuk National University, 79 Gobongro, Iksan-si 54596, Jeollabuk-do, Republic of Korea;
| | - Min Yu Choi
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
| | - Min Jung Kim
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
| | - Jin-Ha Choi
- School of Chemical Engineering, Clean Energy Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea; (D.H.P.); (M.Y.C.); (M.J.K.)
- Department of Bioprocess Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Jeollabuk-do, Republic of Korea;
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4
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola GD, Guy R, Vallely AJ, Kelly-Hanku A. "This is really something: same place, same day result, same day treatment" women's experiences of testing positive for HPV and receiving same-day treatment in Papua New Guinea: an interpretative phenomenological analysis. BMC Womens Health 2023; 23:438. [PMID: 37596636 PMCID: PMC10439555 DOI: 10.1186/s12905-023-02557-z] [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: 07/19/2022] [Accepted: 07/19/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is transforming cervical screening globally. The World Health Organization (WHO) now recommends same-day HPV screen-and-treat for primary cervical screening in low- and middle-income countries (LMIC) but there is a lack of evidence on women's lived experience of testing positive for oncogenic HPV and receiving same-day treatment. This study aimed to address this knowledge gap among women participating in a same-day HPV screen-and-treat (HPV S&T) program in Papua New Guinea. METHODS As part of a larger qualitative study, this paper explores the lived experiences of 26 women who tested positive for oncogenic HPV and were treated the same day. We analysed the data using the interpretative phenomenological analysis method. All data were managed using Nvivo 12.5. RESULTS The interpretative phenomenological analysis led to three superordinate themes: 1) facing and alleviating initial worries, (2) transforming the disclosure process, and (3) connecting to their faith. Women's experiences of the same day HPV screen-and-treat were framed by initial emotional reactions to their positive HPV test result, and having access to treatment on the same day, which helped address their worries and fears, and transformed their experience of disclosing their test result and subsequent treatment to family and friends. CONCLUSION This study shows that, while women experience similar initial emotional reactions, undergoing same day treatment quickly resolved the women's worries, making this program highly acceptable. Overall, women's engagement in the program confirmed its high acceptability and cultural congruence, leaving women feeling empowered and hopeful about their future, and the future of all Papua New Guinea women.
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Affiliation(s)
- Hawa Camara
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia.
| | - Somu Nosi
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Gloria Munnull
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
- Department of Obstetrics & Gynaecology, Mt Hagen Provincial Hospital, WHP 281, PO Box 36, Mt Hagen, Papua New Guinea
| | - Steven G Badman
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - John Bolgna
- Department of Obstetrics & Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Department of Obstetrics & Gynaecology, Mt Hagen Provincial Hospital, WHP 281, PO Box 36, Mt Hagen, Papua New Guinea
| | - Glen Dl Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, NCD, PO Box 5623, Boroko, Papua New Guinea
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
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Baena A, Mesher D, Salgado Y, Martínez S, Villalba GR, Amarilla ML, Salgado B, Flores B, Bellido‐Fuentes Y, Álvarez‐Larraondo M, Valls J, Lora O, Virreira‐Prout G, Figueroa J, Turcios E, Soilán AM, Ortega M, Celis M, González M, Venegas G, Terán C, Ferrera A, Mendoza L, Kasamatsu E, Murillo R, Wiesner C, Broutet N, Luciani S, Herrero R, Almonte M. Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study. Int J Cancer 2023; 152:1581-1592. [PMID: 36451311 PMCID: PMC10107773 DOI: 10.1002/ijc.34384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
VIA is recommended for triage of HPV-positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV-positive women was evaluated. Women aged 30-64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study-trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty-two HPV-positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2-89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9-86.6). Overall specificity was 58.6% (95% CI 56.7-60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8-73.5) compared to women <50 (54.3%, 95% CI 52.1-56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9-38.6) compared to women <50 (53.2, 95% CI 51.1-55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%-95.4%, 44.9%-94.4%, 8.2%-65.3%, 0%-98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV-positive women performed by trained providers was high with an important reduction in referral rates. However, scaling-up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision.
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Affiliation(s)
- Armando Baena
- International Agency for Research on CancerLyonFrance
| | - David Mesher
- International Agency for Research on CancerLyonFrance
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV ServiceUK Health Security AgencyLondonUK
| | - Yuli Salgado
- Instituto Nacional de CancerologíaBogotáColombia
| | | | - Griselda Raquel Villalba
- Hospital Materno Infantil de San LorenzoMinisterio de Salud Pública y Bienestar SocialSan LorenzoParaguay
| | | | - Brenda Salgado
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Bettsy Flores
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | | | | | - Joan Valls
- International Agency for Research on CancerLyonFrance
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Oscar Lora
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
| | - Gonzalo Virreira‐Prout
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
- Seguro Social Universitario (SSU)SucreBolivia
| | | | - Elmer Turcios
- Programa Nacional contra el CáncerTegucigalpaHonduras
| | - Ana María Soilán
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Marina Ortega
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | | | | | - Gino Venegas
- Clínica AngloamericanaLimaPeru
- Escuela de Medicina HumanaUniversidad de PiuraLimaPeru
| | - Carolina Terán
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Raúl Murillo
- International Agency for Research on CancerLyonFrance
- Centro Javeriano de OncologíaHospital Universitario San IgnacioBogotáColombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Silvana Luciani
- Pan American Health Organization (PAHO)WashingtonDistrict of ColumbiaUSA
| | - Rolando Herrero
- International Agency for Research on CancerLyonFrance
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)Fundación InciensaGuanacasteCosta Rica
| | - Maribel Almonte
- International Agency for Research on CancerLyonFrance
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
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Smith SK, Nwosu O, Edwards A, Zerihun M, Chung MH, Suvada K, Ali MK. Performance of screening tools for cervical neoplasia among women in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001598. [PMID: 36963095 PMCID: PMC10021669 DOI: 10.1371/journal.pgph.0001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To evaluate the performance of visual inspection with acetic acid (VIA) testing, visual inspection with Lugol's iodine (VILI), primary HPV testing, and conventional Pap smear in detecting CIN2+ among non-pregnant women aged 30-65 in LMICs between 1990 and 2020. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Low- and middle-income countries, non-pregnant women aged 30-65. METHODS CENTRAL (Cochrane Library), CINAHL, Embase, Global Health, PubMed, and Web of Science databases were systematically searched to identify studies evaluating the performance of cervical cancer screening methods in LMICs. A diagnostic test accuracy meta-analysis was conducted to evaluate the performance of 4 screening methods in detecting CIN2+ relative to biopsy or cytology reference standards. Pooled statistics for sensitivity, specificity, diagnostic odds ratios, and summary receiver operating characteristic curves were determined for each method. Subgroup analyses were performed to examine whether there was variation in performance based on different reference standards for defining CIN2+, specifically: colposcopy-directed biopsy, biopsy alone, colposcopy alone, or liquid-based cytology. RESULTS Eighteen studies were identified through systematic review. Twelve studies were included in meta-analysis; 11 were cross-sectional and 1 was a randomized controlled clinical trial. The remaining six of the eighteen studies were inclided in a narrative syntehsis. Pooled estimates for sensitivity for VIA, VILI, primary HPV testing, and conventional Pap smear were 72.3%, 64.5%, 79.5%, and 60.2%, respectively; pooled estimates for specificity were 74.5%, 68.5%, 72.6%, and 97.4%, respectively; the diagnostic odds ratios were 7.31, 3.73, 10.42, 69.48, respectively; and the area under the summary receiver operating characteristic curves were 0.766, 0.647, 0.959, and 0.818, respectively. Performance of the screening method varied based on the reference standard used; pooled estimates using either colposcopy-directed biopsy or biopsy alone as the reference standard generally reported lower estimates; pooled estimates using either colposcopy alone or liquid-based cytology as references reported higher estimates. CONCLUSIONS AND IMPLICATIONS This meta-analysis found primary HPV testing to be the highest performing cervical cancer screening method in accurately identifying or excluding CIN2+. Further evaluation of performance at different CIN thresholds is warranted.
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Affiliation(s)
- Sabrina K Smith
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Oguchi Nwosu
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Alex Edwards
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Meseret Zerihun
- Department of Family Medicine, Addis Abba University, Addis Abba, Ethiopia
| | - Michael H Chung
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Kara Suvada
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
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7
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Creagh NS, Boyd LAP, Bavor C, Zammit C, Saunders T, Oommen AM, Rankin NM, Brotherton JML, Nightingale CE. Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence. JCO Glob Oncol 2023; 9:e2200297. [PMID: 36724416 PMCID: PMC10166429 DOI: 10.1200/go.22.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Although cervical cancer is a disease of inequity, it can be eliminated as a public health problem through vaccination, screening, and treatment. Human papillomavirus vaginal self-collection cervical screening is a high-performance test that can increase reach of screening. This review describes the different contexts and models of care used to pilot or implement self-collection within the Asia-Pacific, measures the extent that implementation outcome measures are reported and, where available, summarizes key implementation findings. METHODS A scoping review was conducted by searching five databases of the peer-reviewed literature on June 20, 2022. Two researchers assessed eligibility and extracted data independently to the model of care used and the Conceptual Framework for Implementation Outcomes. A mixed-method consolidation of findings (quantitative: count and frequencies; qualitative: content analysis) was undertaken to narratively report findings. RESULTS Fifty-seven articles, comprising 50 unique studies from 11 countries and two special autonomous regions, were included; 82% were conducted in trials. The implementation of self-collection was conducted in low- (2%), lower-middle- (32%), upper-middle- (32%), and high-income (35%) settings, with 10 different delivery models used; 80% delivered through practitioner-supported models with diversity in how samples were processed, and treatment was offered. Acceptability (73%) and appropriateness (64%) measures were most reported, followed by adoption (57%), feasibility (48%), and fidelity (38%). Only 7% of articles reported implementation cost or penetration measures. No articles reported sustainability measures. CONCLUSION The literature confirms that self-collection cervical screening has been implemented within the Asia-Pacific region, with evidence demonstrating that it is acceptable and appropriate from the user's perspective. Well-designed, high-quality implementation trials and real-world evaluations of self-collection that report the breadth of implementation outcomes can support the progression toward the elimination of cervical cancer.
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Affiliation(s)
- Nicola Stephanie Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Ann Patricia Boyd
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Bavor
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tessa Saunders
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anu Mary Oommen
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nicole Marion Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Mary Louise Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Claire Elizabeth Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola G, Guy R, Vallely AJ, Kelly-Hanku A. Women's acceptability of a self-collect HPV same-day screen-and-treat program in a high burden setting in the Pacific. BMC Health Serv Res 2022; 22:1514. [PMID: 36510192 PMCID: PMC9746197 DOI: 10.1186/s12913-022-08842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A field trial to evaluate a self-collect point-of-care HPV screen-and-treat (HPV S&T) program was implemented in two Well Women Clinics in Papua New Guinea (Papua New Guinea). Assessing the acceptability of a health intervention is a core element of evaluation. In this study, we examined women's acceptability of both self-collection and HPV S&T intervention in Papua New Guinea. METHODS: Sixty-two semi-structured interviews were conducted with women who had undergone cervical screening in the same-day self-collected HPV screen-and-treat program in Madang and Western Highlands Provinces, Papua New Guinea. Data were thematically analysed using the Theoretical Framework of Acceptability (TFA) and managed using NVivo 12.5. RESULTS Most women agreed that self-collection was transformative: it helped circumvent the culturally embarrassing pelvic examination and increased their self-efficacy, especially due to the provision of health education, instructions, and pictorial aids. The availability of same-day results, and treatment if indicated, was particularly valued by the women because it reduced the financial and temporal burden to return to the clinic for results. It also meant they did not need to wait anxiously for long periods of time for their results. Women also appreciated the support from, and expertise of, health care workers throughout the process and spoke of trust in the HPV-DNA testing technology. Most women were willing to pay for the service to ensure its sustainability and timely scale-up throughout Papua New Guinea to support access for women in harder to reach areas. CONCLUSION This study reported very high levels of acceptability from a field trial of self-collection and HPV same-day screen-and-treat. The program was deemed culturally congruent and time efficient. This innovative cervical screening modality could be the 'solution' needed to see wider and more immediate impact and improved outcomes for women in Papua New Guinea and other high-burden, low-resource settings.
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Affiliation(s)
- Hawa Camara
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Somu Nosi
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Gloria Munnull
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea ,Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Steven G. Badman
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - John Bolgna
- Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Mt Hagen Provincial Hospital, PO Box 36, Mt Hagen, WHP 281 Papua New Guinea
| | - Glen Mola
- grid.412690.80000 0001 0663 0554School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD Papua New Guinea
| | - Rebecca Guy
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Andrew J. Vallely
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Angela Kelly-Hanku
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
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9
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Point-of-care HPV DNA testing of self-collected specimens and same-day thermal ablation for the early detection and treatment of cervical pre-cancer in women in Papua New Guinea: a prospective, single-arm intervention trial (HPV-STAT). THE LANCET GLOBAL HEALTH 2022; 10:e1336-e1346. [DOI: 10.1016/s2214-109x(22)00271-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 12/28/2022] Open
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10
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Petignat P, Kenfack B, Wisniak A, Saiji E, Tille JC, Tsuala Fouogue J, Catarino R, Tincho E, Vassilakos P. ABCD criteria to improve visual inspection with acetic acid (VIA) triage in HPV-positive women: a prospective study of diagnostic accuracy. BMJ Open 2022; 12:e052504. [PMID: 35379615 PMCID: PMC8981272 DOI: 10.1136/bmjopen-2021-052504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES A simple system for visual inspection with acetic acid assessment, named ABCD criteria, has been developed to increase accuracy for triaging of high-risk human papillomavirus (HPV)-positive women. This study aimed to determine the accuracy of ABCD criteria for the detection of histologically confirmed cervical intraepithelial neoplasia grade two or worse (CIN2+) in HPV-positive women living in a low-resource setting. DESIGN Prospective study of diagnostic accuracy. SETTING Cervical cancer screening programme based on a 3T-Approach (test, triage and treat) in the Health District of Dschang, West Cameroon. PARTICIPANTS Asymptomatic non-pregnant women aged 30-49 years were eligible to participate. Exclusion criteria included history of CIN treatment, anogenital cancer or hysterectomy. A total of 1980 women were recruited (median age, 40 years; IQR 35-45 years), of whom 361 (18.4%) were HPV-positive and 340 (94.2%) completed the trial. INTERVENTIONS HPV-positive women underwent a pelvic examination for visual assessment of the cervix according to ABCD criteria. The criteria comprised A for acetowhiteness, B for bleeding, C for colouring and D for diameter. The ABCD criteria results were codified as positive or negative and compared with histological analysis findings (reference standards). PRIMARY OUTCOME MEASURE Diagnostic performance of ABCD criteria for CIN2+, defined as sensitivity, specificity, negative and positive predictive values. RESULTS ABCD criteria had a sensitivity of 77.5% (95% CI 61.3% to 88.2%), specificity of 42.0% (95% CI 36.5% to 47.7%), positive predictive value of 15.1% (95% CI 10.8% to 20.8%), and negative predictive value of 93.3% (95% CI 87.6% to 96.5%) for detection of CIN2 +lesions. Most (86.7%) of the ABCD-positive women were treated on the same day. CONCLUSIONS ABCD criteria can be used in the context of a single-visit approach and may be the preferred triage method for management of HPV-positive women in a low-income context. TRIAL REGISTRATION NUMBER NCT03757299.
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Affiliation(s)
- Patrick Petignat
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Science, University of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Essia Saiji
- Division of Clinical Pathology, Diagnostic Department, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Jean-Christophe Tille
- Division of Clinical Pathology, Diagnostic Department, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | | | - Rosa Catarino
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Eveline Tincho
- Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Science, University of Dschang, Dschang, Cameroon
| | - Pierre Vassilakos
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
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11
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Nguyen DTN, Simms KT, Keane A, Mola G, Bolnga JW, Kuk J, Toliman PJ, Badman SG, Saville M, Kaldor J, Vallely A, Canfell K. Towards the elimination of cervical cancer in low-income and lower-middle-income countries: modelled evaluation of the effectiveness and cost-effectiveness of point-of-care HPV self-collected screening and treatment in Papua New Guinea. BMJ Glob Health 2022; 7:bmjgh-2021-007380. [PMID: 35241461 PMCID: PMC8896000 DOI: 10.1136/bmjgh-2021-007380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/23/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction WHO has launched updated cervical screening guidelines, including provisions for primary HPV screen-and-treat. Papua New Guinea (PNG) has a high burden of cervical cancer, but no national cervical screening programme. We recently completed the first field trials of a screen-and-treat algorithm using point-of-care self-collected HPV and same-day treatment (hereafter self-collected HPV S&T) and showed this had superior clinical performance and acceptability to visual inspection of the cervix with acetic acid (VIA). We, therefore, evaluated the effectiveness, cost-effectiveness and resource implications of a national cervical screening programme using self-collected HPV S&T compared with VIA in PNG. Methods An extensively validated platform (‘Policy1-Cervix’) was calibrated to PNG. A total of 38 strategies were selected for investigation, and these incorporated variations in age ranges and screening frequencies and allowed for the identification of the optimal strategy across a wide range of possibilities. A selection of strategies that were identified as being the most effective and cost-effective were then selected for further investigation for longer-term outcomes and budget impact estimation. In the base case, we assumed primary HPV testing has a sensitivity to cervical intraepithelial neoplasia 2 (CIN2+) + of 91.8% and primary VIA of 51.5% based on our earlier field evaluation combined with evidence from the literature. We conservatively assumed HPV sampling and testing would cost US$18. Costs were estimated from a service provider perspective based on data from local field trials and local consultation. Results Self-collected HPV S&T was more effective and more cost-effective than VIA. Either twice or thrice lifetime self-collected HPV S&T would be cost-effective at 0.5× gross domestic product (GDP) per capita (incremental cost-effectiveness ratio: US$460–US$656/life-years saved; 1GDPper-capita: US$2829 or PGK9446 (year 2019)) and could prevent 33 000–42 000 cases and 23 000–29 000 deaths in PNG over the next 50 years, if scale-up reached 70% coverage from 2023. Conclusion Self-collected HPV S&T was effective and cost-effective in the high-burden, low-resource setting of PNG, and, if scaled-up rapidly, could prevent over 20 000 deaths over the next 50 years. VIA screening was not effective or cost-effective. These findings support, at a country level, WHO updated cervical screening guidelines and indicate that similar approaches could be appropriate for other low-resource settings.
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Affiliation(s)
| | - Kate T Simms
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Keane
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Glen Mola
- Department of Reproductive Health, Obstetrics and Gynecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, CND, Papua New Guinea.,Department of Obstetrics and Gynecology, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - John Walpe Bolnga
- Department of Obstetrics and Gynecology, Modilion Hospital, Mango, Madang, Papua New Guinea
| | - Joseph Kuk
- Department of Obstetrics and Gynecology, Mt Hagen Provincial Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea
| | - Pamela J Toliman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Steven G Badman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Vallely
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
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12
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A novel cervical cancer screen-triage-treat demonstration project with HPV self-testing and thermal ablation for women in Malawi: Protocol for a single-arm prospective trial. Contemp Clin Trials Commun 2022; 26:100903. [PMID: 35243124 PMCID: PMC8857441 DOI: 10.1016/j.conctc.2022.100903] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 01/25/2023] Open
Abstract
Cervical cancer is the leading cause of cancer mortality among Malawian women, despite being preventable through screening and preventive therapy. In 2004, Malawi implemented a national screening program, using visual inspection with acetic acid (VIA) and cryotherapy, but its success has been limited due to equipment and human resources challenges. Since the development of that program, new technologies for screening and treatment that are less resource-intensive and more scalable have become available. GeneXpert systems provide fast, accurate HPV results and are increasingly available in low-income countries. Self-collection for human papillomavirus (HPV) testing is a validated method for screening and improves uptake. Thermal ablation provides an alternative ablative treatment that is simpler to use than cryotherapy and can be performed with portable devices. Meanwhile, urine HPV testing methods provide promising options for primary screening. We designed a single-arm prospective study to investigate a novel HPV screen-triage-treat strategy among 1250 women in Lilongwe, Malawi. Our proposed strategy consists of (1) Xpert HPV testing of self-collected samples, (2) VIA and colposcopy for HPV-positive women, and (3) thermal ablation for HPV-positive/ablation-eligible women. We will collect cervical biopsies, Pap smears, and endocervical samples to validate the HPV results and VIA/colposcopy findings against endpoints of high-grade cervical intraepithelial neoplasia or cancer (CIN2+). We will evaluate same-day completion of our algorithm, its performance in triaging women for treatment, and 24-week treatment efficacy of thermal ablation. We will also explore the performance of HPV and methylation tests in urine samples, as compared to provider- and self-collected cervicovaginal samples.
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13
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Keane A, Ng CW, Simms KT, Nguyen D, Woo YL, Saville M, Canfell K. The road to cervical cancer elimination in Malaysia: Evaluation of the impact and cost-effectiveness of human papillomavirus screening with self-collection and digital registry support. Int J Cancer 2021; 149:1997-2009. [PMID: 34363620 PMCID: PMC9291320 DOI: 10.1002/ijc.33759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/06/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022]
Abstract
The WHO has launched a global strategy to eliminate cervical cancer through the scale‐up of human papillomavirus (HPV) vaccination, cervical screening, and cervical cancer treatment. Malaysia has achieved high‐coverage HPV vaccination since 2010, but coverage of the existing cytology‐based program remains low. Pilot studies found HPV self‐sampling was acceptable and effective, with high follow‐up rates when a digital registry was used, and recently the Malaysian Government announced plans for a national HPV‐based screening program. We therefore evaluated the impact of primary HPV screening with self‐collection in Malaysia in the context of Malaysia's existing vaccination program. We used the “Policy1‐Cervix” modeling platform to assess health outcomes, cost‐effectiveness, resource use and cervical cancer elimination timing (the year when cervical cancer rates reach four cases per 100 000 women) of implementing primary HPV testing with self‐collection, assuming 70% routine‐screening coverage could be achieved. Based on available data, we assumed that compliance with follow‐up was 90% when a digital registry was used, but that compliance with follow‐up would be 50‐75% without the use of a digital registry. We found that the current vaccination program would prevent 27 000 to 32 200 cervical cancer cases and 11 700 to 14 000 deaths by 2070. HPV testing with a digital registry was cost‐effective (CER = $US 6953‐7549 < $US 11 373[<1×GDP per capita]) and could prevent an additional 15 900 to 17 800 cases and 9700 to 10 600 deaths by 2070, expediting national elimination by 11 to 20 years, to 2055 to 2059. If HPV screening were implemented without a digital registry, there would be 1800 to 4900 fewer deaths averted by 2070 and the program would be less cost‐effective. These results underline the importance of HPV testing as a key elimination pillar in Malaysia.
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Affiliation(s)
- Adam Keane
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu Wan Ng
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kate T Simms
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Diep Nguyen
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Yin Ling Woo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Karen Canfell
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
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14
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Camara H, Zhang Y, Lafferty L, Vallely AJ, Guy R, Kelly-Hanku A. Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis. BMC Public Health 2021; 21:1503. [PMID: 34348689 PMCID: PMC8336264 DOI: 10.1186/s12889-021-11554-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Cervical cancer is the fourth most common cancer affecting women worldwide, with 85% of the burden estimated to occur among women in low and middle-income countries (LMICs). Recent developments in cervical cancer screening include a novel self-collection method for the detection of oncogenic HPV strains in the collected samples. The purpose of this review is to synthesise qualitative research on self-collection for HPV-based testing for cervical screening and identify strategies to increase acceptability and feasibility in different settings, to alleviate the burden of disease. Methods This review includes qualitative studies published between 1986 and 2020. A total of 10 databases were searched between August 2018 and May 2020 to identify qualitative studies focusing on the perspectives and experiences of self-collection for HPV-based cervical screening from the point of view of women, health care workers and other key stakeholders (i.e., policymakers). Two authors independently assessed studies for inclusion, quality, and framework thematic synthesis findings. The Socio-Ecological Model (SEM) was used to synthesize the primary studies. Results A total of 1889 publications were identified, of which 31 qualitative studies were included. Using an adapted version of SEM, 10 sub-themes were identified and classified under each of the adapted model’s constructs: (a) intrapersonal, (b) interpersonal, and (c) health systems/public policy. Some of the themes included under the intrapersonal (or individual) construct include the importance of self-efficacy, and values attributed to self-collection. Under the intrapersonal construct, the findings centre around the use of self-collection and its impact on social relationships. The last construct of health systems focuses on needs to ensure access to self-collection, the need for culturally sensitive programs to improve health literacy, and continuum of care. Conclusion This review presents the global qualitative evidence on self-collection for HPV-based testing and details potential strategies to address socio-cultural and structural barriers and facilitators to the use of self-collection. If addressed during the design of an HPV-based cervical cancer screening testing intervention program, these strategies could significantly increase the acceptability and feasibility of the intervention and lead to more effective and sustainable access to cervical screening services for women worldwide. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11554-6.
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Affiliation(s)
- Hawa Camara
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Ye Zhang
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Lise Lafferty
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Centre for Social Research in Health, UNSW Sydney, Goodsell Building, Sydney, NSW, 2052, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
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15
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Parra SG, López-Orellana LM, Molina Duque AR, Carns JL, Schwarz RA, Smith CA, Ortiz Silvestre M, Diaz Bazan S, Escobar PA, Felix JC, Ramalingam P, Castle PE, Cremer ML, Maza M, Schmeler KM, Richards-Kortum RR. Cervical cancer prevention in El Salvador: A prospective evaluation of screening and triage strategies incorporating high-resolution microendoscopy to detect cervical precancer. Int J Cancer 2021; 148:2571-2578. [PMID: 33368249 PMCID: PMC10568648 DOI: 10.1002/ijc.33454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 01/28/2023]
Abstract
Cervical cancer remains a leading cause of cancer death for women in low- and middle-income countries. The goal of our study was to evaluate screening and triage strategies, including high-resolution microendoscopy (HRME), to detect cervical abnormalities concerning for precancer at the point of care. Women (n = 1824) were enrolled at the Instituto de Cáncer de El Salvador. All underwent screening by both human papillomavirus (HPV) testing using careHPV and visual inspection with acetic acid (VIA). Screen-positives, along with 10% of screen-negatives, were invited to return for a follow-up examination that included triage with VIA, colposcopy and HRME imaging. Biopsies were taken of any abnormalities identified. If no abnormalities were identified, then the worst scoring site by HRME was biopsied. The sensitivities of HPV testing and VIA to screen for cervical intraepithelial neoplasia Grade 2 or more severe diagnoses (CIN2+) were 82.1% and 75% (P = .77), while the specificities were 90.4% and 80.9% (P < .001), respectively. The sensitivities of VIA, colposcopy and HRME as triage tests for CIN2+ were 82.1%, 82.1% and 71.4%, respectively (P ≥ .38). HRME had a significantly higher specificity (66.7%) than VIA (51.9%) (P < .001) and colposcopy (53.3%) (P < .001). When evaluating different theoretical screening and triage strategies, screening with HPV testing followed by triage with HRME would result in more women receiving appropriate care (97%) compared to screening with VIA (75%) or HPV alone (90%). Our findings demonstrate that screening with HPV is superior to VIA, and that triage with HRME imaging increases the specificity of detecting CIN2+ at the point of care in a low-resource setting.
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Affiliation(s)
- Sonia G Parra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Jennifer L Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Chelsey A Smith
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Pablo A Escobar
- Liga Contra el Cáncer de El Salvador, San Salvador, El Salvador
| | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Preetha Ramalingam
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Miriam L Cremer
- Basic Health International, San Salvador, El Salvador
- Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mauricio Maza
- Basic Health International, San Salvador, El Salvador
| | - Kathleen M Schmeler
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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16
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Jain S, Nehra M, Kumar R, Dilbaghi N, Hu T, Kumar S, Kaushik A, Li CZ. Internet of medical things (IoMT)-integrated biosensors for point-of-care testing of infectious diseases. Biosens Bioelectron 2021; 179:113074. [PMID: 33596516 PMCID: PMC7866895 DOI: 10.1016/j.bios.2021.113074] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023]
Abstract
On global scale, the current situation of pandemic is symptomatic of increased incidences of contagious diseases caused by pathogens. The faster spread of these diseases, in a moderately short timeframe, is threatening the overall population wellbeing and conceivably the economy. The inadequacy of conventional diagnostic tools in terms of time consuming and complex laboratory-based diagnosis process is a major challenge to medical care. In present era, the development of point-of-care testing (POCT) is in demand for fast detection of infectious diseases along with “on-site” results that are helpful in timely and early action for better treatment. In addition, POCT devices also play a crucial role in preventing the transmission of infectious diseases by offering real-time testing and lab quality microbial diagnosis within minutes. Timely diagnosis and further treatment optimization facilitate the containment of outbreaks of infectious diseases. Presently, efforts are being made to support such POCT by the technological development in the field of internet of medical things (IoMT). The IoMT offers wireless-based operation and connectivity of POCT devices with health expert and medical centre. In this review, the recently developed POC diagnostics integrated or future possibilities of integration with IoMT are discussed with focus on emerging and re-emerging infectious diseases like malaria, dengue fever, influenza A (H1N1), human papilloma virus (HPV), Ebola virus disease (EVD), Zika virus (ZIKV), and coronavirus (COVID-19). The IoMT-assisted POCT systems are capable enough to fill the gap between bioinformatics generation, big rapid analytics, and clinical validation. An optimized IoMT-assisted POCT will be useful in understanding the diseases progression, treatment decision, and evaluation of efficacy of prescribed therapy.
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Affiliation(s)
- Shikha Jain
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, 125001, India
| | - Monika Nehra
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, 125001, India; Department of Mechanical Engineering, UIET, Panjab University, Chandigarh, 160014, India
| | - Rajesh Kumar
- Department of Mechanical Engineering, UIET, Panjab University, Chandigarh, 160014, India
| | - Neeraj Dilbaghi
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, 125001, India
| | - TonyY Hu
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Sandeep Kumar
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, 125001, India.
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Health Systems Engineering, Department of Natural Sciences, Florida Polytechnic University, Lakeland, FL, 33805-8531, United States.
| | - Chen-Zhong Li
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Department of Biomedical Engineering, Florida International University, Miami, FL, 33174, USA.
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17
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Saidu R, Kuhn L, Tergas A, Boa R, Moodley J, Svanholm-Barrie C, Persing D, Campbell S, Tsai WY, Wright TC, Denny L. Performance of Xpert HPV on Self-collected Vaginal Samples for Cervical Cancer Screening Among Women in South Africa. J Low Genit Tract Dis 2021; 25:15-21. [PMID: 33105451 PMCID: PMC7748046 DOI: 10.1097/lgt.0000000000000575] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Self-sampling may increase access to cervical cancer screening in low-resource settings. Using Xpert HPV, we compared test performance of self- and clinician-collected samples in HIV-positive and HIV-negative women in South Africa. MATERIALS AND METHODS Three hundred thirty HIV-positive and 375 HIV-negative women in the screening group and 202 HIV-negative and 200 HIV-positive women in the referral group, aged 30-65 years, participated in the study. All women self-collected a vaginal sample, and then, a cervical sample was collected by a clinician (both tested using Xpert HPV), followed by colposcopic examination and collection of histologic specimens. RESULTS There was good agreement between self- and clinician-collected samples for detection of any high-risk human papillomavirus (HPV, κ = 0.72 [95% CI = 0.669-0.771]). Prevalence of HPV and sensitivity of the test to detect cervical intraepithelial neoplasia 2+ was similar in self- and clinician-collected samples. Specificity was lower in self-collected than in clinician-collected samples in both HIV-negative (self: 77.5% [95% CI = 72.8-81.8] vs clinician: 86.9% [95% CI = 82.9-90.2]) and HIV-positive (self: 44.0% [95% CI = 38.0-50.1] vs clinician: 59.7% [95% CI = 53.6-65.6]) women. Restricting the definition of screen-positive to 3 of 5 channels on HPV Xpert improved specificity in both HIV-negative (self: 83.2% [95% CI = 78.8-87.0] vs clinician: 89.7% [95% CI = 86.1-92.7]) and HIV-positive (self: 54.2% [95% CI = 48.1-60.2] vs clinician: 67.4% [95% CI = 61.5-72.9]) women. CONCLUSIONS The self-collected sample had good agreement with the clinician-collected sample for the detection of HPV, and restricting the HPV types may improve the specificity in HIV-positive women.
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Affiliation(s)
- Rakiya Saidu
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Centre, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
| | - Ana Tergas
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
- Department of Obstetrics and Gynaecology, Vangelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
| | - Rosalind Boa
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
| | - Jennifer Moodley
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- Department of Public Health, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
| | - Thomas C. Wright
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
| | - Lynette Denny
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
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18
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Lawal IK, Suleiman AK, Bagudu Z, Kanmodi KK, Abdulsalam GA, Olakunle OS. Planning and advocating for cervical cancer prevention in Kebbi State, Nigeria: Learning points for the global call to eliminate cervical cancer. Int J Gynaecol Obstet 2020; 152:26-31. [PMID: 33034059 DOI: 10.1002/ijgo.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/29/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
The WHO is leading a global call for the elimination of cervical cancer by the year 2030. Although the call in itself is ambitious, the adopted strategy is realistic. The WHO is optimistic that cervical cancer will be eliminated as a disease of public health concern if 90% of girls receive the HPV vaccine by 15 years of age, 70% of women are screened by HPV testing at 35 and 45 years, and 90% of identified cases are treated. The success of the global call will significantly depend on the capacity to operationalize, finance, and implement the strategy in low- and middle-income countries (LMIC), where more than 80% of the disease burden resides. This capacity varies among and within countries. A SWOT (strength, weakness, opportunity, and threat) analysis of the WHO global strategy for elimination of cervical cancer, conducted through the lens of experience in planning and advocating for a comprehensive cervical cancer prevention program in Kebbi State, Nigeria, highlights the delicate balance between evidence of efficacy and science of implementation that program managers in LMIC have to consider while rolling out or scaling up cervical cancer prevention programs.
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Affiliation(s)
- Ishak K Lawal
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin-Kebbi, Nigeria
| | - Aliyu K Suleiman
- Department of Pathology, Federal Medical Centre, Birnin-Kebbi, Nigeria
| | | | | | - Ganiyu A Abdulsalam
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin-Kebbi, Nigeria
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19
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Camara H, Zhang Y, Lafferty L, Vallely A, Guy R, Kelly-Hanku A. Qualitative Evidence Synthesis on Self-Collection for Human Papillomavirus-Based Cervical Screening: Protocol for Systematic Review. JMIR Res Protoc 2020; 9:e21093. [PMID: 33090114 PMCID: PMC7644378 DOI: 10.2196/21093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background Cervical cancer is the fourth most common cancer affecting women worldwide. In the 1980s, it was found that the sexually transmitted disease human papillomavirus causes over 90% of all cervical cancer cases. Since that discovery, diagnostic technologies have been developed for the detection of human papillomavirus DNA in cervical samples. However, significant sociocultural and structural barriers remain. Considerable strides have taken place in recent years to address these barriers, such as the self-collection for human papillomavirus–based cervical screening method. Objective The purpose of this review is to synthesize qualitative evidence around the self-collection method and identify strategies to increase acceptability and feasibility in different settings. This qualitative synthesis will be used to better understand how to conceptualize and implement more effective, accessible, and socially and culturally acceptable cervical screening programs and policies globally. Methods A systematic search will be conducted in Global Health, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest, ScienceDirect, EMBASE, EMCARE, Medline (OVID), Scopus, and Web of Science. Published and peer-reviewed articles will be included. Two reviewers will independently screen and assess the studies. The data will be coded and analyzed using a thematic synthesis process. The socioecological model will be used to organize emergent themes at the micro and macro levels. The results will be presented in narrative and tabular form. Results The article search and data extraction were completed in May 2020. The data were analyzed in June 2020. The review will be submitted for publication in Fall 2020. Conclusions This review will present the global evidence of the perspectives and experiences of various key stakeholders and how these perspectives and experiences impact their decision-making process to perform or accept self-collection for human papillomavirus–based cervical screening. The review will provide guidance to implementation researchers as well as implications for future research. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019109073; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=109073 International Registered Report Identifier (IRRID) DERR1-10.2196/21093
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Affiliation(s)
- Hawa Camara
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia
| | - Ye Zhang
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia
| | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia.,Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Andrew Vallely
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia
| | - Angela Kelly-Hanku
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
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20
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Cubie HA, Campbell C. Cervical cancer screening - The challenges of complete pathways of care in low-income countries: Focus on Malawi. ACTA ACUST UNITED AC 2020; 16:1745506520914804. [PMID: 32364058 PMCID: PMC7225784 DOI: 10.1177/1745506520914804] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.
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Affiliation(s)
- Heather A Cubie
- Global Health Academy and Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Christine Campbell
- Global Health Academy and Usher Institute, The University of Edinburgh, Edinburgh, UK
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21
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Clinical evaluation of modifications to a human papillomavirus assay to optimise its utility for cervical cancer screening in low-resource settings: a diagnostic accuracy study. LANCET GLOBAL HEALTH 2020; 8:e296-e304. [PMID: 31981559 DOI: 10.1016/s2214-109x(19)30527-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/07/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND HPV-based screen and treat is the recommended approach for cervical cancer screening in low-resource settings, but quite low specificity of human papillomavirus (HPV) testing, particularly in women living with HIV, leads to overtreatment. We evaluated whether HPV type restriction and more stringent cutoffs on Xpert HPV optimise performance characteristics of this assay for screen and treat. METHODS We recruited HIV-negative and HIV-positive women aged 30-65 years from a primary care facility and a referral colposcopy clinic in Cape Town, South Africa. Women included had no history of any anogenital cancer or treatment for cervical dysplasia, had no hysterectomy, and were not pregnancy at the time of recruitment. All women had cervical samples collected for Xpert HPV (an assay that detects high-risk HPV types in five channels: HPV type 16; HPV types 18 or 45, or both; HPV types 31, 33, 35, 52, or 58, or more than one of these types; HPV types 51 or 59, or both; and HPV types 39, 56, 66, or 68, or more than one of these types) and underwent colposcopy and histological sampling with consensus pathology review. Logistic regression and receiver operating characteristic curves were used to evaluate improvements in specificity attained by modifying cycle threshold cutoffs to define screen-positive results. RESULTS We recruited 1121 women aged 30-65 years, 586 of whom were HIV-negative and 535 HIV-positive. Sensitivity of detecting cervical intraepithelial neoplasia grade 2 or greater in HIV-negative women using manufacturer-defined cycle threshold cutoffs for all channels was 88·7% (95% CI 83·1-94·3), and specificity was 86·9% (83·4-90·4). Sensitivity was 93·6% (90·0-97·3) and specificity 59·9% (54·1-65·7) in HIV-positive women. Cycle threshold values from channels detecting HPV type 16, HPV types 18 or 45 (or both), and HPV types 31, 33, 35, 52, or 58 (or more than one of these types) were informative to predict cervical intraepithelial neoplasia grade 2 or greater. Shifting cycle threshold cutoffs on these three channels allowing sensitivity to decline to 75-85%, led to specificities of 91·3-95·3% in HIV-negative women and 77·0-85·8% in HIV-positive women. INTERPRETATION More stringent cycle threshold cutoffs on selected channels in Xpert HPV improve specificity with only modest losses in sensitivity, making this assay an optimal choice for HPV-based screen and treat in settings with a high prevalence of HIV. These modifications can be made from standard output with no need for new engineering. Decision making about performance characteristics of HPV testing can be shifted to programme implementers and cutoffs selected according to resource availability and community preferences. FUNDING Supported by the National Cancer Institute UH2/3 CA189908.
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22
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Thomson KA, Sandoval M, Bain C, Holme F, Bansil P, Figueroa J, de Sanjosé S. Recall Efforts Successfully Increase Follow-Up for Cervical Cancer Screening Among Women With Human Papillomavirus in Honduras. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:290-299. [PMID: 32606095 PMCID: PMC7326516 DOI: 10.9745/ghsp-d-19-00404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
A reminder phone call had a substantial impact on high rates of women returning for rescreening among those at high risk of developing cervical precancer. Scaling up routine cervical screening coverage must be accompanied by efforts to retain women throughout the screening cascade and continuum of care. Scaling up coverage of routine cervical screening in low-resource settings must be accompanied by efforts to retain women throughout the screening cascade and continuum of care, including adequate follow-up of abnormal results. The Scale-Up Project implemented human papillomavirus (HPV) testing for cervical cancer screening within public-sector health facilities in Honduras between 2015 and 2019. Women who were HPV-positive but did not have visually confirmed cervical lesions upon visual inspection with acetic acid (VIA-negative) were instructed to return to the health center after 1 year for repeat HPV testing. The current evaluation assessed the effectiveness of recall strategies to prompt women to return for retesting. Clinic staff placed reminder phone calls and followed up with short message service (SMS) or home visits, if needed. We summarized number of contacts, type of contacts, and time elapsed until return to the clinic, and used log-binomial regression to identify factors associated with return to the clinic. We identified 558 women who were initially HPV-positive VIA-negative from 8 clinics as needing repeat HPV testing 1 year later. Mean age was 43.2 years. Nearly all women (98.6%) were successfully contacted and 75.1% completed repeat HPV testing. The majority of contacts (65.4%) were phone calls, and nearly half of women who returned to the clinic (42.9%) did so after 1 contact. Mean days between contact and presentation at the clinic was 10.7 (standard deviation: 14.7). Women who required 3 or more contacts were 21% less likely to return for repeat HPV testing (prevalence ratio: 0.79; 95% confidence interval=0.69,0.90; P<.001) as compared to women who received only 1 contact. Reminder phone calls were highly successful at recalling women for HPV retesting in Honduras. This low-touch intervention should be included as part of standard follow-up to retain women throughout the continuum of cervical cancer screening and treatment.
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Affiliation(s)
| | - Manuel Sandoval
- Asociación Hondureña de Planificación de Familia, Tegucigalpa, Honduras
| | - Carolyn Bain
- PATH, Sexual & Reproductive Health Program, Seattle, USA
| | | | - Pooja Bansil
- PATH, Sexual & Reproductive Health Program, Seattle, USA
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23
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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] [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] [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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25
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Castle PE, Varallo JE, Bertram MM, Ratshaa B, Kitheka M, Rammipi K. High-risk human papillomavirus prevalence in self-collected cervicovaginal specimens from human immunodeficiency virus (HIV)-negative women and women living with HIV living in Botswana. PLoS One 2020; 15:e0229086. [PMID: 32053659 PMCID: PMC7018080 DOI: 10.1371/journal.pone.0229086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background The prevalence of high-risk human papillomavirus (hrHPV) is poorly described overall and in women living with HIV (WLWH) and HIV-negative women living in Botswana, a high HIV and cervical cancer-burden country. We conducted a pilot study of self-collection and high-risk HPV testing for cervical screening, from which data on HPV prevalence was available. Methods From five health facilities in the Kweneng East District, 1,022 women aged 30–49 years were enrolled to self-collect their cervicovaginal specimen for hrHPV testing by the Xpert HPV Test (Cepheid, Sunnyvale, CA, USA). Crude and age group-adjusted hrHPV prevalence by HIV status were calculated, and the relationship of hrHPV risk groups HPV16>HPV18/45>other hrHPV types) to the presence and severity of visible lesions. Results Of the 1,022 women enrolled, 1,019 (99.7%), 570 WLWH and 449 HIV-negative women, had hrHPV testing results. Crude hrHPV prevalences were 25.2% (95%CI = 21.2–29.4%) for HIV-negative women and 40.4% (95%CI = 36.3–44.5%) for WLWH. Age group-adjusted hrHPV prevalences were 23.7% (95%CI = 19.9–27.9%) for HIV-negative women and 41.3% (95%CI = 37.2–45.4%) for WLWH. Age group-adjusted prevalences of HPV16 (p<0.001), HPV18/45 (p<0.001), HPV31/33/35/52/58 (p<0.001), and HPV39/56/66/68 (p = 0.011) were greater among WLWH than HIV-negative women. Riskier hrHPV groups were more likely to have visible abnormalities (ptrend = 0.004) and visible abnormalities not eligible for cryotherapy (ptrend = 0.030). Conclusions hrHPV infection was common among all women in the study living in Botswana, to a greater extent in WLWH than their HIV-negative counterparts. Strategies to triage hrHPV-positive women will be needed to avoid over-treating many women with benign hrHPV infections.
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Affiliation(s)
- Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - John E. Varallo
- Jhpiego USA, Baltimore, MD, United States of America
- * E-mail:
| | | | | | | | - Kereng Rammipi
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
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Ekeroma A, Dyer R, Palafox N, Maoate K, Skeen J, Foliaki S, Vallely AJ, Fong J, Hibma M, Mola G, Reichhardt M, Taulung L, Aho G, Fakakovikaetau T, Watters D, Toliman PJ, Buenconsejo-Lum L, Sarfati D. Cancer management in the Pacific region: a report on innovation and good practice. Lancet Oncol 2019; 20:e493-e502. [PMID: 31395474 DOI: 10.1016/s1470-2045(19)30414-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
Pacific island countries and territories (PICTs) face the challenge of a growing cancer burden. In response to these challenges, examples of innovative practice in cancer planning, prevention, and treatment in the region are emerging, including regionalisation and coalition building in the US-affiliated Pacific nations, a point-of-care test and treat programme for cervical cancer control in Papua New Guinea, improving the management of children with cancer in the Pacific, and surgical workforce development in the region. For each innovation, key factors leading to its success have been identified that could allow the implementation of these new developments in other PICTs or regions outside of the Pacific islands. These factors include the strengthening of partnerships within and between countries, regional collaboration within the Pacific islands (eg, the US-affiliated Pacific nations) and with other regional groupings of small island nations (eg, the Caribbean islands), a local commitment to the idea of change, and the development of PICT-specific programmes.
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Affiliation(s)
- Alec Ekeroma
- National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa; Department of Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HA, USA; Population Sciences in the Pacific Program (Cancer Prevention in the Pacific), University of Hawaii Cancer Center, Honolulu, HA, USA
| | - Kiki Maoate
- Pacific Islands Programme, Royal Australasian College of Surgeons, Melbourne, VIC, Australia; Department of Paediatric Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Jane Skeen
- Starship Blood and Cancer Centre, Starship Children's Health, Auckland, New Zealand
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Andrew J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - James Fong
- Obstetrics and Gynaecology Unit, Colonial War Memorial Hospital, Ministry of Health, Suva, Fiji; Fiji National University, Suva, Fiji
| | - Merilyn Hibma
- Cervical Cancer Prevention in the Pacific Alliance, Dunedin, New Zealand; Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Glen Mola
- Department of Obstetrics, Gynaecology and Reproductive Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea; School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Martina Reichhardt
- Cancer Council of the Pacific Islands, Yap State Department of Health Services, Yap State, Federated States of Micronesia
| | - Livinston Taulung
- Cancer Council of the Pacific Islands, Kosrae State Department of Health Services, Kosrae State, Federated States of Micronesia
| | - George Aho
- Department of Paediatrics, Vaiola Hospital, Nuku'alofa Tonga
| | | | - David Watters
- Deakin University and Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Pamela J Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lee Buenconsejo-Lum
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HA, USA
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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de Sanjose S, Tsu VD. Prevention of cervical and breast cancer mortality in low- and middle-income countries: a window of opportunity. Int J Womens Health 2019; 11:381-386. [PMID: 31308762 PMCID: PMC6617716 DOI: 10.2147/ijwh.s197115] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/16/2019] [Indexed: 02/02/2023] Open
Abstract
Breast and cervical cancer are the two most common women’s cancers worldwide. Countries have invested for decades in early detection programs for breast and cervical cancer through screening, community education, and opportunistic case detection by health professionals. However, effectiveness in low- and middle-income countries (LMICs) has been limited due to low coverage, insufficient laboratory capacities for diagnosis, health information systems (HIS) that are not designed to track patients or monitor program performance, barriers that inhibit women’s uptake of services, and inadequate treatment options. Even where some screening activities exist, there has not been sufficient attention to ensuring completion of appropriate diagnosis and treatment after women receive a positive screening test result or report symptoms suggesting cervical or breast cancer. Because of this failure to provide adequate follow-up care, these women miss the potential benefit from early detection and have a higher than average risk to develop cancer or progress to more advanced cancer stages that could have been avoided. There are several critical steps in a woman’s journey from good health to elevated cancer risk, then to cancer prevention or diagnosis, and finally to treatment. There is a window of opportunity that extends from the time a positive finding is identified—by a cervical or breast screening test or recognition of a breast abnormality—to the point when cervical precancer treatment is delivered or a treatment plan for diagnosed breast cancer is initiated. Building on existing health systems and adapting measurable, affordable, and culturally acceptable interventions can achieve a lasting impact. If women can successfully navigate this window of opportunity, they can avoid progression to cervical cancer or greatly reduce the need for invasive treatments for breast cancer and improve their chances for survival and improved quality of life. We propose several actions that can lead us on the path towards reduction of this cancer burden.
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Affiliation(s)
| | - Vivien D Tsu
- Sexual and Reproductive Health, PATH, Seattle, WA, USA
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Vallely A, Tollman P. Health service delivery models for scaling use of point-of-care HPV 'test and treat' strategies in high-burden, low-income settings. J Virus Erad 2019; 5:1-3. [PMID: 30997143 PMCID: PMC6428153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Visual inspection of the cervix with acetic acid (VIA) has shown disappointing performance when used alone as part of screen and treat strategies for cervical cancer prevention in Papua New Guinea. Point-of-care testing with the Xpert® HPV assay (Cepheid, Sunnyvale, CA, USA) offers a new approach, enabling 'test and treat' services using self-collected specimens with same-day curative cervical ablation (cryotherapy or thermocoagulation).
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29
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Vallely A, Tollman P. Health service delivery models for scaling use of point-of-care HPV ‘test and treat’ strategies in high-burden, low-income settings. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30062-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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