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Sahasrabuddhe VV. Cervical Cancer: Precursors and Prevention. Hematol Oncol Clin North Am 2024:S0889-8588(24)00032-7. [PMID: 38760198 DOI: 10.1016/j.hoc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Cervical cancer, caused due to oncogenic types of human papillomavirus (HPV), is a leading preventable cause of cancer morbidity and mortality globally. Chronic, persistent HPV infection-induced cervical precursor lesions, if left undetected and untreated, can progress to invasive cancer. Cervical cancer screening approaches have evolved from cytology (Papanicolaou test) to highly sensitive HPV-based molecular methods and personalized, risk-stratified, management guidelines. Innovations like self-collection of samples to increase screening access, innovative triage methods to optimize management of screen positives, and scalable and efficacious precancer treatment approaches will be key to further enhance the utility of prevention interventions.
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Affiliation(s)
- Vikrant V Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 5E-338, Rockville, MD, USA.
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Lubeya MK, Mwanahamuntu M, Chibwesha CJ, Mukosha M, Kawonga M. Selecting and Tailoring Implementation Strategies to Improve Human Papillomavirus Vaccine Uptake in Zambia: A Nominal Group Technique Approach. Vaccines (Basel) 2024; 12:542. [PMID: 38793793 PMCID: PMC11126122 DOI: 10.3390/vaccines12050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The human papillomavirus (HPV) vaccine is effective in cervical cancer prevention. However, many barriers to uptake exist and strategies to overcome them are needed. Therefore, this study aimed to select and tailor implementation strategies to barriers identified by multiple stakeholders in Zambia. The study was conducted in Lusaka district between January and February 2023. Participants were purposively sampled from three stakeholder groups namely, adolescent girls, parents, and teachers and healthcare workers. With each of the stakeholders' groups (10-13 participants per group), we used the nominal group technique to gain consensus to tailor feasible and acceptable implementation strategies for mitigating the identified contextual barriers. The identified barriers included low levels of knowledge and awareness about the HPV vaccine, being out of school, poor community sensitisation, lack of parental consent to vaccinate daughters, and myths and misinformation about the HPV vaccine. The lack of knowledge and awareness of the HPV vaccine was a common barrier across the three groups. Tailored strategies included conducting educational meetings and consensus-building meetings, using mass media, changing service sites, re-examining implementation, and involving patients/consumers and their relatives. Our study contributes to the available evidence on the process of selecting and tailoring implementation strategies to overcome contextual barriers. Policymakers should consider these tailored strategies to mitigate barriers and improve HPV vaccine uptake.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg 2193, South Africa;
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
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Salcedo MP, Lathrop E, Osman N, Neves A, Rangeiro R, Mariano AAN, Nkundabatware JC, Tivir G, Carrilho C, Monteiro ECS, Burny R, Thomas JP, Carns J, Andrade V, Mavume C, Paulo Mugolo R, Atif H, Hoover H, Chivambo E, Chissano M, Oliveira C, Milan J, Varon ML, Fellman BM, Baker E, Jeronimo J, Castle PE, Richards-Kortum R, Schmeler KM, Lorenzoni C. The Mulher Study: cervical cancer screening with primary HPV testing in Mozambique. Int J Gynecol Cancer 2023; 33:1869-1874. [PMID: 37907263 DOI: 10.1136/ijgc-2023-004958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally. METHODS Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected. RESULTS Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology. CONCLUSION It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.
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Affiliation(s)
- Mila Pontremoli Salcedo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eva Lathrop
- Population Services International, Washington, District of Columbia, USA
| | | | - Andrea Neves
- Hospital Geral e Centro de Saúde José Macamo, Maputo, Mozambique
| | | | | | | | | | | | | | | | - Joseph P Thomas
- Oncology Care & Research IS, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Celda Mavume
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | | | - Hira Atif
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Hannah Hoover
- Population Services International, Washington, District of Columbia, USA
| | | | | | | | - Jessica Milan
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Lopez Varon
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan M Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ellen Baker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chisele S, Mwanahamuntu M, Kamfwa P, Kalima-Munalula M, Fundafunda S, Chanda K, Hicks MM, Pinder LF, Pfaendler KS, Parham GP, Hicks ML. Gynaecologic oncology surgical cancellations in Zambia. Ecancermedicalscience 2023; 17:1617. [PMID: 38414948 PMCID: PMC10898890 DOI: 10.3332/ecancer.2023.1617] [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: 06/22/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Cancellations of elective surgery in low-and middle-income countries (LMIC) are common and a major hindrance for patients who are in need of surgical therapeutic modalities. This is especially important in the context of scaling up needed surgical interventions for gynaecological cancer care. There is a knowledge gap in the literature related to cancellation of gynaecologic oncology surgeries in LMIC, where there is enormous need for this specific cancer surgical capacity. We report in an observational descriptive fashion, our experience at the UTH/CDH in Lusaka, Zambia, on the causes of surgical cancellations in gynaecologic oncology. Methods From January 1, 2021 through June 31, 2023, we retrospectively evaluated the surgical registry for gynaecologic oncology at the UTH/CDH in Lusaka, Zambia to assess the number and causes of surgical cancellations. Results There were a total of 66 (16.96%) surgical cancellations out of 389 scheduled gynaecologic oncology cases. Lack of available blood and/or low haemoglobin was the most frequent cause of surgical cancellations, 27 cases (40.90%). Conclusion We highlight in our series that the lack of blood, leading to surgical cancellations was the most frequent impediment related to performing scheduled gynaecologic oncology surgical procedures. As gynaecologic oncology services scale up in LMIC, given the radical nature of surgery and its association with blood loss, it is incumbent on the entire clinical ecosystem to address this issue and to develop mitigating strategies, specific to their respective resource setting.
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Affiliation(s)
- Samson Chisele
- Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka 10101, Zambia
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka 10101, Zambia
| | - Paul Kamfwa
- Cancer Diseases Hospital, Lusaka, 10101, Zambia
| | - Mukatimui Kalima-Munalula
- Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka 10101, Zambia
| | | | - Kenneth Chanda
- Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka 10101, Zambia
| | - Maya M Hicks
- Anne Arundel Medical Center, Department of Obstetrics and Gynecology, 2000 Medical Pkwy, Belcher Pavilion, Ste 309, Annapolis, MD 21401, USA
| | - Leeya F Pinder
- University of Cincinnati College of Medicine, Ob/Gyn, Cincinnati, OH 45267, USA
| | - Krista S Pfaendler
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, 64 Medical Center Drive, Morgantown, WV 26506, USA
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka 10101, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka 10101, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
- St. Joseph Mercy Oakland Cancer Center, Michigan Cancer Institute, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA
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Brevik TB, da Matta Calegari LR, Mosquera Metcalfe I, Laake P, Maza M, Basu P, Todd A, Carvalho AL. Training health care providers to administer VIA as a screening test for cervical cancer: a systematic review of essential training components. BMC MEDICAL EDUCATION 2023; 23:712. [PMID: 37770904 PMCID: PMC10540456 DOI: 10.1186/s12909-023-04711-5] [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: 12/15/2022] [Accepted: 09/21/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Training health care providers to administer visual inspection after application of acetic acid (VIA) is paramount in improving cervical cancer screening services for women in low- and middle-income countries. The objective of this systematic review was to create a framework of essential VIA training components and provide illustrating examples of how VIA training programs can be carried out in different clinical settings. METHODS A systematic review of PubMed, Embase, and Web of Science (from 2006 to 2021) was undertaken. Our inclusion criteria comprised articles reporting on implemented cervical cancer screening programs using VIA in a screen-and-treat approach. Trained health care providers with any level of health education were included, and the outcome of interest was the reporting of training components. Data were extracted by two reviewers, and a narrative synthesis of the training programs was performed. We developed a framework of seven essential training components and applied it to assess how training courses were conducted in different settings. RESULTS 13 primary studies were eligible for inclusion, including 2,722 trained health care providers and 342,889 screened women. Most training courses lasted 5-7 days and included theoretical education, practical skill development, and competence assessment. It was unclear how visual aids and training in client counselling and quality assessment were integrated in the training courses. After the training course, nearly all the VIA training programs made provisions for on-job training at the providers' own clinical settings through supervision, feedback, and refresher training. CONCLUSIONS This study demonstrates the feasibility of implementing international training recommendations for cervical cancer screening in real-world settings and provides valuable examples of training program implementation across various clinical settings. The diverse reporting practices of quality indicators in different studies hinder the establishment of direct links between these data and training program effectiveness. To enhance future reporting, authors should emphasize specific training components, delivery methods, and contextual factors. Standardized reporting of quality indicators for effective evaluation of VIA training programs is recommended, fostering comparability, facilitating research, and enhancing reporting quality in this field.
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Affiliation(s)
- Thea Beate Brevik
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.
- Clinic of Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway.
| | | | - Isabel Mosquera Metcalfe
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Petter Laake
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Violence, and Injury Prevention, Pan American Health Organization, Washington, DC, USA
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Andre L Carvalho
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, Lyon, France
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Wang W, Li H, Huang M. A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations. Front Oncol 2023; 13:1178092. [PMID: 37519811 PMCID: PMC10382130 DOI: 10.3389/fonc.2023.1178092] [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: 03/02/2023] [Accepted: 05/15/2023] [Indexed: 08/01/2023] Open
Abstract
This review article highlights the critical role of nurses in disaster management, with a specific focus on addressing blood tumors in disaster-affected populations. Disasters have a significant impact on healthcare systems and populations, and nurses play a crucial role in disaster preparedness, response, and recovery. The article provides case studies and successful examples of nursing interventions in disaster settings and tumor management, emphasizing the challenges and opportunities in providing cancer care in disaster settings. Recommendations for future research and practice in disaster nursing and blood tumor care are also presented. This information is essential for healthcare professionals and policymakers involved in disaster management, as well as researchers and clinicians working in the field of cancer care.
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Chipanta D, Kapambwe S, Nyondo-Mipando AL, Pascoe M, Amo-Agyei S, Bohlius J, Estill J, Keiser O. Socioeconomic inequalities in cervical precancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe: analysis of Population-Based HIV Impact Assessment surveys. BMJ Open 2023; 13:e067948. [PMID: 37339830 PMCID: PMC10314495 DOI: 10.1136/bmjopen-2022-067948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES We examined age, residence, education and wealth inequalities and their combinations on cervical precancer screening probabilities for women. We hypothesised that inequalities in screening favoured women who were older, lived in urban areas, were more educated and wealthier. DESIGN Cross-sectional study using Population-Based HIV Impact Assessment data. SETTING Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe. Differences in screening rates were analysed using multivariable logistic regressions, controlling for age, residence, education and wealth. Inequalities in screening probability were estimated using marginal effects models. PARTICIPANTS Women aged 25-49 years, reporting screening. OUTCOME MEASURES Self-reported screening rates, and their inequalities in percentage points, with differences of 20%+ defined as high inequality, 5%-20% as medium, 0%-5% as low. RESULTS The sample size of participants ranged from 5882 in Ethiopia to 9186 in Tanzania. The screening rates were low in the surveyed countries, ranging from 3.5% (95% CI 3.1% to 4.0%) in Rwanda to 17.1% (95% CI 15.8% to 18.5%) and 17.4% (95% CI 16.1% to 18.8%) in Zambia and Zimbabwe. Inequalities in screening rates were low based on covariates. Combining the inequalities led to significant inequalities in screening probabilities between women living in rural areas aged 25-34 years, with a primary education level, from the lowest wealth quintile, and women living in urban areas aged 35-49 years, with the highest education level, from the highest wealth quintile, ranging from 4.4% in Rwanda to 44.6% in Zimbabwe. CONCLUSIONS Cervical precancer screening rates were inequitable and low. No country surveyed achieved one-third of the WHO's target of screening 70% of eligible women by 2030. Combining inequalities led to high inequalities, preventing women who were younger, lived in rural areas, were uneducated, and from the lowest wealth quintile from screening. Governments should include and monitor equity in their cervical precancer screening programmes.
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Affiliation(s)
- David Chipanta
- ERA, UNAIDS, Geneve, Switzerland
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | | | | | | | - Silas Amo-Agyei
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| | - Julia Bohlius
- Swiss Tropical and Public Health Institute, University of Bern, Basel, Switzerland
| | - Janne Estill
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - Olivia Keiser
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
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Taghavi K, Moono M, Mwanahamuntu M, Roumet M, Limacher A, Kapesa H, Madliwa T, Rutjes A, Basu P, Low N, Manasyan A, Bohlius J. Accuracy of screening tests for cervical pre-cancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.31.23290779. [PMID: 37398043 PMCID: PMC10312869 DOI: 10.1101/2023.05.31.23290779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction To provide evidence to improve cervical screening for women living with HIV (WLHIV), we assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit. Methods We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18-65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was high-grade cervical intraepithelial neoplasia (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius), and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% confidence intervals. A sensitivity analysis considered disease when only visible lesions were biopsied. Results Among 371 participants with histopathological results, 27% (101/371) women had CIN2+ and 23% (23/101) was not detected by any index test. Sensitivity and specificity for stand-alone tests were: hrHPV, 67.3% (95% CI: 57.7-75.7) and 65.3% (59.4-70.7); Gynocular 51.5% (41.9-61.0) and 80.0% (74.8-84.3); and VIA 22.8% (15.7-31.9) and 92.6% (88.8-95.2), respectively. The combination of hrHPV testing followed by Gynocular had the best balance of sensitivity (42.6% [33.4-52.3]) and specificity (89.6% [85.3-92.7]). All test accuracies improved in sensitivity analysis. Conclusion The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed. Registration number The trial was registered prospectively at ClinicalTrials.gov (ref: NCT03931083 ). The study protocol has been previously published, and the statistical analysis plan can be accessed on ClinicalTrials.gov . Key messages What is already known on this topic: The 2021 World Health Organization guidelines recommend that women living with HIV (WLHIV) receive screening for high risk human papillomavirus high-risk human papillomavirus (hrHPV) genotypes at three- to five-year intervals, followed by a triage test to determine whether treatment is needed but this is based on low and moderate certainty evidence.What this study adds: This study among WLHIV in Lusaka, Zambia evaluated three screening tests that allow same-day treatment; hrHPV test, portable colposcopy (Gynocular), and visual inspection with acetic acid (VIA), using strict methods to reduce verification and misclassification biases. The test accuracy of the different screening was poor, with sensitivities and specificity for stand-alone tests: hrHPV, 67.3% and 65.3%; Gynocular 51.5% and 80.0%; and VIA 22.8% and 92.6%; respectively.How this study might affect research, practice or policy: Our findings have implications for research and cervical cancer screening policies among WLHIV if test-accuracy in this high-risk population has been overestimated from a majority of exsisting studies that are affected by verification and misclassification biases. Methodologically robust studies are crucial to inform cervical cancer screening practices and policies for the successful implementation of a cervical cancer elimination plan in sub-Saharan Africa, where 85% of women with cervical cancer and HIV live.
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Chongsuwat T, Wang C, Sohn Y, Klump K. Digital cervicography for cervical cancer screening in low-resource settings: A scoping review. Gynecol Oncol Rep 2023; 45:101130. [PMID: 36683777 PMCID: PMC9845952 DOI: 10.1016/j.gore.2022.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Digital cervicography (DC) is a method of capturing images for analysis during visual inspection with acetic acid (VIA) for cervical cancer screening. Cervical cancer is the 3rd leading cause of female cancer in the world with approximately 90 % of deaths due to cervical cancer occurring in low and middle income countries (LMICs). The need for cost-effective and sustainable methods for screening is vital in these settings. This scoping review systematically synthesizes published data illustrating the use of DC in screening programs. We aim to understand how digital cervicography is used, implemented, and impacted on programs. Methods Search of eight online databases identified 53 studies published between 1993 and 2021. Inclusion of articles were English language, cervical cancer screening program located in an LMIC, and DC as an intervention. Results All studies were cross-sectional studies (n = 53), with variation in terminology, uses, and device methods. Devices were grouped as either smartphones (n = 14), commercially available digital cameras (n = 17), or other (EVA®, n = 4; Cerviscope, n = 12; custom device, n = 4; or not specified, n = 2). Nineteen studies found acceptability and feasibility for DC in their screening programs. Various programs using DC found benefits such as task sharing, healthcare worker training, patient education and using images for review from a remote specialist or mentor. Conclusion The use of DC in LMICs is beneficial for support of healthcare workers, enhances quality improvement and demonstrates overall acceptability in screening programs. Advancing technologies for human papillomavirus (HPV) testing and cytology are common methods for cervical cancer screening, although are limited in LMICs. This scoping review demonstrates the different methods, uses, and benefit of digital cervicography in cervical cancer screening programs.
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Affiliation(s)
- Tana Chongsuwat
- University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States,Corresponding author at: 1100 Delaplaine Ct, Madison, WI 53715, United States.
| | - Connor Wang
- University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States
| | - Younji Sohn
- University of Oklahoma College of Medicine, 900 NE 10th St, Oklahoma City, OK 73104, United States
| | - Kathryn Klump
- University of Oklahoma College of Medicine, 900 NE 10th St, Oklahoma City, OK 73104, United States
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Chongsuwat T, Ibrahim AO, Evensen AE, Conway JH, Zwick M, Oloya W. Health facility assessments of cervical cancer prevention, early diagnosis, and treatment services in Gulu, Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000785. [PMID: 36962762 PMCID: PMC10021907 DOI: 10.1371/journal.pgph.0000785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Cervical cancer is ranked globally in the top three cancers for women younger than 45 years, with the average age of death at 59 years of age. The highest burden of disease is in low-to-middle income countries (LMICs), responsible for 90% of the 311,000 cervical cancer deaths in 2018. This growing health disparity is due to the lack of quality screening and treatment programs, low human papillomavirus (HPV) vaccination rates, and high human immunodeficiency virus (HIV) co-infection rates. To address these gaps in care, we need to develop a clear understanding of the resources and capabilities of LMICs' health care facilities to provide prevention, early diagnosis through screening, and treatment for cervical cancer. OBJECTIVES This project aimed to assess baseline available cervical cancer prevention, early diagnosis, and treatment resources, at facilities designated as Health Center III or above, in Gulu, Uganda. METHODS We adapted the World Health Organization's Harmonized Health Facility Assessment for our own HFA and grading scale, deploying it in October 2021 for a cross-sectional analysis of 21 health facilities in Gulu. RESULTS Grading of Health Center IIIs (n = 16) concluded that 37% had "excellent" or "good" resources available, and 63% of facilities had "poor" or "fair" resources available. Grading of Health Center IVs and above (n = 5) concluded that 60% of facilities had "excellent" or "good" resources, and 40% had "fair" resources available. DISCUSSION The analysis of health facilities in Gulu demonstrated subpar resources available for cervical cancer prevention, early diagnosis, and treatment. Focused efforts are needed to expand health centers' resources and capability to address rising cervical cancer rates and related health disparities in LMICs. The development process for this project's HFA can be applied to global cervical cancer programming to determine gaps in resources and indicate areas to target improved health equity.
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Affiliation(s)
- Tana Chongsuwat
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, United States of America
| | - Aaliyah O Ibrahim
- Gulu Women's Economic Development & Globalization (GWED-G), Gulu, Uganda
| | - Ann E Evensen
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, United States of America
| | - James H Conway
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, United States of America
| | - Margaret Zwick
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, United States of America
| | - William Oloya
- Gulu Women's Economic Development & Globalization (GWED-G), Gulu, Uganda
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Mulongo M, Chibwesha CJ. Prevention of Cervical Cancer in Low-Resource African Settings. Obstet Gynecol Clin North Am 2022; 49:771-781. [PMID: 36328679 DOI: 10.1016/j.ogc.2022.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical cancer is a leading cause of cancer among women. Approximately 350,000 women die from cervical needlessly from cancer each year, and 85% of the global burden occurs in low- and middle-income countries (LMICs). Disparities in the incidence and mortality between LMICs and industrialized countries can be attributed to differences in access to human papillomavirus (HPV) vaccination and cervical cancer screening and treatment. The World Health Organization (WHO) is leading a renewed international effort to reduce the global burden of cervical cancer. In this article, we discuss recommendations for HPV vaccination, primary HPV screening, and treatment of precancerous lesions.
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Hicks MM, Chanda K, Mwanahamuntu M, Jones MB, Mattison AR, Pfaendler KS, Pinder LF, Parham GP, Hicks ML. Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme. Ecancermedicalscience 2022; 16:1468. [PMID: 36819817 PMCID: PMC9934879 DOI: 10.3332/ecancer.2022.1468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries. Methods Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure. Results Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme. Conclusion There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.
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Affiliation(s)
- Maya M Hicks
- Department of Obstetrics and Gynecology, Anne Arundel Medical Center, 2000 Medical Pkwy, Belcher Pavilion, Ste 309, Annapolis, MD 21401, USA,https://orcid.org/0000-0002-1993-3367
| | - Kenneth Chanda
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
| | - Monica B Jones
- Department of Obstetrics and Gynecology, Anne Arundel Medical Center, 2000 Medical Pkwy, Belcher Pavilion, Ste 309, Annapolis, MD 21401, USA
| | - Anissa R Mattison
- Trinity Health Academic Obstetrics and Gynecology, 44428 Woodward Ave Ste 104, Pontiac, MI 48341, USA
| | - Krista S Pfaendler
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, 64 Medical Center Drive, Morgantown, WV 26506, USA
| | - Leeya F Pinder
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA,https://orcid.org/0000-0002-8929-7810
| | - Groesbeck P Parham
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia,Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,https://orcid.org/0000-0001-5922-5990
| | - Michael L Hicks
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia,Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,St. Joseph Mercy Oakland, Michigan Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA,https://orcid.org/0000-0002-1819-155X
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13
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Hicks ML, Parham GP. To parachute or not. Ecancermedicalscience 2022; 16:ed125. [PMID: 36819825 PMCID: PMC9934870 DOI: 10.3332/ecancer.2022.ed125] [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: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
This editorial was prompted by a criticism of our inability to identify all existing local oncologic human resources prior to the initiation of a women's cancer care platform in the Democratic Republic of the Congo. We discuss the act of parachuting, i.e., intermittent visits by investigators from high-income countries to low-and middle-income countries, its dichotomization (positive and negative), role in bilateral collaborations between high-income and low-and middle-income countries, contributing etiologies and potential harms. Lastly, we highlight our use of parachuting to successfully transfer breast and cervical cancer diagnostic and surgical skills to healthcare providers in a low-income African nation, while simultaneously building clinical infrastructure for women's cancers. We conclude with recommendations that pertain to the development of better research ecosystems in Africa.
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Affiliation(s)
- Michael L Hicks
- St. Joseph Mercy Oakland, Michigan Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA,University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, Chapel Hill, 101 Manning Dr. Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way Lusaka, Zambia,https://orcid.org/0000-0002-1819-155X
| | - Groesbeck P Parham
- University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, Chapel Hill, 101 Manning Dr. Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way Lusaka, Zambia,https://orcid.org/0000-0001-5922-5990
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14
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Hicks ML, Mwanahamuntu M, Butler R, Bloomfield H, Mutombo A, Anaclet MM, Sylvain MK, Chinula L, Kachingwe J, Parham GP. The evolution of a novel approach to building surgical capacity for cervical cancer in Africa. Ecancermedicalscience 2022; 16:1469. [PMID: 36819807 PMCID: PMC9934882 DOI: 10.3332/ecancer.2022.1469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
The human, financial, and infrastructural resources required to effectively treat invasive cancer of the cervix are grossly inadequate in the African region, inclusive of a paucity of surgeons capable of performing life-saving radical pelvic surgery for early-stage disease, and the requisite medical ecosystem (blood banking, anesthesia, laboratory, imaging, diagnostics, etc.) Death without treatment, therefore, is a common sequela of cervical cancer in Africa. As African American gynaecologic oncology sub-specialists working in Africa and its Diaspora, we set out to find a way to alter these circumstances. Herein, we provide an overview of our efforts and how they evolved into a novel method of training that rapidly builds surgical capacity for the treatment of early-stage cervical cancer in resource-constrained environments.
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Affiliation(s)
- Michael L Hicks
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia,St. Joseph Mercy Oakland, Michigan Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
| | - Raleigh Butler
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Nassau, Bahamas
| | - Homer Bloomfield
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Nassau, Bahamas
| | - Alex Mutombo
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Nassau, Bahamas
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuka Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Lameck Chinula
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - James Kachingwe
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Groesbeck P Parham
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
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Chueiri PS, Gonçalves MR, Hauser L, Mengue S, Agostinho M, Roman R, Wollmann L, Dilda A, da Silva RAM, Harzheim E. Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis. Int J Health Policy Manag 2022; 11:1905-1912. [PMID: 34523857 PMCID: PMC9808240 DOI: 10.34172/ijhpm.2021.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/24/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. METHODS We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. RESULTS The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. CONCLUSION These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.
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Affiliation(s)
| | - Marcelo Rodrigues Gonçalves
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisiane Hauser
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sotero Mengue
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Rudi Roman
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas Wollmann
- Community Health Services, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Anna Dilda
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Erno Harzheim
- School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
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Selmouni F, Sauvaget C, Dangbemey DP, Kpebo DDO, Dieng NM, Lucas E, Chami Khazraji Y, Bennani M, Bekkali R, Basu P. Lessons Learnt From Pilot Cervical Cancer Screening and Treatment Programmes Integrated to Routine Primary Health Care Services in Benin, Cote d'Ivoire, and Senegal. JCO Glob Oncol 2022; 8:e2200051. [PMID: 36070534 PMCID: PMC9812504 DOI: 10.1200/go.22.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/04/2022] [Accepted: 07/20/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The project aimed to implement pilot screening and treatment services for cervical cancer integrated with existing primary health centers (PHCs) in Benin, Cote d'Ivoire, and Senegal and evaluate these services using implementation research outcomes such as reach, effectiveness, adoption, and acceptability. MATERIALS AND METHODS The Ministry of Health in each country took the lead in setting up a stakeholder's group that designed a protocol tailored to the local context. The target age was 25-49 years in Benin and Cote d'Ivoire and 30-49 years in Senegal. Visual inspection with acetic acid (VIA) was the screening test, and thermal ablation (TA) was the ablative treatment of choice in all. The Ministry in each country identified 4-5 PHCs to set up screening and ablation services and one higher-level center for colposcopy referral. After a master-trainer led training program, nurses, midwives, or general practitioners screened opportunistically the eligible women attending the clinics. The VIA-positive women eligible for ablation were offered immediate treatment. RESULTS Between May 2018 and January 2021, 16,530 women were screened opportunistically. VIA positivity was 8.1% with huge variability within and between countries. Sixty-one percent of all VIA-positive cases were eligible for immediate TA, and 88% of them accepted same-day treatment. Compliance to TA at PHCs was 99%. Majority of women treated with TA complained of minor side effects. Significant dropouts occurred as the women were referred to colposcopy clinics. CONCLUSION Opportunistic screening provided as part of routine PHC service can screen many women and treat a significant proportion of screen-positive women with TA with minimal side effects. Primary concerns are the hard-to-reach women who remain out of opportunistic screening coverage and noncompliance of the screen-positive women referred to higher-level centers.
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Affiliation(s)
- Farida Selmouni
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Catherine Sauvaget
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Djima Patrice Dangbemey
- Department of Obstetrics and Gynaecology, Lagoon Mother and Child University Hospital Center, Faculty of Health Science, University of Abomey Calavi, Cotonou, Benin
| | | | - Ndeye Mbombe Dieng
- Division of Noncommunicable Disease Control, Senegal Ministry of Health and Social Action, Dakar, Senegal
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Maria Bennani
- Foundation Lalla Salma, Cancer Prevention and Treatment, Rabat, Morocco
| | - Rachid Bekkali
- Foundation Lalla Salma, Cancer Prevention and Treatment, Rabat, Morocco
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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17
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Richter P, Aslam M, Kostova D, Lasu AAR, Vliet GV, Courtney LP, Chisenga T. The Case for Integrating Health Systems to Manage Noncommunicable and Infectious Diseases in Low- and Middle-Income Countries: Lessons Learned From Zambia. Health Secur 2022; 20:286-297. [PMID: 35904943 DOI: 10.1089/hs.2022.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Noncommunicable diseases (NCDs) are the leading cause of death in the world, and 80% of all NCD deaths occur in low- and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that patients with NCDs are at increased risk of becoming severely ill from the virus. Disproportionate investment in vertical health programs can result in health systems vulnerable to collapse when resources are strained, such as during pandemics. Although NCDs are largely preventable, globally there is underinvestment in efforts to address them. Integrating health systems to collectively address NCDs and infectious diseases through a wide range of services in a comprehensive manner reduces the economic burden of healthcare and strengthens the healthcare system. Health system resiliency is essential for health security. In this article, we provide an economically sound approach to incorporating NCDs into routine healthcare services in LMICs through improved alignment of institutions that support prevention and control of both NCDs and infectious diseases. Examples from Zambia's multisector interventions to develop and support a national NCD action plan can inform and encourage LMIC countries to invest in systems integration to reduce the social and economic burden of NCDs and infectious diseases.
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Affiliation(s)
- Patricia Richter
- Patricia Richter, PhD, is Chief, Office of Global Noncommunicable Diseases, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Maria Aslam
- Maria Aslam, PhD, is an Economist, Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Deliana Kostova
- Deliana Kostova, PhD, is a Senior Economist, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Ally A R Lasu
- Ally A. R. Lasu, MPH, is a Research Public Health Analyst, RTI International, Research Triangle Park, NC
| | - Gretchen Van Vliet
- Gretchen Van Vliet, MPH, is Senior Public Health Project Director, RTI International, Research Triangle Park, NC
| | - Lauren P Courtney
- Lauren P. Courtney, MPH, is a Research Epidemiologist, RTI International, Research Triangle Park, NC
| | - Tina Chisenga
- Tina Chisenga, MD, MPH, is Assistant Director, Communicable Diseases, Ministry of Health, Lusaka, Zambia
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Nakisige C, Adams SV, Namirembe C, Okoche L, Ferrenberg J, Towlerton A, Larsen A, Orem J, Casper C, Frenkel L, Uldrick TS. Multiple High-Risk HPV Types Contribute to Cervical Dysplasia in Ugandan Women Living With HIV on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2022; 90:333-342. [PMID: 35195571 PMCID: PMC9203909 DOI: 10.1097/qai.0000000000002941] [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: 08/02/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer mortality remains high in sub-Saharan Africa, especially among women living with HIV (WLWH). Characterization of prevalent high-risk human papillomavirus (hrHPV) types and immune function in WLWH with cervical abnormalities despite antiretroviral therapy (ART) can inform prevention strategies. SETTING Kampala, Uganda. METHODS From 2017 to 2020, we enrolled Ugandan women with cervical dysplasia detected with visual inspection with acetic acid (VIA). WLWH were required to be on ART >3 months with plasma HIV RNA <1000 copies/mL. Biopsies from VIA-positive lesions underwent histopathologic grading and cervical swab specimens were tested for hrHPV. Clinical correlations were evaluated with Poisson regression to estimate adjusted prevalence ratios (aPR). RESULTS One hundred eighty-eight WLWH and 116 HIV-seronegative women participated. Among WLWH, median ART duration was 6 years and median CD4 667 cells/µL. Cervical intraepithelial neoplasia (CIN) grade 2/3 was found in 29% of WLWH versus 9% of HIV-seronegative women. In women with CIN1 or without histopathology-confirmed dysplasia, hrHPV (aPR [95% confidence interval]: 2.17 [1.43 to 3.29]) and multiple hrHPV (aPR 3.73 [1.07 to 13.1]) were more common in WLWH, as were vaccine-targeted and vaccine-untargeted hrHPVtypes. Differences in hrHPV prevalence by HIV serostatus were not observed in women with CIN2/3 (interaction P < 0.01). Among WLWH, low CD4/8 ratio was associated with hrHPV while detectable plasma HIV RNA (20-1000 copies/mL) was associated with CIN2/3 or invasive cancer. CONCLUSION Despite ART, WLWH with cervical VIA abnormalities remain at elevated risk for multiple hrHPV and high-grade dysplasia. Cervical cancer prevention and research tailored for WLWH are warranted in the ART era.
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Affiliation(s)
| | - Scott V. Adams
- Vaccine and Infectious Disease Division and Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Lazarus Okoche
- Hutchinson Centre Research Institute - Uganda, Fred Hutch, Kampala, Uganda
| | | | - Andrea Towlerton
- Clinical Research Division and Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Corey Casper
- Infectious Disease Research Institute, Seattle, WA, USA
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa Frenkel
- Departments of Pediatrics, Laboratory Medicine and Pathology, Global Health and Medicine, University of Washington; and Center for Infectious Disease Research, Seattle Children’s Research Institute; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Thomas S. Uldrick
- Vaccine and Infectious Disease Division and Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, and University of Washington, Seattle, WA, USA
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Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, Singini GC, Kgarosi K, Mchunu N, Nevhungoni P, Silinda P, Ekwomadu T, Maposa I. Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review. Front Public Health 2022; 10:908302. [PMID: 35784211 PMCID: PMC9246362 DOI: 10.3389/fpubh.2022.908302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer remains a major public health problem, especially in Sub-Saharan Africa (SSA) where the provision of health care is poor. This scoping review mapped evidence in the literature regarding the burden of cervical, breast and prostate cancers in SSA.MethodsWe conducted this scoping review using the Arksey and O'Malley framework, with five steps: identifying the research question; searching for relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the data. We performed all the steps independently and resolved disagreements through discussion. We used Endnote software to manage references and the Rayyan software to screen studies.ResultsWe found 138 studies that met our inclusion criteria from 2,751 studies identified through the electronic databases. The majority were retrospective studies of mostly registries and patient files (n = 77, 55.8%), followed by cross-sectional studies (n = 51, 36.9%). We included studies published from 1990 to 2021, with a sharp increase from 2010 to 2021. The quality of studies was overall satisfactory. Most studies were done in South Africa (n = 20) and Nigeria (n = 17). The majority were on cervical cancer (n = 93, 67.4%), followed by breast cancer (67, 48.6%) and the least were on prostate cancer (48, 34.8%). Concerning the burden of cancer, most reported prevalence and incidence. We also found a few studies investigating mortality, disability-adjusted life years (DALYs), and years of life lost (YLL).ConclusionsWe found many retrospective record review cross-sectional studies, mainly in South Africa and Nigeria, reporting the prevalence and incidence of cervical, breast and prostate cancer in SSA. There were a few systematic and scoping reviews. There is a scarcity of cervical, breast and prostate cancer burden studies in several SSA countries. The findings in this study can inform policy on improving the public health systems and therefore reduce cancer incidence and mortality in SSA.
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Affiliation(s)
- Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Alfred Musekiwa
| | - Maureen Moyo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohanad Mohammed
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Kabelo Kgarosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nobuhle Mchunu
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Portia Nevhungoni
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patricia Silinda
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theodora Ekwomadu
- Department of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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21
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Ramogola-Masire D, Grover S, Mathoma A, Monare B, Gabaitiri L, Bazzett-Matabele L, Hofmeyr GJ, Morroni C, Luckett R. Support for lowering cervical cancer screening age to 25 for women living with HIV: retrospective cross-sectional programmatic data from Botswana. BMC Womens Health 2022; 22:100. [PMID: 35366863 PMCID: PMC8976959 DOI: 10.1186/s12905-022-01680-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Women living with human immunodeficiency virus (HIV) tend to develop cervical cancer at a younger age than women without HIV. The World Health Organization's (WHO) 2021 guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention include a conditional recommendation for initiating screening at age 25 for women living with HIV (WLWH). This recommendation is based on low-certainty evidence, and WHO calls for additional data. We describe the association of age and HIV status with visual inspection with acetic acid (VIA) positivity and cervical intraepithelial neoplasia grade two or higher (CIN2+) in Botswana. METHODS This was a retrospective cross-sectional study of 5714 participants aged 25 to 49 years who underwent VIA screening in a clinic mainly serving WLWH. VIA-positive women received cryotherapy if eligible or were referred for colposcopy and excisional treatment. Known cervical cancer risk factors, screening outcome, and histological results were extracted from the program database. We compared the proportions and association of VIA positivity and CIN2+ by age and HIV status. RESULTS The median age was 35 years [IQR 31-39], and 18% of the women were aged 25-29. Ninety percent were WLWH; median CD4 count was 250 cells/µL [IQR 150-428], and 34.2% were on anti-retroviral treatment (ART). VIA-positivity was associated with younger age (OR 1.48, CI 1.28, 1.72 for 25-29 years vs. 30-49 years), and HIV-positivity (OR 1.85, CI 1.51, 2.28). CIN2+ was only associated with HIV-positivity (OR 6.12, CI 3.39, 11.10), and proportions of CIN2+ were similar for both age groups in WLWH (69.1% vs. 68.3%). CONCLUSIONS Younger WLWH in Botswana had a significant burden of CIN2+. This finding further supports lowering the screening age for WLWH from 30 to 25.
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Affiliation(s)
- Doreen Ramogola-Masire
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana
| | - Surbhi Grover
- grid.25879.310000 0004 1936 8972Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA ,Botswana U-Penn Partnership, Gaborone, Botswana
| | - Anikie Mathoma
- grid.7621.20000 0004 0635 5486Office of Research, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Lesego Gabaitiri
- grid.7621.20000 0004 0635 5486Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana
| | - GJustus Hofmeyr
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana
| | - Chelsea Morroni
- grid.462829.3Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana ,grid.4305.20000 0004 1936 7988MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Rebecca Luckett
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana ,grid.462829.3Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana ,grid.239395.70000 0000 9011 8547Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
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22
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Mwanahamuntu M, Kapambwe S, Pinder LF, Matambo J, Chirwa S, Chisele S, Basu P, Prendiville W, Sankaranarayanan R, Parham GP. The use of thermal ablation in diverse cervical cancer "screen-and-treat" service platforms in Zambia. Int J Gynaecol Obstet 2022; 157:85-89. [PMID: 34197624 DOI: 10.1002/ijgo.13808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Thermal ablation (TA) was implemented in public sector cervical cancer prevention services in Zambia in 2012. Initially introduced as a treatment modality in primary healthcare clinics, it was later included in mobile outreach campaigns and clinical research trials. We report the feasibility, acceptability, safety, and provider uptake of TA in diverse clinical contexts. METHODS Screening services based on visual inspection with acetic acid were offered by trained nurses to non-pregnant women aged 25-59 years. Women with a type 1 transformation zone (TZ) were treated with same-visit TA. Those with a type 2 or 3 TZ, or suspicious for cancer, were managed with same-visit electrosurgical excision or punch biopsy, respectively. A provider survey was conducted. RESULTS Between 2012 and 2020, 2123 women were treated with TA: primary healthcare clinics, n = 746; mobile outreach clinics, n = 1127; research clinics, n = 250. Of the 996 women treated in primary healthcare and research clinics, 359 (48%) were HIV positive. Mild cramping during treatment was the most common adverse effect. No treatment interruptions occurred. No major complications were reported in the early (6 weeks) follow-up period. Providers expressed an overwhelming preference for TA over cryotherapy. CONCLUSION TA was feasible, safe, and acceptable in diverse clinical contexts. It was the preferred ablation method of providers when compared with cryotherapy.
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Affiliation(s)
- Mulindi Mwanahamuntu
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia
| | | | - Leeya F Pinder
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Jane Matambo
- Center for Infectious Disease Research in Zambia, Cervical Cancer Prevention Program, Lusaka, Zambia
| | - Susan Chirwa
- Center for Infectious Disease Research in Zambia, Cervical Cancer Prevention Program, Lusaka, Zambia
| | - Samson Chisele
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia
| | - Partha Basu
- International Agency for Research on Cancer, WHO Screening Group, Early Detection and Prevention Section, Lyon, France
| | - Walter Prendiville
- International Agency for Research on Cancer, WHO Screening Group, Early Detection and Prevention Section, Lyon, France
| | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer, WHO Screening Group, Early Detection and Prevention Section, Lyon, France
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Banerjee D, Mittal S, Mandal R, Basu P. Screening technologies for cervical cancer: Overview. Cytojournal 2022; 19:23. [PMID: 35510117 PMCID: PMC9063504 DOI: 10.25259/cmas_03_04_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Ever since the introduction of the Papanicolaou (PAP) smear test was published in 1941 in American Journal of Obstetrics and Gynecology, PAP test linked with definitive treatment has prevented millions of women from cervical cancer in the developed countries. Due to limited availability of resources, a lack of infrastructure and difficulty in getting highly trained professionals, widespread implementation of PAP test dependent cervical cancer screening program has not been established in low and middle income countries such as India. Therefore, after availability of non-cytological tests such as visual inspection on acetic acid (VIA) and human papillomavirus (HPV) DNA test, there is a paradigm shift in cervical cancer screening methods. In past two decades, various research work has convincingly established the utility of VIA and HPV test in developing countries. The evidences were evaluated by the World Health Organization (WHO) and recommendations have been recently published for comprehensive cervical cancer control strategies for the low and middle income countries. For any successful screening program, achieving high coverage (>70%) of the target population rather than frequent screening is the most important determinant. It is also equally important to ensure appropriate investigations of the screen positive women to establish the disease and treatment of the screen detected cases of cervical intra epithelial neoplasia (CIN) and cancer. HPV testing is the WHO recommended test for cervical cancer screening especially in view of widespread HPV vaccination in young population leading to lower prevalence of CIN and other HPV related diseases.
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Affiliation(s)
- Dipanwita Banerjee
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | | | - Ranajit Mandal
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Partha Basu
- Early Detection and Prevention Section/Screening Group, International Agency for Research on Cancer, Lyon, France
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24
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Trejo MJ, Soliman AS, Chen Y, Kalima M, Chuba A, Chama E, Mwaba CK, Banda L, Lishimpi K. Effects of HIV infection on metastatic cervical cancer and age at diagnosis among patients in Lusaka, Zambia. Int J Gynaecol Obstet 2022; 156:521-528. [PMID: 34121186 PMCID: PMC8669036 DOI: 10.1002/ijgo.13784] [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: 02/18/2021] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the association between the duration of HIV infection and the stage of cervical cancer in Lusaka, Zambia. METHODS This retrospective case-case study included 1583 cervical cancer patients from the Cancer Diseases Hospital in Lusaka, Zambia. A sub-population of HIV-positive patients with additional clinical HIV information was identified following linkage of cancer and HIV databases. Logistic regression models examined the relationship between HIV status and early-onset cervical cancer diagnosis, and between HIV infection duration and initial diagnosis of metastatic cervical cancer. RESULTS The study population had an average age of 49 years and 40.9% had an initial diagnosis of metastatic cancer. HIV-positive women were more than twice as likely to be diagnosed at early-onset cervical cancer compared with HIV-negative women. Among the sub-population of HIV-positive patients, a longer duration of HIV infection was associated with 20% lowered odds of initial metastatic cancer diagnosis. CONCLUSION The availability, accessibility, and impact of the cervical screening program in this population should be further examined to elucidate the relationship between cervical screening, age, and duration of HIV infection and the the stage of diagnosis of cervical cancer.
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Affiliation(s)
- Mario Jesus Trejo
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Amr S. Soliman
- Department of Community Health and Social Medicine, School of Medicine, The City College of New York, New York, NY, USA,Correspondence Amr S. Soliman, City University of New York School of Medicine, New York, NY, USA.
| | - Yuli Chen
- Department of Epidemiology, Colorado School of Public Health, University of Colorado
| | - Mulele Kalima
- University Teaching Hospital – HIV/AIDS Program, Lusaka, Zambia
| | - Alick Chuba
- University Teaching Hospital – HIV/AIDS Program, Lusaka, Zambia
| | - Eslone Chama
- University Teaching Hospital – HIV/AIDS Program, Lusaka, Zambia
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25
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Ibrahim Khalil A, Mpunga T, Wei F, Baussano I, de Martel C, Bray F, Stelzle D, Dryden‐Peterson S, Jaquet A, Horner M, Awolude OA, Trejo MJ, Mudini W, Soliman AS, Sengayi‐Muchengeti M, Coghill AE, van Aardt MC, De Vuyst H, Hawes SE, Broutet N, Dalal S, Clifford GM. Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa. Int J Cancer 2022; 150:761-772. [PMID: 34626498 PMCID: PMC8732304 DOI: 10.1002/ijc.33841] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 01/28/2023]
Abstract
HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age-specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Tharcisse Mpunga
- Butaro Cancer Centre of Excellence, Ministry of HealthButaroRwanda
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Catherine de Martel
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Dominik Stelzle
- Center for Global Health, Department of Neurology, Faculty of MedicineTechnical University of MunichMunichGermany,Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Scott Dryden‐Peterson
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMassachusettsUSA,Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA,Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219BordeauxFrance
| | - Marie‐Josèphe Horner
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMarylandUSA
| | - Olutosin A. Awolude
- Department of Obstetrics and Gynaecology, College of MedicineUniversity of IbadanIbadanNigeria,Infectious Disease Institute, College of MedicineUniversity of IbadanIbadanNigeria
| | - Mario Jesus Trejo
- Department of Epidemiology and BiostatisticsUniversity of ArizonaTucsonArizonaUSA
| | - Washington Mudini
- Division of Anatomical Pathology, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Amr S. Soliman
- Community Health and Social Medicine Department, CUNY School of MedicineThe City College of New YorkNew York CityNew YorkUSA
| | - Mazvita Sengayi‐Muchengeti
- National Cancer Registry, National Health Laboratory ServiceJohannesburgSouth Africa,School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa,South African DSI‐NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA)Stellenbosch UniversityStellenboschSouth Africa
| | - Anna E. Coghill
- Cancer Epidemiology Program, Division of Population ScienceH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Matthys C. van Aardt
- Gynaecologic Oncology Unit, Department of Obstetrics and GynaecologyUniversity of PretoriaPretoriaSouth Africa
| | - Hugo De Vuyst
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Stephen E. Hawes
- Departments of Epidemiology, Health Services, and Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health OrganizationGenevaSwitzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health OrganizationGenevaSwitzerland
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
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26
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Cervical cancer screening and treatment, HIV infection, and age: Program implementation in seven regions of Namibia. PLoS One 2022; 17:e0263920. [PMID: 35171941 PMCID: PMC8849510 DOI: 10.1371/journal.pone.0263920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to assess differences in cervical cancer screening and treatment outcomes by HIV status in a routine programmatic setting with a high generalized HIV prevalence. Women living with HIV (WLHIV) are at heightened risk of developing cervical cancer and the World Health Organization recommends all WLHIV who are sexually active be screened, regardless of age. In 2018, Namibia’s Ministry of Health and Social Services introduced a screen-and-treat approach using visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy or thermocoagulation with a focus on screening HIV-positive women due to Namibia’s 11.5% prevalence of HIV in women aged 15–49. Using program data from October 2018 to March 2020 from seven of the country’s 14 regions, we calculated descriptive statistics and chi-square tests to test the statistical significance of differences in VIA-positivity, ineligibility for ablative treatment, treatment completion, and same day treatment completion by HIV status. Between October 2018 and March 2020, the program conducted 14,786 cervical cancer screenings. Among 8,150 women who received their first VIA screening, more WLHIV screened VIA-positive (17%) than HIV-negative women (15%). This difference was statistically significant (p = 0.02). Among 2,272 women who screened VIA-positive at any screening, 1,159 (82%) completed ablative treatment. This suggests ablative treatment is feasible and acceptable in resource-limited settings. WLHIV were also more likely to complete treatment than HIV-negative women (p<0.01). Differences in health seeking behavior of sub-populations as well as resource availability between service delivery points should be considered for further investigation. Going forward in order to strengthen program implementation and expand screening access and uptake further investigation is needed to determine cancer incidence by HIV status, age, and time since last screening to assess cases that are averted as well as potential rates of overtreatment.
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27
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Zhao S, Huang L, Basu P, Domingo EJ, Supakarapongkul W, Ling WY, Ocviyanti D, Rezhake R, Qiao Y, Tay EH, Zhao F. Cervical cancer burden, status of implementation and challenges of cervical cancer screening in Association of Southeast Asian Nations (ASEAN) countries. Cancer Lett 2022; 525:22-32. [PMID: 34728309 DOI: 10.1016/j.canlet.2021.10.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
Multiple barriers impede the transformation of evidence-based research into implementation of cervical cancer screening in ASEAN countries. This review is the first of its kind to show the disease burden of cervical cancer, progress till date to implement screening and corresponding challenges, and propose tailored solutions to promote cervical cancer prevention in ASEAN. In 2020, approximately 69 000 cervical cancer cases and 38 000 deaths happened in ASEAN, and more than 44% and 63% increases on new cases and deaths are expected in 2040. Only four countries have initiated population-based cervical cancer screening programs, but the participation rate is less than 50% in some countries and even lower than 10% in Myanmar and Indonesia. Inequity and unavailability in service delivery, lack of knowledge and awareness, limited follow-up and treatment capacity, and funding sustainability affect successful scale-up of cervical cancer screening most in ASEAN. Implementing HPV detection-based primary screening, appropriate management of screen-positives, enhancing health education, integrating health services can accelerate reduction of cervical cancer burden in ASEAN. Achieving high screening coverage and high treatment compliance will help ASEAN countries remain aligned to cervical cancer elimination strategies.
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Affiliation(s)
- Shuang Zhao
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liuye Huang
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Efren Javier Domingo
- Department of Obstetrics and Gynecology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | | | - Woo Yin Ling
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Dwiana Ocviyanti
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Remila Rezhake
- The 3rd Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Cancer Hospital), Xinjiang, China
| | - Youlin Qiao
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Fanghui Zhao
- Department of Epidemiology, 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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28
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Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vikrant V Sahasrabuddhe
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Abstract
Since the publication of the 2018 FIGO Cancer Report, giant strides have been made in the global effort to reduce the burden of cervical cancer, with the World Health Organization (WHO) rolling out a global strategy for cervical cancer elimination, aiming for implementation by 2030. In over 130 countries, including low- and middle-income countries, HPV vaccination is now included in the national program. Screening has seen major advances with wider implementation of HPV testing. These interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. FIGO's revised staging of cervical cancer (2018) has been widely implemented and retrospective analyses of data based on the new staging have been published. Minimally invasive surgery has been shown to be disadvantageous in women with cervical cancer. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Daisuke Aoki
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Daya Nand Sharma
- Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia
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30
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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31
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Abstract
It is estimated that 5% of the global cancer burden, or approximately 690,000 cancer cases annually, is attributable to human papillomavirus (HPV). Primary prevention through prophylactic vaccination is the best option for reducing the burden of HPV-related cancers. Most high-income countries (HICs) have introduced the HPV vaccine and are routinely vaccinating adolescent boys and girls. Unfortunately, although they suffer the greatest morbidity and mortality due to HPV-related cancers, many lower- and middle-income countries (LMICs) have been unable to initiate and sustain vaccination programs. Secondary prevention in the form of screening has led to substantial declines in cervical cancer incidence in areas with established screening programs, but LMICs with absent or inadequate screening programs have high incidence rates. Meanwhile, HICs have seen incidence rates of anal and oropharyngeal cancers rise owing to the limited availability of organized screening for anal cancer and no validated screening options for oropharyngeal cancer. The implementation of screening programs for individuals at high risk of these cancers has the potential to reduce the burden of cervical cancer in LMICs, of anal and oropharyngeal cancers in HICs, and of anal cancer for highly selected HIV+ populations in LMICs. This review will discuss primary prevention of HPV-related cancers through vaccination and secondary prevention through screening of cervical, anal, and oropharyngeal cancers. Areas of concern and highlights of successes already achieved are included.
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32
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Boni SP, Gnahatin F, Comoé JC, Tchounga B, Ekouevi D, Horo A, Adoubi I, Jaquet A. Barriers and facilitators in cervical cancer screening uptake in Abidjan, Côte d'Ivoire in 2018: a cross-sectional study. BMC Cancer 2021; 21:952. [PMID: 34433459 PMCID: PMC8390229 DOI: 10.1186/s12885-021-08650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
Backgrounds Cervical cancer (CC) incidence remains unacceptably high in Côte d’Ivoire. In an effort to prevent this malignant condition, a national CC screening program has been scaled up in the country. This study aimed at assessing CC screening uptake and its associated factors in Abidjan in 2018. Methods A cross-sectional survey was conducted from July to September 2018 in the main healthcare facilities of three randomly selected out of the eight health districts of Abidjan. During the study period, a standardized questionnaire was administrated by research assistants to all women aged 25 to 55 years old, attending the three participating facilities. Demographics, knowledge on CC, personal history of CC screening and reasons for not attending CC screening were collected. A logistic regression model was computed to document factors associated with reported CC screening uptake. Results A total of 1158 women with a median age of 32 years (IQR [27–36]), including 364 (31.4%) with no formal education were included. Of those participants, 786 (67.9%) had ever heard about CC. CC screening uptake at least once was reported by 7.5% [95% CI: 6.0–9.0] participants. In multivariable analysis, being ≥45 years (aOR: 6.2 [2.3–17.2]), having a university level (aOR: 2.8 [1.2–6.6]) (versus non formal education) and access to mass campaign information (aOR: 18.2 [8.5–39.1]) were associated with a reported CC screening uptake. The main reported barriers to CC screening were unawareness towards CC screening (75.5%), negligence (20.5%), fear of CC detection (3.9%) and fear of additional costs (3.3%). Conclusion CC screening uptake remains low despite current initiatives to support awareness and prevention in Abidjan. Awareness campaigns need to be massively increased with the adjunction of tailored messages based on the level of women’s education to enhance the CC screening coverage and reach the WHO goal of CC elimination by 2030.
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Affiliation(s)
- Simon P Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire. .,Programme PAC-CI, Site ANRS Treichville, Abidjan, Côte d'Ivoire.
| | - Franck Gnahatin
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire
| | - Jean-Claude Comoé
- Jhpiego, a John Hopkins University affiliate, oncology department, Abidjan, Côte d'Ivoire
| | - Boris Tchounga
- Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé, Cameroon
| | - Didier Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219, Bordeaux, France.,Département de Santé Publique, Université de Lomé, Lomé, Togo
| | - Apollinaire Horo
- Département mère-enfant, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.,Service de Gynéco-Obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.,Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.,Département Cancérologie-Immunologie-Hématologie, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219, Bordeaux, France
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33
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Rafferty H, Sturt AS, Phiri CR, Webb EL, Mudenda M, Mapani J, Corstjens PLAM, van Dam GJ, Schaap A, Ayles H, Hayes RJ, van Lieshout L, Hansingo I, Bustinduy AL. Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women. BMC Infect Dis 2021; 21:691. [PMID: 34273957 PMCID: PMC8286581 DOI: 10.1186/s12879-021-06380-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by Schistosoma haematobium, a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR. METHODS Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18-31. FGS was defined as positive Schistosoma DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression. RESULTS VIA results were available from 237 BILHIV participants. A positive Schistosoma PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223). Schistosoma PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58-23.37, P = 0.02). CONCLUSIONS This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.
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Affiliation(s)
- H Rafferty
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A S Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - E L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - M Mudenda
- Livingstone Central Hospital, Livingstone, Zambia
| | - J Mapani
- Livingstone Central Hospital, Livingstone, Zambia
| | - P L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - G J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - H Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Zambart, Lusaka, Zambia
| | - R J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - L van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - I Hansingo
- Livingstone Central Hospital, Livingstone, Zambia
| | - A L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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34
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Pry JM, Manasyan A, Kapambwe S, Taghavi K, Duran-Frigola M, Mwanahamuntu M, Sikazwe I, Matambo J, Mubita J, Lishimpi K, Malama K, Bolton Moore C. Cervical cancer screening outcomes in Zambia, 2010-19: a cohort study. LANCET GLOBAL HEALTH 2021; 9:e832-e840. [PMID: 34019837 DOI: 10.1016/s2214-109x(21)00062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Globally, cervical cancer is the fourth leading cause of cancer-related death among women. Poor uptake of screening services contributes to the high mortality. We aimed to examine screening frequency, predictors of screening results, and patterns of sensitisation strategies by age group in a large, programmatic cohort. METHODS We did a cohort study including 11 government health facilities in Lusaka, Zambia, in which we reviewed routine programmatic data collected through the Cervical Cancer Prevention Program in Zambia (CCPPZ). Participants who underwent cervical cancer screening in one of the participating study sites were considered for study inclusion if they had a screening result. Follow-up was accomplished per national guidelines. We did descriptive analyses and mixed-effects logistic regression for cervical cancer screening results allowing random effects at the individual and clinic level. FINDINGS Between Jan 1, 2010, and July 31, 2019, we included 183 165 women with 204 225 results for visual inspection with acetic acid and digital cervicography (VIAC) in the analysis. Of all those screened, 21 326 (10·4%) were VIAC-positive, of whom 16 244 (76·2%) received treatment. Of 204 225 screenings, 92 838 (45·5%) were in women who were HIV-negative, 76 607 (37·5%) were in women who were HIV-positive, and 34 780 (17·0%) had an unknown HIV status. Screening frequency increased 65·7% between 2010 and 2019 with most appointments being first-time screenings (n=158 940 [77·8%]). Women with HIV were more likely to test VIAC-positive than women who were HIV-negative (adjusted odds ratio 3·60, 95% CI 2·14-6·08). Younger women (≤29 years) with HIV had the highest predictive probability (18·6%, 95% CI 14·2-22·9) of screening positive. INTERPRETATION CCPPZ has effectively increased women's engagement in screening since its inception in 2006. Customised sensitisation strategies relevant to different age groups could increase uptake and adherence to screening. The high proportion of screen positivity in women younger than 20 years with HIV requires further consideration. Our data are not able to discern if women with HIV have earlier disease onset or whether this difference reflects misclassification of disease in an age group with a higher sexually transmitted infection prevalence. These data inform scale-up efforts required to achieve WHO elimination targets. FUNDING US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
- Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Internal Medicine, School of Medicine, Washington University, St Louis, MO, USA.
| | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; The Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Miquel Duran-Frigola
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Joint IRB-BSC-CRG Program in Computational Biology, Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain; Ersilia Open Source, Cambridge, UK
| | - Mulindi Mwanahamuntu
- Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Women and Newborn Hospital, Lusaka, Zambia
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jane Matambo
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jack Mubita
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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35
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Nyambe A, Lubeya MK. Cervical cancer and HIV in Zambian women. LANCET GLOBAL HEALTH 2021; 9:e734-e735. [PMID: 34019827 DOI: 10.1016/s2214-109x(21)00230-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Anayawa Nyambe
- School of Public Health, University of Zambia, 50110 Lusaka, Zambia.
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Ridgeway, Lusaka, Zambia; Young Emerging Scientists Zambia, Lusaka, Zambia
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36
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de Souza França PD, Guru N, Kostolansky AR, Mauguen A, Pirovano G, Kossatz S, Roberts S, Abrahão M, Patel SG, Park KJ, Reiner T, Jewell E. PARP1: A Potential Molecular Marker to Identify Cancer During Colposcopy Procedures. J Nucl Med 2021; 62:941-948. [PMID: 33188153 PMCID: PMC8882878 DOI: 10.2967/jnumed.120.253575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Despite efforts in prevention, cervical cancer still presents with a high worldwide incidence and remains a great problem in public health, especially in low-income countries. Screening programs, such as colposcopy with Papanicolaou testing, have greatly improved mortality rates. However, the agents currently used to delineate those lesions (topical application of acetic acid or Lugol iodine) lack specificity and sometimes can lead to unnecessary biopsies or even cervical excisions. A tool to enable in vivo histology to quickly and quantitatively distinguish between tumor, dysplastic tissue, and healthy tissue would be of great clinical interest. Methods: Here, we describe the use of PARPi-FL, a fluorescent inhibitor of poly[adenosine diphosphate-ribose]polymerase 1 (PARP1), which is a nuclear enzyme that is overexpressed in cancer when compared with the normal surrounding tissues. We exploit its use as an optical imaging agent to specifically target PARP1 expression, which was demonstrated to be higher in cervical cancer than the normal surrounding tissue. Results: After topical application of PARPi-FL on freshly excised cone biopsy samples, the nuclei of tumor cells emitted a specific fluorescent signal that could be visualized using a handheld fluorescence confocal microscope. Conclusion: This approach has the potential to improve in vivo identification of tumor cells during colposcopy examination, allowing a rapid, noninvasive, and accurate histopathologic assessment.
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Affiliation(s)
- Paula Demétrio de Souza França
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abigail R Kostolansky
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Chemistry, Princeton University, Princeton, New Jersey
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Giacomo Pirovano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Nuclear Medicine, University Hospital Klinikum Rechts der Isar and TranslaTUM, Technical University Munich, Munich, Germany
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
- Department of Radiology, Weill Cornell Medical College, New York, New York; and
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth Jewell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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37
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Parham GP, Mathieu KM, YouYou TG, Hicks ML, Henry-Tillman R, Mutombo A, Anaclet MM, Sylvain MK, Pinder L, Hicks MM, Kanda L, Kanda M. Establishing women's cancer care services in a fragile, conflict and violence affected ecosystem in Africa. Ecancermedicalscience 2021; 15:1231. [PMID: 34221114 PMCID: PMC8225336 DOI: 10.3332/ecancer.2021.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of the world's poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising. METHODS Employing competency-based learning strategies, Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous lesions of the cervix; same-day clinical breast examination and breast ultrasound diagnostics; surgical treatment of invasive cancers of the breast and cervix; and infusion of cytotoxic chemotherapy. Outpatient breast and cervical cancer care clinics, a chemotherapy suite and surgical theatres were outfitted with equipment and supplies. RESULTS Combining local and regional hands-on training seminars with wise infrastructure investments, a team of US and Zambian oncology experts successfully implemented a clinical service platform for women's cancers in a private sector health facility in the Democratic Republic of the Congo. CONCLUSION We forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organisations, a cancer medicine access initiative and an established African cancer centre to build women's cancer services in a FVC-affected African setting.
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Affiliation(s)
- Groesbeck Preer Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- https://orcid.org/0000-0001-5922-5990
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA
- St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA
- McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA
- https://orcid.org/0000-0002-1819-155X
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA
- https://orcid.org/0000-0002-1782-9523
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Leeya Pinder
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
- https://orcid.org/0000-0002-8929-7810
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA
- https://orcid.org/0000-0002-1993-3367
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
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38
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Hicks ML, Mutombo A, YouYou TG, Anaclet MM, Sylvain MK, Mathieu KM, Henry-Tillman R, Lombe D, Hicks MM, Pinder L, Kanda L, Kanda M, Parham GP. Building workforce capacity for the surgical management of cervical cancer in a fragile, low-income African nation-Democratic Republic of the Congo. Ecancermedicalscience 2021; 15:1232. [PMID: 34221115 PMCID: PMC8225330 DOI: 10.3332/ecancer.2021.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Indexed: 11/06/2022] Open
Abstract
Objectives Surgery is a cornerstone of the management of cervical cancer. Women diagnosed with cervical cancer in sub-Saharan Africa have very little access to specialised (gynaecologic oncology) surgical services. We describe our experiences and challenges of training local general gynaecologists to surgically treat early stage invasive cervical cancer at a private sector healthcare facility in a fragile, low-income African nation. Methods Implementation of the training curriculum began with assigned self-directed learning. It continued with on-site training which consisted of preoperative surgical video reviews, pre- and intra-operative assessment of disease status, deconstruction of the designated surgical procedure into its critical subcomponents and trainees orally communicating the steps of the surgical procedure with the master trainers. High-volume repetition of a single surgical procedure over a short time interval, intra-operative bedside mentoring, post-operative case review and mental narration were critical to the process of surgical skills transfer. Results Nineteen radical abdominal hysterectomies were successfully performed over four training visits; trainees were able to perform the procedure alone after eight cases; surgical complications decreased over time. The trainees have continued to perform the surgical procedures independently. Conclusion Life-saving surgical capacity for the treatment of cervical cancer has been established and sustained at a private sector healthcare facility in a fragile, low-income African setting, through an innovative model of surgical training.
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Affiliation(s)
- Michael L Hicks
- St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA.,Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA.,McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA.,https://orcid.org/0000-0002-1819-155X
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA.,https://orcid.org/0000-0002-1782-9523
| | - Dorothy Lombe
- Department of Oncology, University Teaching Hospital, Cancer Diseases Hospital, Lusaka Zambia PO Box Rw, 51337 Lusaka, Zambia.,https://orcid.org/0000-0002-5083-1801
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA.,https://orcid.org/0000-0002-1993-3367
| | - Leeya Pinder
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,https://orcid.org/0000-0001-5922-5990
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YouYou TG, Mathieu KM, Hicks ML, Henry-Tillman R, Mutombo A, Anaclet MM, Sylvain MK, Hicks MM, Pinder L, Kanda L, Kanda M, Parham GP. Leveraging a matrix of stakeholders to facilitate access to chemotherapy for women's cancers in the Democratic Republic of the Congo. Ecancermedicalscience 2021; 15:1234. [PMID: 34221117 PMCID: PMC8225332 DOI: 10.3332/ecancer.2021.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Cancer incidence is increasing worldwide. Over the next 20 years, the growing proportion of cases in low- and middle-income countries (LMICs) will account for an estimated 70% of all cancers diagnosed. The vast majority of cancer patients in LMICs will require chemotherapy, due to the advanced stage of their disease at the time of initial presentation. Unfortunately, the availability of cancer drugs in these environments is sparse, resulting in premature death and years of life lost. In an effort to lay a foundation for women’s cancer control in the Democratic Republic of the Congo (DRC), we implemented a programme which combined workforce development, infrastructure creation and cancer drug access. This manuscript reports on our experience with the latter. Methods A private sector healthcare facility was selected as the programme implementation site. Workforce capacity was developed through a south–south partnership with an African national cancer centre. Cancer drugs were procured through a global cancer medicine access initiative. Results A new chemotherapy infusion unit was successfully established at the Biamba Marie Mutombo Hospital in Kinshasa, DRC. A team of Congolese healthcare providers was trained at the Cancer Disease Hospital in Zambia to safely and effectively administer chemotherapy for breast and cervical cancer. Over 100 breast and cervical cancer patients have been treated with 337 courses of chemotherapy, without any serious adverse events. Conclusion Common barriers to cancer drug access and its administration can be eliminated using regional educational resources to build oncologic workforce capacity, private sector healthcare facilities for infrastructure support and pharmaceutical consortiums to procure low-cost cancer medicines. By leveraging a matrix of global, regional and local stakeholders, the prevailing status quo of very limited access to chemotherapy for women’s cancers was creatively disrupted in DRC, Africa’s largest fragile, conflict and violence-affected country.
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Affiliation(s)
- Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynaecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynaecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,St Mary Mercy Cancer Center 36475 Five Mile Rd, Livonia, MI 48154, USA.,St Joseph Mercy Oakland Cancer Center 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA.,McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA.,https://orcid.org/0000-0002-1819-155X
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham, Slot #725, Little Rock, AR 72205, USA.,https://orcid.org/0000-0002-1782-9523
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA.,https://orcid.org/0000-0002-1993-3367
| | - Leeya Pinder
- Department of Obstetrics and Gynaecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, Washington, DC 98195, USA.,https://orcid.org/0000-0002-8929-7810
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Groesbeck P Parham
- Department of Obstetrics and Gynaecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynaecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,https://orcid.org/0000-0001-5922-5990
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Kostova D, Richter P, Van Vliet G, Mahar M, Moolenaar RL. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security. Health Secur 2021; 19:288-301. [PMID: 33961498 PMCID: PMC8217593 DOI: 10.1089/hs.2020.0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.
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Affiliation(s)
- Deliana Kostova
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Patricia Richter
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Gretchen Van Vliet
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Michael Mahar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Ronald L Moolenaar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
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Jaquet A, Boni S, Tchounga B, Comoe K, Tanon A, Horo A, Diomandé I, Didi-Kouko Coulibaly J, Ekouevi DK, Adoubi I. Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire. JCO Glob Oncol 2021; 7:782-789. [PMID: 34043415 PMCID: PMC8457855 DOI: 10.1200/go.21.00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10-4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
| | - Boris Tchounga
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Kouassi Comoe
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Isidore Diomandé
- Service anatomopathologie, Centre Hospitalier Universitaire (CHU) Cocody, Abidjan, Cote d'Ivoire
| | | | - Didier K. Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
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Kakani P, Kojima N, Banda BA, Lewis S, Suri R, Chibwana F, Chivwara M, Sullivan L, Chimombo M, Sigauke H, Tymchuk C, Kahn D. Increasing cervical cancer screening at a non-government medical center in Lilongwe, Malawi. Int J STD AIDS 2021; 32:933-939. [PMID: 33910402 DOI: 10.1177/09564624211007260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malawi has the highest incidence of and mortality rate due to cervical cancer in the world. This is largely because of inadequate screening and high rates of human immunodeficiency virus (HIV) infection, which greatly increases cervical cancer risk. We describe the implementation of a quality improvement program to increase use of cervical cancer screening at a non-government medical center in Lilongwe, Malawi. The intervention, developed and launched from March to August 2017, aimed to promote education among patients and clinicians about the importance of cervical cancer screening and improve accessibility of screening information within medical records. Visual inspection with acetic acid (VIA) was used to screen for cervical cancer. Women with a positive VIA were offered treatment using thermocoagulation. The number of VIA screenings conducted in 2016 (pre-intervention), 2017 (intervention), and 2018 (post-intervention) was 125, 234 and 456, respectively. Of the 815 women screened during this period, 36 (4.4%) had a VIA-positive result and 12 (1.5%) had suspect cancer. Of the VIA-positive women, 13 (36.1%) received same-day treatment with thermocoagulation. An interrupted time series regression revealed that there was a sustained increase in monthly screenings between the pre- and post-intervention period (β = 30.84; p = 0.006; 95% CI 9.72-51.97), suggesting that the intervention likely was effective in increasing cervical cancer screening. Our results demonstrate that focusing on developing sustainable solutions and improving system processes, without additional equipment or funding, significantly increased the number of women screened and should be considered in other settings to enhance cervical cancer prevention services.
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Affiliation(s)
- Preeti Kakani
- 12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Noah Kojima
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Samuel Lewis
- 12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rajat Suri
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Lauren Sullivan
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Chris Tymchuk
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel Kahn
- Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA
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Søfteland S, Sebitloane MH, Taylor M, Roald BB, Holmen S, Galappaththi-Arachchige HN, Gundersen SG, Kjetland EF. A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis. Int J Gynaecol Obstet 2021; 153:190-199. [PMID: 33316096 PMCID: PMC8248063 DOI: 10.1002/ijgo.13538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022]
Abstract
Background Visualization of the lesions in the lower genital tract is the mainstay for diagnosis of the four lesions found in female genital schistosomiasis (FGS), but colposcopes are generally not available in low‐resource settings. Objective We sought to review handheld devices that could potentially be used for FGS diagnosis. Search strategy We searched Medline and Embase 2015–2019 for handheld devices used in cervical cancer screening and FGS diagnosis. Selection criteria We excluded studies that did not compare the device to standard‐of‐care colposcopes or histopathology. Main results and conclusion In 11 studies, four handheld colposcopes, two smartphones, and one compact digital camera were evaluated. Two handheld colposcopes were found to be potentially adequate for FGS diagnosis, namely Gynocular and Mobile ODT. The smartphones and digital camera did not have sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software should be made to support the diagnosis of both FGS and cervical neoplasia. Real‐time postgraduate training and quality control should be considered in future studies of handheld colposcopes. For patients from schistosomiasis endemic areas, we recommend that handheld devices are used for FGS. Studies are needed to determine which of the two devices is most adequate for FGS diagnosis in schistosomiasis endemic areas. Handheld colposcopy for schistosomiasis endemic areas should be adequate for both cervical cancer and genital schistosomiasis diagnoses.
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Affiliation(s)
- Solrun Søfteland
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Motshedisi Hannah Sebitloane
- Discipline of Obstetrics and Gynecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Borghild Barth Roald
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Pediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sigve Holmen
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
| | | | - Svein Gunnar Gundersen
- Institute for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Eyrun Floerecke Kjetland
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.,Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Joshi S, Muwonge R, Kulkarni V, Lucas E, Kulkarni S, Kand S, Mandolkar M, Baig M, Wankhede S, Surwase K, Pardeshi D, Basu P, Rengaswamy S. Mobile Screening Unit (MSU) for the Implementation of the 'Screen and Treat' Programme for Cervical Cancer Prevention In Pune, India. Asian Pac J Cancer Prev 2021; 22:413-418. [PMID: 33639655 PMCID: PMC8190336 DOI: 10.31557/apjcp.2021.22.2.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES We are reporting the evaluation of an opportunistic point of care cervical cancer screening initiative in Pune, India using a mobile screening unit (MSU). METHODS We conducted 290 cervical cancer screening outreach clinics in the MSU. Screening was performed by trained nurses/ health care providers using visual inspection with 5% acetic acid (VIA). Screen positive women when eligible were treated by thermal ablation during the same sitting. Women with large lesions not eligible for treatment with thermal ablation were referred for colposcopy and treatment. RESULTS A total of 10, 925 women were screened between Nov 2016 and June 2019 in 290 outreach clinics in the MSU. The overall screen positivity was 6.6% (95% CI 6.1, 7.0) with a declining trend over time. A total of 304/717 (42.4%, 95% CI 38.7, 46.1) women received treatment with thermal ablation. About 3.6% (11/304) reported minor side effects and 1.6% (5/304) reported lower abdominal pain and all of them subsided after treatment. Among the 413 women who were advised colposcopy, only 84 (20.33%) women underwent the procedure. Of these 84 women, 64 (76.19%) had normal colposcopy/ histopathology, 7 (8.33%) had CIN1, 2 (2.38%) had CIN 2, 9 (10.71%) had CIN 3 disease and 2 (2.38%) women were diagnosed with invasive cancer. CONCLUSION MSUs are useful for providing cervical cancer screening services, using the 'screen and treat' strategy. Thermal ablation is safe in the field clinics. Additional efforts are needed to improve the compliance for referral of those with large lesions requiring additional visits.
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Affiliation(s)
- Smita Joshi
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Vinay Kulkarni
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Sanjeevani Kulkarni
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Seema Kand
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Mahesh Mandolkar
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Mufid Baig
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Sudhakar Wankhede
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Kavita Surwase
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Dilip Pardeshi
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Sankaranarayanan Rengaswamy
- Research Triangle Institute, International-India, Commercial Tower, Pullman Hotel Aerocity, New Delhi, India.
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Mandiriri AM, Pascoe MJ, Shamu T, Lowe S. Cervical human papillomavirus prevalence, risk factors and outcomes in a cohort of HIV-infected women in Harare, Zimbabwe. South Afr J HIV Med 2020; 21:1123. [PMID: 33240535 PMCID: PMC7670035 DOI: 10.4102/sajhivmed.v21i1.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/30/2020] [Indexed: 12/25/2022] Open
Abstract
Background Human papillomavirus (HPV) associated invasive cervical cancer (ICC) is common in Zimbabwe, disproportionately affecting women living with HIV (WLHIV). Understanding high-risk HPV (hrHPV) infection in relation to cervical disease is important for ICC prevention amongst WLHIV. Objectives To describe the prevalence of cervical hrHPV, type distribution, associated risk factors and ICC screening outcomes in an urban cohort of Zimbabwean women. Methods In this cohort study, WLHIV were tested for hrHPV infection using the Cepheid Xpert® HPV assay and followed up for incident cervical disease. Follow-up assessments were done by visual inspection with acetic acid (VIA). Descriptive statistics and logistic regression were used to describe hrHPV burden and association between hrHPV and potential risk factors. Incidence rates (IR) and rate ratios of cervical disease by hrHPV infection status were also calculated. Results Amongst 321 WLHIV recruited, hrHPV prevalence was 24.9% (n = 80). Fifty-two of these women (65%) were positive for hrHPV types other than 16 or 18/45. Younger age (22–29 years), early sexual debut (13–16 years) and antiretroviral therapy (ART) regimen (second-line ART) were independently associated with hrHPV positivity. Positive VIA IR ratio between hrHPV-positive and -negative women was 12.57 (95% confidence interval [CI]: 4.14–38.19). Only women with hrHPV infection had incident cervical disease (IR: 6.41/100 person-years, (95% CI: 3.33–12.32). There were no ICC cases by the end of the 2-year follow-up. Conclusion There was a high prevalence of hrHPV infection other than 16 and 18/45 in this cohort. Integrating HPV testing in cervical cancer screening programmes may increase screening intervals in hrHPV-negative women, reducing costs for programmes. We recommend further research into cross protectivity of the bivalent and quadrivalent HPV vaccines against these other hrHPV types.
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Affiliation(s)
- Ardele M Mandiriri
- Newlands Clinic, Harare, Zimbabwe.,Department of Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sara Lowe
- Newlands Clinic, Harare, Zimbabwe.,Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Retrospective Review of Loop Electrosurgical Excision Procedure (LEEP) Outcomes at a Tertiary Hospital in Zambia. Obstet Gynecol Int 2020; 2020:1920218. [PMID: 32922449 PMCID: PMC7453247 DOI: 10.1155/2020/1920218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/19/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
There is a lack of knowledge on the histologic outcomes of loop electrosurgical excision procedure (LEEP) biopsies in the diagnosis, treatment, and prevention of cervical cancer in Zambia. This study determined the outcomes of LEEP biopsies and associated factors at a tertiary hospital. We conducted a retrospective chart review of patients evaluated at a tertiary hospital cervical cancer screening centre. From the database, we identified patients who underwent LEEP between January 2015 and June 2018. We extracted demographic data, HIV data, and LEEP biopsy results. A P value less than 0.05 was considered statistically significant. 137 charts were identified, and 114 were included in the final analysis. 23 were excluded for missing histology. The mean age of participants was 36.3 ± 9.6. Histology outcomes revealed that 37% had cervicitis, while CIN 1, 2, and 3 contributed to 27%, 14%, and 3%, respectively. Squamous cell cancer was present in 8% (age groups 35-49) and was three times higher (13%) in HIV-positive compared to HIV-negative participants (3.8%). Normal histology accounted for 11%. Increasing age (P=0.029), less than tertiary education (P=0.0011), and being married (P=0.017) increased the chances of having cancer in the chi-square analysis, while single women had lower odds of having CIN 1 (OR = 0.012) in the multinomial logistic regression. There is a need for increased cervical cancer screening and training in precancer treatment and holistic consideration of other factors like age in addition to the positive VIA test in advising patients on treatment options.
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Cabanes A, Kapambwe S, Citonje-Msadabwe S, Parham GP, Lishimpi K, Cruz TA, Shastri S. Challenges, Opportunities, and Priorities for Advancing Breast Cancer Control in Zambia: A Consultative Meeting on Breast Cancer Control. J Glob Oncol 2020; 5:1-7. [PMID: 30908146 PMCID: PMC6449071 DOI: 10.1200/jgo.18.00222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In 2016, the Zambian government made cancer control a national priority and released a National Cancer Control Strategic Plan for 2016 to 2021, which focuses on malignancies of the breast, cervix, and prostate, and retinoblastoma. The plan calls for a collective reduction in the cancer burden by 50%. In support of this vision, Susan G. Komen sponsored a consultative meeting in Lusaka, Zambia, in September 2017 to bring together the country's main breast cancer stakeholders and identify opportunities to improve breast cancer control. The recommendations generated during the discussions are presented. There was general agreement that the first step toward breast cancer mortality reduction should consist of implementation of early detection service platforms focused on women who are symptomatic. Participants also agreed that the management of all components of the national breast cancer control program should be integrated and led by the Ministry of Health. As much as possible, early detection and treatment services presently offered by the Cervical Cancer Prevention Program of Zambia and Cancer Diseases Hospital should be leveraged. Efforts are under way through multiple stakeholders to implement the following recommendations: development of national guidelines for the early diagnosis of breast cancer, training of breast surgeons, implementation of early detection and surgical treatment service platforms at the district-hospital level, and epidemiologic research, including the improvement of electronic recording mechanisms.
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Affiliation(s)
| | | | | | - Groesbeck P Parham
- University of North Carolina, Chapel Hill, NC, and University of Zambia, Lusaka, Zambia
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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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Yeates K, Erwin E, Mtema Z, Magoti F, Nkumbugwa S, Yuma S, Hopman WM, Ferguson A, Oneko O, Macheku G, Mtei AF, Smith C, Andrews L, West N, Dalton M, Newcomb A, Ginsburg O. Smartphone-Enhanced Training, QA, Monitoring, and Evaluation of a Platform for Secondary Prevention of Cervical Cancer: Opportunities and Challenges to Implementation in Tanzania. JCO Glob Oncol 2020; 6:1114-1123. [PMID: 32692627 PMCID: PMC7392775 DOI: 10.1200/go.20.00124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Until human papillomavirus (HPV)-based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who "graduated" from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.
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Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- New York University School of Global Public Health, New York NY
- Pamoja Tunaweza Women’s Centre, Moshi, Tanzania
| | - Erica Erwin
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Zac Mtema
- SkyConnect Company and Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Frank Magoti
- SkyConnect Company and Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Simoni Nkumbugwa
- SkyConnect Company and Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Safina Yuma
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Wilma M. Hopman
- Kingston General Health Research Institute; Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Olola Oneko
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Agnes Feksi Mtei
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | | | | | - Nicola West
- Pamoja Tunaweza Women’s Centre, Moshi, Tanzania
- Queen’s University, Kingston, Ontario, Canada
| | | | - Ashley Newcomb
- Section for Global Health, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Ophira Ginsburg
- Section for Global Health, Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Perlmutter Cancer Center, New York University Langone Health, New York, NY
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Manga SM, Shi L, Welty TK, DeMarco RF, Aronowitz T. <p>Factors Associated with Treatment Uptake Among Women with Acetic Acid/Lugol’s Iodine Positive Lesions of the Cervix in Cameroon</p>. Int J Womens Health 2020; 12:495-504. [PMID: 32612397 PMCID: PMC7323798 DOI: 10.2147/ijwh.s249607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Treatment of cervical precancer is the primary aim in secondary prevention of cervical cancer. The purpose of this study was to examine factors associated with treatment uptake among women with acetic acid/Lugol’s iodine positive lesions identified by digital cervicography (DC) in a cervical cancer prevention program in Cameroon. Patients and Methods We conducted a cross-sectional survey of medical records from 2013 to 2018 of 755 women in Cameroon who screened positive with acetic acid/Lugol’s iodine in 2013. Results Of the 755 women, 422 (55.9%) had treatment/biopsy on the same day or followed up later, but only 344 (45.6%) received treatment/biopsy and 333 (44.1%) were lost to follow-up. Overall, 180 (52.3%) of the 344 women were treated/biopsied the same day they were screened, and 164 (47.7%) were treated/biopsied after the initial visit. Women aged 30–49 and HIV-positive women were significantly more likely to have received treatment or returned for treatment than women less than 30 and HIV-negative women. Of the 266 women who followed up at a later date, the lesions of 78 (29.3%) women regressed spontaneously without treatment. Women with low-grade lesions, HIV-negative women and women who had follow-up more than a year after the initial exam were significantly more likely to have spontaneous regression with regression rates of 30.6%, 32.1% and 62.2%, respectively (p<0.001). Age was not a significant determinant of spontaneous regression (p=0.149). Conclusion Efforts to increase treatment uptake are needed in this population, including adherence to same day “See and treat” policies.
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Affiliation(s)
- Simon M Manga
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
- Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
- Correspondence: Simon M Manga Tel +237 671863768 Email
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Thomas K Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Rosanna F DeMarco
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Teri Aronowitz
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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