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Wang S, Dang L, Liu S, Rezhake R, Yan H, Duan X, Zhang L, Zhang L, Zhang L, Su M, Guo F, Yan C, Liu M, Cao X, Sun M, Qiao Y, Zhao F. Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women. JAMA Netw Open 2024; 7:e244090. [PMID: 38551562 PMCID: PMC10980959 DOI: 10.1001/jamanetworkopen.2024.4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
Importance Limited evidence supports the performance of human papillomavirus (HPV) DNA testing as a primary screening method, followed by triage with visual inspection with acetic acid, in areas with limited health care resources, as suggested by the 2021 World Health Organization guidelines. Objective To evaluate the performance of visual inspection with acetic acid and Lugol iodine as a triage method for detecting cervical precancerous lesions among HPV-positive women in 1 visit. Design, Setting, and Participants This cohort study examined the implementation of a government-led cervical cancer screening program conducted from January 1, 2016, to December 31, 2020, in Ordos City, China. Female residents, aged 35 to 64 years, who understood the screening procedures and voluntarily participated were included in the study. Women were excluded if they reported never having had sexual intercourse, were pregnant, had a hysterectomy, or had ever undergone treatment for cervical lesions. Statistical analysis was conducted from December 2022 to December 2023. Exposures The program used the careHPV DNA assay as the primary screening method, and immediate triage was performed by visual inspection if HPV screening results were positive, with a 5-year screening interval. A colposcopy was performed for the women who had suspected cancer on visual inspection results or who were HPV positive and had abnormal visual inspection results, all in 1 visit. Main Outcomes and Measures The rate of compliance with colposcopy and the detection rate of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). Results The study included 187 863 women (median age, 46 years [IQR, 40-52 years]) who participated in the program and had valid HPV test results. The overall prevalence of HPV positivity was 12.8% (24 070 of 187 863), and the adherence to triage with visual inspection among HPV-positive women was 93.9% (22 592 of 24 070). Among HPV-positive women, the rate of compliance with colposcopy was 65.6% (2714 of 4137), and the CIN2+ detection rate was 2.8% (643 of 22 592). Conclusions and Relevance The findings of this cohort study suggest that the implementation of HPV testing, visual inspection, and colposcopy within 1 visit may mitigate losses to follow-up, detect precancerous lesions, and hold significant implications for screening in comparable areas with limited health care resources.
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Affiliation(s)
- Sumeng Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Dang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujun Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Remila Rezhake
- Cancer Research Institute, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Huijiao Yan
- Department of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianzhi Duan
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China
| | - Le Zhang
- Dean’s Office, Ordos Maternal and Child Health Care Hospital, Inner Mongolia Autonomous Region, Ordos, China
| | - Linlin Zhang
- Women’s Health Department, Ikinholo Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Lifeng Zhang
- Women’s Health Department, Otog Front Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Meili Su
- Dean’s Office, Dalad Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Fumei Guo
- Women’s Health Department, Jungar Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Cailing Yan
- Women’s Health Department, Otog Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Meili Liu
- Department of Obstetrics and Gynecology, Hangjin Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Xiaoyan Cao
- Women’s Health Department, Uxin Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Min Sun
- Department of Obstetrics and Gynecology, Dongsheng District Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Youlin Qiao
- Department of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Tong Y, Orang’o E, Nakalembe M, Tonui P, Itsura P, Muthoka K, Titus M, Kiptoo S, Mwangi A, Ong’echa J, Tonui R, Odongo B, Mpamani C, Rosen B, Moormann A, Cu-Uvin S, Bailey JA, Oduor CI, Ermel A, Yiannoutsos C, Musick B, Sang E, Ngeresa A, Banturaki G, Kiragga A, Zhang J, Song Y, Chintala S, Katzenellenbogen R, Loehrer P, Brown DR. The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS. Ann Med 2022; 54:1202-1211. [PMID: 35521812 PMCID: PMC9090376 DOI: 10.1080/07853890.2022.2067897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022] Open
Abstract
The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.
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Affiliation(s)
- Y. Tong
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - M. Nakalembe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | - M. Titus
- Maseno University, Kisumu, Kenya
| | | | | | - J. Ong’echa
- Kenya Medical Research Institute, Eldoret, Kenya
| | | | | | - C. Mpamani
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - B. Rosen
- Beaumont Gynecology Oncology, Royal Oak, MI, USA
| | - A. Moormann
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | - A. Ermel
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - C. Yiannoutsos
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - B. Musick
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - G. Banturaki
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - A. Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - J. Zhang
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Y. Song
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - S. Chintala
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - P. Loehrer
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - D. R. Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
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Nakalembe M, Makanga P, Kambugu A, Laker-Oketta M, Huchko MJ, Martin J. A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision. Cancer Med 2020; 9:8701-8712. [PMID: 32966684 PMCID: PMC7666725 DOI: 10.1002/cam4.3468] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023] Open
Abstract
The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub‐Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low‐resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community‐based self‐administered HPV testing and mobile treatment provision. In two rural districts of western‐central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self‐collection of vaginal samples for high‐risk human papillomavirus (hrHPV) testing. High‐risk human papillomavirus‐positive women were re‐contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self‐collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low‐resource settings.
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Affiliation(s)
- Miriam Nakalembe
- Infectious Diseases Institute-Makerere University, Kampala, Uganda
| | - Philippa Makanga
- Infectious Diseases Institute-Makerere University, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute-Makerere University, Kampala, Uganda
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Adewumi K, Oketch SY, Choi Y, Huchko MJ. Female perspectives on male involvement in a human-papillomavirus-based cervical cancer-screening program in western Kenya. BMC WOMENS HEALTH 2019; 19:107. [PMID: 31395060 PMCID: PMC6688365 DOI: 10.1186/s12905-019-0804-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To be effective, population-based cervical cancer prevention programs must be tailored to meet the needs of the target population. One important factor in cervical cancer screening may include male involvement. To iteratively improve a screening program employing self-collected vaginal swabs for human-papillomavirus (HPV) testing in western Kenya, we examined the role of male partners and community leaders in decision-making and accessing screening services. METHODS We carried out 604 semi-structured, in-depth interviews (IDIs) with women and community health volunteers who took part in a multiphase trial of implementation strategies for HPV-based cervical cancer screening. IDIs were coded and themes related to decision-making, screening and treatment barriers, and influence of male partners and community leaders were identified and analyzed. RESULTS Women experienced both support and opposition from their male partners. Partner support took the form of financial support for transportation and emotional support and encouragement, while opposition ranged from anticipated negative reactions to lack of permission, isolation, and abandonment. Though most women described their own partners as supportive, many felt that other male partners would not be supportive. Most participants believed that increased HPV and cervical cancer knowledge would increase partner support. Women reported a general acceptance of involvement of community leaders in education and screening campaigns, in a setting where such leaders may hold influence over men in the community. CONCLUSION There was a clear interest in involving male partners in the cervical cancer prevention process, specifically in increasing knowledge and awareness. Future research should explore the feasibility and effectiveness of engaging male partners in cervical cancer screening and prevention programs.
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Affiliation(s)
- Konyin Adewumi
- Department of Obstetrics and Gynecology, Duke University, 2301 Erwin Road, Durham, NC, 27710, UK.
| | - Sandra Y Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Off Mbagathi Road, Nairobi, Kenya
| | - Yujung Choi
- Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, UK
| | - Megan J Huchko
- Department of Obstetrics and Gynecology, Duke University, 2301 Erwin Road, Durham, NC, 27710, UK.,Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, UK
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