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Wilkinson M, McCrea K, Culbertson A. Cancer Prevention and Screening for People Living with Human Immunodeficiency Virus. Nurs Clin North Am 2024; 59:273-288. [PMID: 38670694 DOI: 10.1016/j.cnur.2024.01.002] [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: 04/28/2024]
Abstract
People living with human immunodeficiency virus (HIV) (PLWH) live near-normal life expectancies due to advances in antiretroviral therapy. PLWH are experiencing more non-HIV-related comorbidities and deaths. PLWH are diagnosed with cancer more often and experience worse cancer-related outcomes than the general population. Cancer prevention and screening in PLWH is essential and leads to earlier diagnosis and treatment which may result in improved health outcomes and increased long-term survival. Few cancer screening guidelines specific to PLWH exist. There are often discrepancies in general population cancer screening guidelines. Familiarity with the utilization of cancer screening guidelines in this population is imperative.
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Affiliation(s)
- Melody Wilkinson
- School of Nursing, Georgetown University, 3700 Reservoir Road, Washington, DC 20057, USA.
| | - Karen McCrea
- School of Nursing, Georgetown University, 3700 Reservoir Road, Washington, DC 20057, USA
| | - Amy Culbertson
- School of Nursing, Georgetown University, 3700 Reservoir Road, Washington, DC 20057, USA
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2
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Solomon D, Cabecinha M, Gibbs J, Burns F, Sabin CA. How do we measure unmet need within sexual and reproductive health? A systematic review. Perspect Public Health 2024; 144:78-85. [PMID: 36127856 PMCID: PMC10916345 DOI: 10.1177/17579139221118778] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing health inequality with sexual and reproductive health requires an understanding of unmet need within a range of populations. This review examined the methods and definitions that have been used to measure unmet need, and the populations most frequently assessed. METHODS Five databases (PubMed, Web of Science, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Health Management and Policy Database (HMIC)) were searched for studies that described quantitative measurement of unmet need within sexual and/or reproductive health between 2010 and 2021. A narrative synthesis was then undertaken to ascertain themes within the literature. RESULTS The database search yielded 19,747 papers; 216 papers were included after screening. 190 studies assessed unmet reproductive health need, of which 137 were analyses of trends among people living in low/lower-middle income countries; 181 used cross-sectional data, with only nine analyses being longitudinal. Eighteen studies analysed unmet sexual health need, of which 12 focused on high and upper-middle income populations. 16 papers used cross-sectional analyses. The remaining 10 studies examined unmet need for a combination of sexual and reproductive health services, eight among populations from upper-middle or high income countries. All were cross-sectional analyses. 165 studies used the Demographic and Health Surveys (DHS) definition of unmet need; no other standardised definition was used among the remaining papers. DISCUSSION There is a significant focus on unmet need for contraception among women in low income countries within the published literature, leaving considerable evidence gaps in relation to unmet need within sexual health generally and among men in particular, and unmet reproductive health need in high income settings. In addition, using an increased range of data collection methods, analyses and definitions of unmet need would enable better understanding of health inequality in this area.
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Affiliation(s)
- D Solomon
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, UK
| | - M Cabecinha
- Institute for Global Health, University College London, London, UK
| | - J Gibbs
- Institute for Global Health, University College London, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - CA Sabin
- Institute for Global Health, University College London, London, UK
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3
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Koebel J, Kazemi M, Kennedy VL, Medeiros P, Bertozzi B, Bevan L, Tharao W, Logie CH, Underhill A, Pick N, King E, Kestler M, Yudin MH, Rana J, Carvalhal A, Webster K, Lee M, Islam S, Nicholson V, Ndung’u M, Narasimhan M, Gagnier B, Habanyama M, de Pokomandy A, Kaida A, Loutfy M. Dissemination of the Women-Centred HIV Care Model: A Multimodal Process and Evaluation. J Int Assoc Provid AIDS Care 2024; 23:23259582231226036. [PMID: 38389331 PMCID: PMC10894538 DOI: 10.1177/23259582231226036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Using data from a national cohort study and focus groups, the Women-Centred HIV Care (WCHC) Model was developed to inform care delivery for women living with HIV. METHODS Through an evidence-based, integrated knowledge translation approach, we developed 2 toolkits based on the WCHC Model for service providers and women living with HIV in English and French (Canada's national languages). To disseminate, we distributed printed advertising materials, hosted 3 national webinars and conducted 2 virtual capacity-building training series. RESULTS A total of 315 individuals attended the webinars, and the average WCHC knowledge increased by 29% (SD 4.3%). In total, 131 service providers engaged in 22 virtual capacity-building training sessions with 21 clinical cases discussed. Learners self-reported increased confidence in 15/15 abilities, including the ability to provide WCHC. As of December 2023, the toolkits were downloaded 7766 times. CONCLUSIONS We successfully developed WCHC toolkits and shared them with diverse clinical and community audiences through various dissemination methods.
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Affiliation(s)
- Jill Koebel
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - V Logan Kennedy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Priscilla Medeiros
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Breklyn Bertozzi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | | | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Angela Underhill
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Elizabeth King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jesleen Rana
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Adriana Carvalhal
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Scarborough Health Network Research Institute, Toronto, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Alliance for South Asian AIDS Prevention, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mary Ndung’u
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research/Human Reproduction Programme, World Health Organization, Geneva, Switzerland
| | - Brenda Gagnier
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Muluba Habanyama
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- The Ontario HIV Treatment Network, Toronto, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
- The CHIWOS Research Team is detailed in the Acknowledgments
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4
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Gilles C, Konopnicki D, Rozenberg S. The recent natural history of human papillomavirus cervical infection in women living with HIV: A scoping review of meta-analyses and systematic reviews and the construction of a hypothetical model. HIV Med 2023; 24:877-892. [PMID: 37062862 DOI: 10.1111/hiv.13490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Women with HIV are more often infected with human papillomavirus (HPV) and are more prone to develop precancerous cervical lesions (squamous intraepithelial lesions, SIL) and invasive cervical cancer (ICC) than HIV-negative women. OBJECTIVE This scoping-review analyses the impact of HIV on HPV prevalence, incidence and evolution to SIL and ICC. METHODS We selected all PubMed systematic reviews and meta-analyses published between January 2000 and July 2021 reporting data about HPV, cervical intraepithelial neoplasia (CIN), SIL and ICC prevalence, incidence and evolution in women with HIV. A hypothetical model comparing the history of HPV infection in HIV-negative, combined antiretroviral therapy (cART)-treated and -untreated women with HIV was built. RESULTS Data from 11 meta-analyses and 10 systematic reviews were selected, which included between 770 and 236 127 women with HIV. Women with HIV have a 3 to 6 times higher risk of being infected by HPV, of progression to high-grade SIL (HSIL) and to ICC. These risks are exacerbated when the CD4 cell counts are low and when they are not using cART, whereas these risks are reduced by 20%-30% when they are optimally treated with cART and have had a suppressed HIV viral load for at least 2 years. In our model, we illustrated that optimal HIV treatment and preventing HIV reduce the number of ICC cases by 2.5 and 6 times, respectively. CONCLUSIONS Optimal treatment and care of HIV patients are essential to reduce their prevalence of ICC, as are preventive strategies which include HPV vaccination, cervical cancer screening strategies and treatment of HSIL.
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Affiliation(s)
- Christine Gilles
- Department of Obstetrics and Gynecology, Saint Pierre University Hospital 322, Belgium Université Libre de Bruxelles (ULB)-Free University of Brussels (ULB-VUB), Brussels, Belgium
| | - Déborah Konopnicki
- Infectious Disease Department Saint Pierre University Hospital 322, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Department of Obstetrics and Gynecology, Saint Pierre University Hospital 322, Belgium Université Libre de Bruxelles (ULB)-Free University of Brussels (ULB-VUB), Brussels, Belgium
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Prevalence of Physical Health, Mental Health, and Disability Comorbidities among Women Living with HIV in Canada. J Pers Med 2022; 12:jpm12081294. [PMID: 36013243 PMCID: PMC9409885 DOI: 10.3390/jpm12081294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022] Open
Abstract
Life expectancy for people living with HIV has increased, but management of HIV is now more complex due to comorbidities. This study aimed to measure the prevalence of comorbidities among women living with HIV in Canada. We conducted a cross-sectional analysis using data from the 18-months survey (2014−2016) of the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). Self-report of diagnosed conditions was used to measure lifetime prevalence of chronic physical conditions, current mental health conditions, and disabilities. We examined frequency of overlapping conditions and prevalence stratified by gender identity, ethnicity, and age. Among 1039 participants, 70.1% reported a physical health diagnosis, 57.4% reported a current mental health diagnosis, 19.9% reported a disability, and 47.1% reported both physical and mental health comorbidities. The most prevalent comorbidities were depression (32.3%), anxiety (29.5%), obesity (26.7%, defined as body mass index >30 kg/m2), asthma/chronic obstructive pulmonary disease (23.3%), sleep disorder (22.0%), drug addiction (21.9%), and arthritis/osteoarthritis (20.9%). These results highlight the complexity of HIV care and the important prevalence of comorbidities. Personalized health care that integrates care and prevention of all comorbidities with HIV, with attention to social determinants of health, is necessary to optimize health and well-being of women living with HIV.
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Skerritt L, Kaida A, Savoie É, Sánchez M, Sarmiento I, O’Brien N, Burchell AN, Bartlett G, Boucoiran I, Kestler M, Rouleau D, Loutfy M, de Pokomandy A. Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study. J Pers Med 2022; 12:jpm12071079. [PMID: 35887575 PMCID: PMC9320512 DOI: 10.3390/jpm12071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Engagement along the HIV care cascade in Canada is lower among women compared to men. We used Fuzzy Cognitive Mapping (FCM), a participatory research method, to identify factors influencing satisfaction with HIV care, their causal pathways, and relative importance from the perspective of women living with HIV. Building from a map of factors derived from a mixed-studies review of the literature, 23 women living with HIV in Canada elaborated ten categories influencing their satisfaction with HIV care. The most central and influential category was “feeling safe and supported by clinics and healthcare providers”, followed by “accessible and coordinated services” and “healthcare provider expertise”. Participants identified factors that captured gendered social and health considerations not previously specified in the literature. These categories included “healthcare that considers women’s unique care needs and social contexts”, “gynecologic and pregnancy care”, and “family and partners included in care.” The findings contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.
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Affiliation(s)
- Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Margarite Sánchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
- Viva Women, Vancouver, BC V5Z 0C9, Canada
| | - Iván Sarmiento
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Nadia O’Brien
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Ann N. Burchell
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Isabelle Boucoiran
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | | | - Danielle Rouleau
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Mona Loutfy
- Women’s College Research Institute, Toronto, ON M5S 1B2, Canada;
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-843-2090
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7
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Cvetkovic A, King E, Skerritt L, Loutfy M, Tseng A, Murray M, van Schalkwyk J, Boucoiran I, Marcotte S, Hankins C, Savoie É, de Pokomandy A, Pick N, Tkachuk S, Rowe T, Smaill F, Walmsley S. A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:278-295. [PMID: 36338461 PMCID: PMC9629258 DOI: 10.3138/jammi-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women's health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women's health and sexual and reproductive health care needs are not being met. METHODS In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women's health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause. RESULTS We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women's health care topics when seeing a patient during a visit. CONCLUSIONS It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women's health issues.
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Affiliation(s)
- Anna Cvetkovic
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Julie van Schalkwyk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Suzanne Marcotte
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Édénia Savoie
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Stacey Tkachuk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Timothy Rowe
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Fiona Smaill
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Walmsley
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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8
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Mohanty K, Cheung HW, Stafford KA, Riedel DJ. Care Outcomes in People Living with HIV and Cancer. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2021. [DOI: 10.1007/s40506-021-00252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Loutfy M, Tharao W, Kazemi M, Logie CH, Underhill A, O’Brien N, Pick N, Kestler M, H.Yudin M, Rana J, MacGillivray J, Kennedy VL, Jaworsky D, Carvalhal A, Conway T, Webster K, Lee M, Islam S, Nicholson V, Ndung’u M, Proulx-Boucher K, Carter A, Gormley R, Narasimhan M, Welbourn A, de Pokomandy A, Kaida A. Development of the Canadian Women-Centred HIV Care Model Using the Knowledge-to-Action Framework. J Int Assoc Provid AIDS Care 2021; 20:2325958221995612. [PMID: 33845677 PMCID: PMC8047935 DOI: 10.1177/2325958221995612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 01/16/2023] Open
Abstract
In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the "Women-Centred HIV Care" (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the "foundation". Person-centred care with attention with attention to social determinants of health and family make up the "first" floor. Women's health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the "second" floor. Peer support, leadership, and capacity building make up the "roof". To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Model should be flexible in its delivery (e.g., single provider, interdisciplinary clinic or multiple providers) and implementation settings (e.g., urban, rural).
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Affiliation(s)
- Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Carmen H. Logie
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Angela Underhill
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mark H.Yudin
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - Jesleen Rana
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - V. Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Denise Jaworsky
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
| | | | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Shaz Islam
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Alliance for South Asian AIDS Prevention, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mary Ndung’u
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Kirby Institute, UNSW Sydney, Australia
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Alice Welbourn
- Salamander Trust, United Kingdom lead coordinator of the Global Values and Preferences Survey
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Rohner E, Mulongo M, Pasipamire T, Oberlin AM, Goeieman B, Williams S, Lubeya MK, Rahangdale L, Chibwesha CJ. Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africa a. Int J Gynaecol Obstet 2020; 152:53-59. [PMID: 33188707 DOI: 10.1002/ijgo.13485] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To map the cervical cancer screening cascade among women living with HIV attending a public-sector cytology screening program in Johannesburg, South Africa. METHODS We conducted a retrospective cohort study of routinely collected clinical data captured in an electronic medical record system. Women (≥18 years) living with HIV with an abnormal Pap result between January 2013 and May 2018 were included. The proportion of women who received follow-up consistent with extant clinical guidelines, stratified by their initial Pap smear result, was examined. RESULTS The study included 2072 women: 1384 (66.8%) with a low-risk Pap result, 681 (32.9%) with a high-risk Pap result, and 7 (0.3%) with suspected cancer. Only 174 (25.6%) women with a high-risk Pap result underwent guideline-indicated management within 18 months. Among women with a low-risk Pap result, 375 (27.1%) received follow-up within 1 year; the cumulative incidence of follow-up increased to 63.1% at 3 years. All women with suspected cancer either received a colposcopic biopsy or were referred for further treatment. CONCLUSION Attrition among South African women living with HIV who attended cervical screening in an urban public-sector program was high. Developing tailored interventions to address bottlenecks in the care cascade and improve cervical screening outcomes will be central to eliminating cervical cancer.
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Affiliation(s)
- Eliane Rohner
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Masangu Mulongo
- Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | - Tafadzwa Pasipamire
- Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Austin M Oberlin
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | | | - Sophie Williams
- Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | - Mwansa K Lubeya
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carla J Chibwesha
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Clinical HIV Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
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11
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A prognostic study of patients with cervical cancer and HIV/AIDS in Bangkok, Thailand. Gynecol Oncol Rep 2020; 34:100669. [PMID: 33251314 PMCID: PMC7680700 DOI: 10.1016/j.gore.2020.100669] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 01/22/2023] Open
Abstract
Favorable prognostic factors were a civil servant medical benefit plan and higher education. Advanced disease was a significant prognostic factor for shorter survival. HIV/AIDS status was not a significant prognostic factor for longer survival.
Cervical cancer is one of the most common cancers of women. In Thailand, the incidence and death rate of cervical cancer are 18.1 and 5.7 per 100,000 women, respectively. Disease progresses faster in patients infected with human immunodeficiency virus (HIV) with acquired immune deficiency syndrome (AIDS). However, limited data are available for Thailand. Here we determined the prevalence of HIV/AIDS and identified factors affecting survival. We reviewed medical records of women infected with HIV with cervical cancer treated at Ramathibodi Hospital from 2007 through 2014. Demographic and clinical data were collected upon diagnosis. We used the Kaplan–Meier method and a Cox proportional hazards model to evaluate the association of overall survival (OS) with risk factors. The mean, median and range of ages at diagnosis of the 1,362 subjects were 53.9 years, 53.0 years and 20–94 years, respectively. The prevalence of HIV/AIDS in patients with cervical cancer was 2.3% and 5-year survival was 61.2%. Multivariable analysis revealed that favourable prognostic factors were a civil servant medical benefit plan and higher education. Advanced cervical cancer was a poor prognostic factor. Prognosis of women with stage III and IV cervical cancer was extremely poor (HR = 7.25 (95%CI: 4.39–11.98)) in stage III and HR = 20.57 (95%CI: 11.59–36.53) in stage IV). The 1-, 3-, and 5-year survival rates of patients with (74.2%, 67.6%, and 63.6%, respectively) or without (87.4%, 71.3% and 63.7%, respectively) HIV/AIDS were not significantly different.
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Makhubo MT, Naidoo TD. Healthcare worker compliance with cervical cancer screening guidelines. An audit at district and regional level of care in the Pietermaritzburg Metropolitan area of KwaZulu-Natal. South Afr J HIV Med 2020; 21:1104. [PMID: 32934833 PMCID: PMC7479429 DOI: 10.4102/sajhivmed.v21i1.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background In South Africa (SA) there are screening guidelines for cervical cancer in women living with HIV (WLWH). To our knowledge there is lack of data concerning the knowledge of health care workers (HCWs) about cervical cancer screening guidelines before the initiation of antiretroviral therapy (ART) in WLWH. Objectives To investigate the knowledge and familiarity of HCWs regarding cervical cancer screening guidelines in WLWH. Methods A cross-sectional questionnaire-based study exploring compliance with cervical cancer screening guidelines before initiating ART was conducted with 85 HCWs in the antiretroviral (ARV) clinics of a district and regional hospitals in KwaZulu-Natal, SA. Data were analysed using Stata V13 and a p-value of ≤ 0.05 was considered statistically significant. Results Eighty-five HCWs were included in the study. Health care workers’ responses to knowledge about cervical cancer screening in WLWH were suboptimal and revealed significant gaps. Most HCWs did not know the screening intervals of WLWH. Statistically significant associations were found between an HCW’s occupation and responses to the Likert scale questions. Conclusion Although the majority of HCWs were familiar with cervical cancer screening guidelines in WLWH, the study highlights that there are deficiencies in both knowledge and practice. Creating awareness among HCWs regarding the current methods of cervical cancer screening is a necessary to reduce morbidity and mortality from cervical cancer in WLWH.
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Affiliation(s)
- Mbali T Makhubo
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Thinagrin D Naidoo
- Department of Obstetrics and Gynaecology, Grey's Hospital, Pietermaritzburg, South Africa.,Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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