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Evina Bolo S, Kenfack B, Wisniak A, Tankeu G, Yakam V, Moukam A, Sormani J, Stoll B, Vassilakos P, Petignat P. Factors influencing cervical cancer re-screening in a semi-rural health district of Cameroon: a cohort study. BMC Womens Health 2024; 24:76. [PMID: 38281960 PMCID: PMC10822157 DOI: 10.1186/s12905-024-02917-3] [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: 06/08/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Screening participation at recommended intervals is a crucial component of cervical cancer prevention effectiveness. However, little is known regarding the rate of re-screening in a Sub-Saharan context. This study aimed to estimate the re-screening rate of women in a semi-rural after an initial HPV-based screening and identify factors that influence adherence. METHODS This cohort study at the Annex Regional Hospital of Dschang enrolled women screened for cervical cancer over 5 years ago and due for re-screening. Women who initially tested HPV-positive (n = 132) and a random sample of HPV-negative women (n = 220) participated in a telephone survey between October 2021 and March 2022 to assess re-screening participation and reasons. Sociodemographic factors were collected, and associations with rescreening were evaluated. RESULTS A total of 352 participants aged under 50 years (mean age 37.4 years) were contacted, and 203 (58.0%) completed the survey. The proportion of women who complied with the screening recommendation was 34.0% (95% CI 27.5% - 40.5%), The weighted re-screening proportion was 28.4%. Age, marital status, education level, type of employment, and place of residence were not associated with the rate of re-screening. Main reported barriers to re-screening were lack of information (39.0%), forgetfulness (39.0%), and impression of being in good health (30.0%). Women who remembered the recommended screening interval were 2 to 3 times more likely to undergo re-screening (aOR (adjusted odds ratio) = 2.3 [1.2-4.4], p = 0.013). Human papilloma virus- positive status at the initial screening was also associated with the re-screening((aOR) (95% CI): 3.4 (1.8-6.5). CONCLUSION Following an initial Human Papilloma Virus-based screening campaign in the West Region of Cameroon, one third of women adhered to re-screening within the recommended timeframe. Existing screening strategies would benefit from developing better information approaches to reinforce the importance of repeated cervical cancer screening.
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Affiliation(s)
- Sophie Evina Bolo
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon.
- Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
- Department of Obstetrics, Gynaecology and Maternal Health, University of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - Gilles Tankeu
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
- Global Research Agency, Dschang, Cameroon
| | - Virginie Yakam
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
| | - Alida Moukam
- Department of Gynaecology and Obstetrics, Annex Regional Hospital of Dschang, Dschang, Cameroon
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jessica Sormani
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
- HES-SO University of Applied Sciences and Arts Western, Delémont, Switzerland
| | - Beat Stoll
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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Morse RM, Jurczuk M, Brown J, Jara LEC, Meza G, López EJR, Tracy JK, Gravitt PE, Paz-Soldan VA. "Day or night, no matter what, I will go": Women's perspectives on challenges with follow-up care after cervical cancer screening in Iquitos, Peru: a qualitative study. BMC Womens Health 2023; 23:293. [PMID: 37259075 DOI: 10.1186/s12905-023-02414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The study's objective was to explore the factors associated with loss to follow-up among women with abnormal cervical cancer screening results in Iquitos, Peru from women's perspectives. METHODS In-depth interviews were conducted with 20 screen-positive women who were referred for follow-up care but for whom evidence of follow-up was not found. Interview transcripts were thematically analyzed inductively, and the codes were then categorized using the Health Care Access Barriers Model for presentation of results. RESULTS All interviewed women were highly motivated to complete the continuum of care but faced numerous barriers along the way, including cognitive barriers such as a lack of knowledge about cervical cancer and poor communication from health professionals regarding the process, structural barriers such as challenges with scheduling appointments and unavailability of providers, and financial barriers including out-of-pocket payments and costs related to travel or missing days of work. With no information system tracking the continuum of care, we found fragmentation between primary and hospital-level care, and often, registration of women's follow-up care was missing altogether, preventing women from being able to receive proper care and providers from ensuring that women receive care and treatment as needed. CONCLUSIONS The challenges elucidated demonstrate the complexity of implementing a successful cervical cancer prevention program and indicate a need for any such program to consider the perspectives of women to improve follow-up after a positive screening test.
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Affiliation(s)
- Rachel M Morse
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Magdalena Jurczuk
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Lita E Carrillo Jara
- Department of Cancer Control and Prevention, Dirección Regional de Salud de Loreto, Iquitos, Loreto, Peru
| | - Graciela Meza
- Facultad de Medicina Humana, Universidad Nacional de La Amazonia Peruana, Iquitos, Peru
| | | | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Valerie A Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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Morse RM, Brown J, Noble HE, Ríos López EJ, Kohler-Smith A, Soto S, Del Cuadro DL, Gonzales Díaz K, Figueredo Escudero M, Vásquez Del Aguila G, Carrillo Jara LE, Silva Delgado HF, Palacios VA, Santos-Ortiz C, Gravitt PE, Paz-Soldan VA. Women's perspectives on the acceptability and feasibility of an HPV screen-and-treat approach to cervical cancer prevention in Iquitos, Peru: a qualitative study. BMC Womens Health 2022; 22:414. [PMID: 36217187 PMCID: PMC9552409 DOI: 10.1186/s12905-022-01943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of this study was to explore women's experiences of a screen-and-treat approach with ablative therapy (referred to by the Spanish acronym TVT-TA) as a method of treatment following a positive HPV test in Iquitos, Peru. METHODS A total of 111 in-depth interviews were conducted with 47 HPV positive women who attended the TVT-TA procedure at a primary-level healthcare facility. Interviews were conducted immediately before, immediately after, and six-weeks after TVT-TA. RESULTS Most interviewed women reported experiencing moderate pain during ablative therapy and minimal pain immediately after and six weeks after ablative therapy. Women also stated that the pain was less intense than they had expected. The most common physical after-effects of treatment were bleeding and vaginal odor. Women experienced oscillating emotions with fear upon receiving a positive HPV result, calming after hearing about ablative therapy treatment, worry about pain from the treatment itself, relaxation with counseling about the procedure, and relief following treatment. CONCLUSIONS Nearly all participants emphasized that they were pleased with the TVT-TA process even if they had experienced pain during TVT-TA, recommended that TVT-TA be expanded and available to more women, and stated that TVT-TA was faster and easier than expected. This study found that TVT-TA is a feasible and acceptable means of treating HPV according to the women receiving the treatment.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Helen E Noble
- Global Health Fogarty International Program, University of Washington Northern Pacific, Seattle, WA, USA
| | | | | | | | - Daniel Lenin Del Cuadro
- Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto, Iquitos, Loreto, Peru
| | - Karina Gonzales Díaz
- Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto, Iquitos, Loreto, Peru
| | - Magaly Figueredo Escudero
- Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto, Iquitos, Loreto, Peru
| | | | - Lita E Carrillo Jara
- Department of Cancer Control and Prevention, Gerencia Regional de Salud de Loreto, Iquitos, Loreto, Peru
| | | | - Victor A Palacios
- Dirección de Prevención y Control de Cáncer, Ministerio de Salud, Lima, Peru
| | - Carlos Santos-Ortiz
- Dirección de Prevención y Control de Cáncer, Ministerio de Salud, Lima, Peru
| | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
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5
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Miller DL, Graham A, Davis KE, Kaur H, White M, Maleki Z, Rodriguez EF. Risk Assessment of Human Papillomavirus-Positive Cytology-Negative Cervical Cancer Screening in Black and White Women. Am J Clin Pathol 2022; 157:399-405. [PMID: 34508551 DOI: 10.1093/ajcp/aqab129] [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: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES As we move toward human papillomavirus (HPV) only as the preferred cervical cancer screening method, we performed a retrospective analysis of Black and White women with negative cytology (Papanicolaou negative [PAPneg]) and positive high-risk HPV (hrHPV) (HPVpos) results and determined follow-up. METHODS We searched our pathology data system for patients with PAPneg/HPVpos results (2017-2019). Follow-up data were reviewed (39 months), and a comparison among race was performed. RESULTS In total, 1,728 patients were identified (Black, 53%; White, 47%). Twenty-nine percent of the patients had no follow-up with no difference among the races. HPV 16 was more common among Whites (P < .01), while non-16/18 hrHPV was more common among Black patients (P = .01). A total of 30 (3.3%) Black and 26 (3.2%) White patients were diagnosed with cervical intraepithelial neoplasia grade 2/3 (CIN 2/3). More White women were diagnosed on biopsy alone (negative endocervical curettage) compared with Black women (20 vs 9, P < .01). Meanwhile, there were 21 Black and 6 White women with CIN 2/3 on endocervical curettage (P = .01). CONCLUSIONS Follow-up of women with PAPneg/HPVpos remains a challenge. There was no disparity in follow-up when cohorts were compared. However, Black women had higher numbers of high-grade intraepithelial lesions on endocervical curettage.
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Affiliation(s)
- Daniel L Miller
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Ashleigh Graham
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katelynn E Davis
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harsimar Kaur
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erika F Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Bao H, Zhang X, Bi H, Zhao Y, Fang L, Wang H, Wang L. How Can a High-Performance Screening Strategy Be Determined for Cervical Cancer Prevention? Evidence From a Hierarchical Clustering Analysis of a Multicentric Clinical Study. Front Oncol 2022; 12:816789. [PMID: 35155253 PMCID: PMC8829547 DOI: 10.3389/fonc.2022.816789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to explore the cluster patterns of cervical cancer screening strategies for detecting high-grade precancerous lesions in terms of benefits, costs, and efficiency. Methods A total of 2,065 referral women aged 25–64 years were recruited and underwent human papillomavirus (HPV) testing, liquid-based cytology with manual reading, and cytology with artificial intelligence (AI)-assisted reading. All women were assessed by colposcopy and histological examination. We formed 14 screening strategies based on primary cytology screening, primary HPV screening incorporating HPV-16/18 genotyping triage, cytology triage, or both, and co-testing. The primary outcomes were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+). The hierarchical clustering method was applied to multifaceted indicators, and then, the resulting clusters were described in terms of benefits, costs, efficiency, and their interaction. This study was registered (No. ChiCTR2000034131). Results The relative sensitivity of HPV-based strategies compared with cytology alone with the threshold of LSIL+ ranged from 0.68 to 1.19 for CIN2+ detection and from 0.72 to 1.11 for CIN3+ detection, whereas the relative specificity ranged from 0.55 to 1.43 for CIN2+ detection and from 0.51 to 1.51 for CIN3+ detection. Five significant clusters according to the trade-off among benefits, costs, and efficiency were identified. The cluster including four primary HPV screening strategies showed the optimal balance. HPV testing with HPV-16/18 genotyping and AI-based cytology triage presented the optimal trade-off for CIN3+ detection relative to cytology alone in terms of relative sensitivity (1.06), relative specificity (0.72), colposcopies for 1 CIN3+ (3.7 vs. 3.1), a load of follow-up for women with HPV-positive and normal cytology (7.0% vs. 22.3%), and the work of manual cytology reading (35.1% vs. 100%). Conclusions Our study provided clinical and methodological evidence on the choice of HPV-based screening strategies. The cluster including primary HPV screening with genotyping and cytology triage showed an optimal balance among benefit, cost, and efficiency.
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Affiliation(s)
- Heling Bao
- Department of Maternal and Child Health, Maternal and Child Health Department, School of Public Health, Peking University, Beijing, China.,National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Hui Bi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Liwen Fang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, Maternal and Child Health Department, School of Public Health, Peking University, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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7
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Wang S, Li L, Yang J, Han N, Bao H, Wang HJ. Comparison of Different HPV-based Strategies and Cytology in Routine Cervical Cancer Screening Programme in China: A Population-based Study. Cancer Prev Res (Phila) 2021; 15:45-54. [PMID: 34556493 DOI: 10.1158/1940-6207.capr-21-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/02/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
The study aimed to compare the performance of human papillomavirus (HPV)-based strategies to cytology for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in routine program in China. The study included 50,434 women ages 30-64 years from January 2015 to December 2019, to assess four strategies: cytology with HPV triage (strategy 1), primary HPV testing with reflex cytology (strategy 2), primary HPV testing with HPV-16/18 genotyping and reflex cytology for non-16-18 high-risk HPV genotypes (strategy 3), and co-testing (strategy 4). The main outcomes were sensitivity for CIN3+ and colposcopy referral rate. Overall, the rates of HPV positivity and cytologic abnormality were 7.0% [95% confidential interval (CI), 6.8-7.2] and 3.5% (95% CI, 3.3-3.6], respectively. The sensitivity for CIN3+ were 88.5% for strategy 4, 83.2% for strategy 3, 64.6% for strategy 1, and 60.1% for strategy 2. The relative sensitivity of strategy 4 and strategy 3 compared with strategy 1 for detecting CIN3+ were 1.38 (95% CI, 1.24-1.54) and 1.29 (95% CI, 1.14-1.46), respectively. The colposcopy referral rates of strategies 4 and 3 were significantly higher than that of strategy 1 (2.4% and 2.2% vs. 1.4%, P < 0.001). In conclusion, co-testing and primary HPV testing with HPV-16/18 genotyping and reflex cytology improved the sensitivity for CIN3+ compared with cytology but increased the colposcopy referral rate. Long-term negative predicted value for HPV-negative women should be studied to determine the screening interval. Our study provides further evidence to the introduction of HPV-based strategies in China. PREVENTION RELEVANCE: Both co-testing and primary HPV testing with HPV-16/18 genotyping and reflex cytology triage provided higher sensitivity for detecting CIN3+; however, the number of colposcopy referrals also increased compared with cytology in a routine program. It has great public health implications for the introduction of HPV-based screening strategies in China.
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Affiliation(s)
- Shi Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Haidian District, Beijing, P.R. China
| | - Ling Li
- Tongzhou Maternal and Child Health Hospital, Tongzhou District, Beijing, P.R. China
| | - Jie Yang
- Tongzhou Maternal and Child Health Hospital, Tongzhou District, Beijing, P.R. China
| | - Na Han
- Tongzhou Maternal and Child Health Hospital, Tongzhou District, Beijing, P.R. China
| | - Heling Bao
- Department of Maternal and Child Health, School of Public Health, Peking University, Haidian District, Beijing, P.R. China.
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Haidian District, Beijing, P.R. China
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Song F, Yan P, Huang X, Wang C, Qu X, Du H, Wu R. Triaging HPV-positive, cytology-negative cervical cancer screening results with extended HPV genotyping and p16 INK4a immunostaining in China. BMC Infect Dis 2021; 21:400. [PMID: 33931022 PMCID: PMC8086315 DOI: 10.1186/s12879-021-06109-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Self-sampling for human papillomavirus (HPV) testing is a feasible option to improve the cervical screening coverage. However, an ideal triage method for HPV-positive self-samples does not yet exist. The aim of this study was to explore the utility of HPV genotyping and p16INK4a immunostaining (p16) in triaging HPV-positive self-samples, focusing on HPV-positive, cytology-negative (HPCN) women. Methods A total of 73,699 women were screened in a cervical screening project in China via SeqHPV assay on self-samples. HPV-positive women were called-back and collected cervical sample for p16 immunostaining and liquid-based cytology, those who met any result of HPV16/18+ or visual inspection with acetic acid (VIA) + or p16+ were referred for colposcopy, and HPCN women with adequate data on p16 and pathology were analyzed. A triage strategy was considered acceptable if the negative predictive value (NPV) for cervical intraepithelial neoplasia 3 or worse (CIN3+) was 98% or more, combined with an improvement of sensitivity and specificity for CIN2+/CIN3+ in reference to the comparator, being HPV16/18 + . Results A total of 2731 HPCN women aged 30–64 years were enrolled, 136 (5.0%) CIN2+ and 53 (1.9%) CIN3+ were detected. Five triage strategies met the criteria: p16+; HPV16/33+; ‘HPV16+ or HPV33/58/31/35+&p16+’; ‘HPV16/33+ or HPV58/31/35+&p16+’; HPV16/18/31/33/45/52/58 + & p16+. These strategies required less or similar colposcopy referrals, and less colposcopies to detected one case of CIN2+/CIN3+, achieving favorable false positive (negative) rates to the comparator. Among them, p16 staining detected 83.1% (79.2%) of underlying CIN2 + (CIN3+) in HPCN women. Moreover, three triage strategies were favorable in sensitivity and/or specificity to the ‘HPV16/33+’ strategy: p16+; ‘HPV16+ or HPV33/58/31/35 + &p16+’; HPV16/18/31/33/45/52/58 + &p16 + . Conclusions Genotyping for HPV16/33 could be utilized to optimize the management of HPCN women. Moreover, p16 immunostaining, either alone or combined with extended genotypes, is more effective than HPV genotypes alone in the triage of HPCN women. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06109-4.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Peisha Yan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen, Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, P. R. China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China.
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Paolino M, Gago J, Pera AL, Cinto O, Thouyaret L, Arrossi S. Adherence to triage among women with HPV-positive self-collection: a study in a middle-low income population in Argentina. Ecancermedicalscience 2020; 14:1138. [PMID: 33281930 PMCID: PMC7685770 DOI: 10.3332/ecancer.2020.1138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Screening for cervical cancer (CC) prevention has substantially changed with the introduction of human papillomavirus (HPV) tests. This technology compared to cytology has increased the detection of pre-malignant and malignant cervical lesions in real-world programmes in different settings. Very importantly, through self-collection, HPV testing can reduce barriers to screening and increase coverage. However, when using HPV self-collection, triage tests are a key step in the CC prevention process, and high adherence to triage has been difficult to obtain in low-middle income settings. The aim of this study was to measure adherence to triage among women with HPV+ self-collection and analysed factors associated with this adherence in a middle-low resource setting in Argentina. We also evaluated key indicators related to the implementation of the HPV self-collection strategy. Methods We analysed data on screening/triage/diagnosis/treatment from women aged 30+ who performed self-collection between 2015 and 2017 (n = 15,763), in the public health system in Tucuman, Argentina. We analysed secondary data from the national screening information system. The primary outcomes were: 1) adherence to cytology triage within the recommended timeframe (120 days) and 2) overall adherence to cytology triage including data at 18 months after screening. Multivariable regression was used to examine the association between age group, year of the screening test, record of the previous Pap-based screening and health insurance status with adherence to triage test as a primary outcome. We reported odds ratios, 95% confidence intervals and p-value of 0.05, which was considered the threshold for p-values). Results We analysed data of 2,389 HPV+ women. The overall adherence to triage at 18 months was 42.9%. The percentage of women completing cytology triage within the recommended timeframe of 120 days was lower (25.2%). Women with the record of a previous Pap-based screening had 1.86 times the odds of having a triage compared to women without a record of a previous Pap-based screening (95% CI: 1.64–2.64, p <0.001). Furthermore, the probability of having triage at the recommended timeframe was higher among women who were older and women with public health insurance. Conclusions Our results showed that adherence to triage in the recommended timeframe was low. In addition, the probability of having triage at the recommended timeframe was higher among women with a record of a previous Pap-based screening, a proxy of the use of health services. Our results showed that adherence to triage in the context of the HPV-self-collection strategy is challenging. The implementation of alternative approaches that might facilitate adherence to triage should be further investigated.
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Affiliation(s)
- Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-8649-1570
| | - Juan Gago
- Department of Population Health, School of Medicine, New York University (NYU), 550 1st Avenue, New York, NY 10016, USA
| | - Anabella Le Pera
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Oscar Cinto
- Ministerio de Salud Pública de Tucumán, Av. República del Líbano 956, San Miguel de Tucumán, Tucumán, Argentina.,Retired
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Piso 9, Buenos Aires 1067, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-5071-0938
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10
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Victoria SA, Racquel E K, Lucila S, Melisa P, Viswanath K, Silvina A. Knowledge and perceptions regarding triage among human papillomavirus-tested women: A qualitative study of perspectives of low-income women in Argentina. ACTA ACUST UNITED AC 2020; 16:1745506520976011. [PMID: 33264086 PMCID: PMC7716054 DOI: 10.1177/1745506520976011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Among cancer prevention studies, little is known about knowledge, attitudes, and beliefs toward triage adherence in the context of the human papillomavirus self-collection test. This formative research aims to identify knowledge, attitudes, and beliefs related to human papillomavirus and cervical cancer prevention specifically about adherence to Pap triage among women residing in a low-income province in Argentina. Methods: We conducted six focus groups, stratified by residence and age. All participants were aged 30 or older and had performed human papillomavirus self-collection. Data collection and thematic analysis were carried out using constructs from the Health Belief Model. Results: Misinformation regarding human papillomavirus and cervical cancer was common and was a source of distress. Women could not distinguish Pap screening from triage; human papillomavirus risk perception was limited but cervical cancer was perceived as a threatening disease. Women were willing to follow-up after receiving an abnormal screening result. Negative views about clinician-collected screening/triage were common, defined as painful and shameful, and comes with an economic cost (transport/time). Lack of help from family/friends was an obstacle to adhering to triage. Health issues in the family’s records and a physician’s recommendation were a cue to adhere to triage. Conclusion: Lack of knowledge or misinformation of the causes of cervical cancer, human papillomavirus, and the multi-step screening and triage process are barriers to follow-up adherence. Interventions to improve communication between women and health providers about screening results and follow-up are needed. Also, health services should be organized to respond to women’s needs and reduce access barriers to follow-up.
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Affiliation(s)
| | - Kohler Racquel E
- Cancer Health Equity, Cancer Institute of New Jersey, Rutgers-The State University of New Jersey, New Brunswick, NJ, USA
| | - Szwarc Lucila
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires, Buenos Aires, Argentina
| | - Paolino Melisa
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires, Buenos Aires, Argentina
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Arrossi Silvina
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires, Buenos Aires, Argentina
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11
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Ibáñez R, Roura E, Monfil L, Rodríguez LA, Sardà M, Crespo N, Pascual A, Martí C, Fibla M, Gutiérrez C, Lloveras B, Oliveras G, Torrent A, Català I, Bosch FX, Bruni L, de Sanjosé S. Long-term protection of HPV test in women at risk of cervical cancer. PLoS One 2020; 15:e0237988. [PMID: 32853216 PMCID: PMC7451648 DOI: 10.1371/journal.pone.0237988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To evaluate the 9-year incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cumulative adherence to perform a next test in a cohort of women aged 40+ years with no cervical screening cytology within a window of 5 years (underscreened women), after baseline cervical cytology and HPV tests. Methods In Catalonia, Spain, co-testing with cytology and HPV test has been recommended in the Public Health system since 2006 for underscreened women. In 2007, 1,594 women with underscreened criteria were identified and followed through medical records form Pathological Department. 9-year cumulative incidence of histologically confirmed CIN2+ and cumulative adherence to perform a next test were estimated using Kaplan-Meier statistics. Results Follow-up was available for 1,009 women (63.3%) resulting in 23 women with. CIN2+ (2.3%). Of them, 4 women (17%) had both tests negative at baseline (3CIN2 and 1CIN3) with cumulative incidence of CIN2+ of 0.4% (95% CI: 0.1–1.4) at 5-years and 1.3% (95% CI: 0.4–3.7) at 9-years. During the first year, the prevalence among women with both tests positive was 27.0% (95% CI: 13.0–50.6) for CIN2+. Lost to follow-up was higher among women with both tests negative compared to those with both positive tests (38.7% vs 4.2%, p-value <0.001). 40.5% of the women HPV-/cyto- had a re-screening test during the 4 years following the baseline, increasing until 53.5% during the 6 years of follow-up. Conclusions HPV detection shows a high longitudinal predictive value at 9-year to identify women at risk to develop CIN2+. The data validate a safe extension of the 3-year screening intervals (current screening interval) to 5-year intervals in underscreened women that had negative HPV result at baseline. It is necessary to establish mechanisms to ensure screening participation and adequate follow-up for these women.
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Affiliation(s)
- Raquel Ibáñez
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Esther Roura
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red: Epidemiologıa y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Laura Monfil
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Montserrat Sardà
- Pathology Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Nàyade Crespo
- Sexual and Reproductive Health centre of Bages-Solsonès, Institut Català de la Salut, Manresa, Barcelona, Spain
| | - Amparo Pascual
- Sexual and Reproductive Health centre of Bages-Solsonès, Institut Català de la Salut, Manresa, Barcelona, Spain
| | - Clara Martí
- Pathology Department, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Montserrat Fibla
- Pathology Department, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Cristina Gutiérrez
- Clinical Laboratory ICS Tarragona, Molecular Biology Section, Hospital universitari Joan XXIII de Tarragona, IISPV Rovira i Virgili University, Tarragona, Spain
| | - Belén Lloveras
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Gloria Oliveras
- Pathology Department, Hospital universitari Dr, Josep Trueta de Girona, Catalan Institute of Oncology, Girona, Spain
| | - Anna Torrent
- Sexual and Reproductive Health centre of Mollet del Vallés, Institut Català de la Salut Mollet del Vallès, Barcelona, Spain
| | - Isabel Català
- Pathology Department, Hospital universitari de Bellvitge, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Xavier Bosch
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red: Epidemiologıa y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
- PATH, Seattle, Washington, United States of America
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12
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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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13
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Miller D, Morris CP, Maleki Z, White M, Rodriguez EF. Health disparities in cervical cancer: Prevalence of high-risk HPV and cytologic diagnoses according to race. Cancer Cytopathol 2020; 128:860-869. [PMID: 32598100 DOI: 10.1002/cncy.22316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the United States, the rate of cervical cancer is disproportionally higher in Hispanic and Black women compared with White women. In the current study, the authors compared human papillomavirus (HPV) testing and cytology results among Black and White women over a 24-month period. They then assessed the rates in young women in 2011 compared with 2017 according to race. METHODS The authors searched the gynecologic cytology case files for Black and White women treated at Johns Hopkins Hospital across all ages for a period of 24 months (2017-2019) and compared HPV results and cytologic interpretations. They then compared results among Black and White cohorts of young women (aged 21-29 years) in 2011 versus 2017. RESULTS A total of 26,302 specimens from January 2017 to January 2019, including 11,676 Black women and 14,626 White women, were reviewed. The most common HPV genotype(s) detected were non-HPV-16 and/or HPV-18 (non-16/18) high-risk HPV (hrHPV) (84% of positive results). Non-16/18 hrHPV was more common in Black women (1309 women; 15%) compared with White women (1075 women; 9%). Non-16/18 hrHPV was more commonly observed in association with atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion and/or high-grade squamous intraepithelial lesion (ASC-H/HSIL) in HPV-positive Black women compared with White women (P = .007). Black women were found to have higher rates of HPV-positive Papanicolaou results and high-grade lesions, including carcinoma (P < .01). In the 2011 cohort, young Black women were found to have a higher rate of ASC-H/HSIL (P = .003) compared with White women. However, the difference was not noted in the 2017 cohort. There was a decrease in ASC-H/HSIL in 2017 compared with 2011, with a lower incidence of ASC-H/HSIL noted among Black women in 2017. CONCLUSIONS Black women appear to have a higher incidence of higher grade lesions, but the difference between Black and White cohorts was not found to be significant in young women in more recent years.
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Affiliation(s)
- Daniel Miller
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - C Paul Morris
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Marissa White
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Erika F Rodriguez
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
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14
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Krekeler BN, Vitale K, Yee J, Powell R, Rogus-Pulia N. Adherence to Dysphagia Treatment Recommendations: A Conceptual Model. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1641-1657. [PMID: 32432958 PMCID: PMC7839030 DOI: 10.1044/2020_jslhr-19-00270] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 05/14/2023]
Abstract
Purpose Conceptual models of complex health problems are useful when designing targeted clinical interventions and focused research studies. Understanding and studying patient adherence often involves interplay among many factors that influence whether a patient successfully follows recommendations or completes a therapy program. Functional frameworks serve to arrange these factors visually, increasing interpretability and allowing for empirical testing of relationships among concepts. The purpose of this article is to integrate relevant factors from the literature into a comprehensive framework that describes adherence to dysphagia treatment. Method Using peer-reviewed, published guidelines regarding conceptual model construction, the authors created a list of potential factors that influence patient adherence to dysphagia-related treatment recommendations. During model construction, following extensive review of the literature and existing theories that have been applied in other areas of health care, factors were identified and grouped into conceptually similar domains (clusters). Clusters were arranged into larger categories that emerged during model optimization. Ultimately, two models were created: one that illustrates the interrelated factors of patient adherence and another that illustrates a subset of modifiable risk factors that a clinical speech-language pathologist may influence when developing a dysphagia treatment plan. Results Three general categories from 14 factors emerged based on relationships between factors and aspects of patient care: health factors, individual patient factors, and contextual factors. A second model consisting of modifiable risk factors included access, treatment type, patient perceptions, self-efficacy, health literacy, support factors, and provider bias. Conclusions This conceptual model allows clinicians and researchers to identify and explore the mechanisms driving adherence. Continual refinements of this model should be made as future studies uncover how the interconnectedness of factors affects adherence in dysphagia management. The models we have presented here are ready for clinical application and should also serve researchers as they generate hypotheses and design targeted research questions.
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Affiliation(s)
- Brittany N. Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Ryan Powell
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Nicole Rogus-Pulia
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
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15
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Arrossi S, Almonte M, Herrero R, Gago J, Sánchez Antelo V, Szwarc L, Thouyaret L, Paolino M, Wiesner C. Psycho-social impact of positive human papillomavirus testing in Jujuy, Argentina results from the Psycho-Estampa study. Prev Med Rep 2020; 18:101070. [PMID: 32257775 PMCID: PMC7113430 DOI: 10.1016/j.pmedr.2020.101070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Human papillomavirus (HPV) testing can have a negative impact on women's lives which might also result in abandoning the follow-up and treatment process. This study measured the psycho-social impact of HPV-positivity among HPV-tested women from Jujuy, Argentina, a middle-low income setting. In this cross-sectional study (2015-2016), the psycho-social impact of HPV-positivity was measured using the Psycho-Estampa Scale, specifically designed and validated to be used in screening contexts. We measured mean scores for each of the five scale domains, and the Overall Impact score (Values from 1: No impact to 4: Heavy impact). We compared scores according to cytology triage diagnosis using ordinal logistic regression. A total of 163 HPV-positive women were recruited at the Centro Carlos Alvarado hospital and included in the study sample; of these, 124 (76.1%) had normal triage cytologies. The overall Impact score was between low and moderate (mean:2.56, SD:0.65). The highest psycho-social impact was measured in the Worries about cancer and treatment domain (mean score:3.60, SD:0.60), followed by Sexuality domain (mean:2.50; SD:1.00). The Uncertainty about information provided by health providers domain had the lowest mean score (mean:2.14, SD:0.73). Compared to women with normal cytologies (n = 124), women with abnormal cytologies (n = 39) had a higher likelihood of greater overall Psycho-social Impact (OR: 2.91; p = 0.0036). No statistically significant differences were found in scores of specific domains according to cytology results. It is important to devise specific counseling interventions to reduce the psycho-social impact of HPV-Testing as primary screening and its potential effect on completion of the diagnosis/ treatment process.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Maribel Almonte
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Rolando Herrero
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Juan Gago
- New York University-NYU, School of Medicine, USA
| | | | - Lucila Szwarc
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Av. Julio A. Roca 781, Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Carolina Wiesner
- Instituto Nacional de Cancerología, Calle 1 No.9-85, Bogotá, Colombia
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16
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Almonte M, Murillo R, Sánchez GI, González P, Ferrera A, Picconi MA, Wiesner C, Cruz-Valdez A, Lazcano-Ponce E, Jerónimo J, Ferreccio C, Kasamatsu E, Mendoza L, Rodríguez G, Calderón A, Venegas G, Villagra V, Tatti S, Fleider L, Terán C, Baena A, Hernández MDLL, Rol ML, Lucas E, Barbier S, Ramírez AT, Arrossi S, Rodríguez MI, González E, Celis M, Martínez S, Salgado Y, Ortega M, Beracochea AV, Pérez N, Rodríguez de la Peña M, Ramón M, Hernández-Nevarez P, Arboleda-Naranjo M, Cabrera Y, Salgado B, García L, Retana MA, Colucci MC, Arias-Stella J, Bellido-Fuentes Y, Bobadilla ML, Olmedo G, Brito-García I, Méndez-Herrera A, Cardinal L, Flores B, Peñaranda J, Martínez-Better J, Soilán A, Figueroa J, Caserta B, Sosa C, Moreno A, Mural J, Doimi F, Giménez D, Rodríguez H, Lora O, Luciani S, Broutet N, Darragh T, Herrero R. Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol. BMJ Open 2020; 10:e035796. [PMID: 32448795 PMCID: PMC7252979 DOI: 10.1136/bmjopen-2019-035796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT01881659.
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Affiliation(s)
- Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Raúl Murillo
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Paula González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | | | | | | | | | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Silvio Tatti
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - María de la Luz Hernández
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- SMS-Oncology, Amsterdam, The Netherlands
| | - Mary Luz Rol
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Sylvaine Barbier
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Arianis Tatiana Ramírez
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - María Isabel Rodríguez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Andrea Verónica Beracochea
- Centro de Salud Ciudad de la Costa, ASSE, Ciudad de la Costa, Uruguay
- Hospital Policial, DNASS, Montevideo, Uruguay
| | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
| | | | | | | | | | - Yessy Cabrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - María Celeste Colucci
- Instituto Nacional de Enfermedades Infecciosas - ANLIS Malbrán, Buenos Aires, Argentina
| | | | | | | | - Gladys Olmedo
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Betsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Jhacquelin Peñaranda
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | | | - Benedicta Caserta
- Departamento de Anatomía Patológica y Citología, Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Carlos Sosa
- Hospital Monseñor Víctor Manuel Sanabria Martínez, CCSS, Puntarenas, Costa Rica
| | - Adrián Moreno
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Juan Mural
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Hernando Rodríguez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
- Hospital Gineco-Obstétrico y Neonatal "Dr Jaime Sánchez Porcel", Sucre, Bolivia
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, District of Columbia, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, California, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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