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Arrossi S, Binder F, Ituarte C, Martiarena N, Campanera A, Bárcena M, Paolino M. [Effect of COVID-19 pandemics in treatment of cervical cancer: pre/post study]. Medicina (B Aires) 2024; 84:236-248. [PMID: 38683508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervical cancer treatment. METHODS We carried out a population-based, before-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initiation by stage. RESULTS Compared with women diagnosed in 2017-2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment duration for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. CONCLUSIONS Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina. E-mail:
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Fernando Binder
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | | | | | | | | | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Lemos M, Restrepo J, Espina C, Feliu A, Ferreccio C, Garcés-Palacio IC, Jurberg C, de Albuquerque Melo F, Cornejo-Ovalle M, Arrossi S, Murillo R, Acosta Pérez E, Venegas G, Finck C. Latin America and the Caribbean Code Against Cancer 1st edition: Formative research on the comprehension and persuasiveness of the recommendations by the general population. Cancer Epidemiol 2023; 86 Suppl 1:102456. [PMID: 37852727 DOI: 10.1016/j.canep.2023.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Cancer prevention is the most efficient and cost-effective strategy in cancer control. One prevention strategy is giving credible, clear, and evidence-based recommendations to the individual; however, it is key that these messages are accepted and understood properly by the public. This study aimed to pilot the draft recommendations developed as part of the Latin America and the Caribbean (LAC) Code Against Cancer 1st edition, in terms of comprehension and persuasion of each message. METHODS A mixed method two-wave study, in which two versions of the messages were presented to the general population in five LAC countries. We used an ad-hoc questionnaire and interviews that followed the cognitive-pretesting methodology. RESULTS Findings suggest that the messages were generally well understood, especially in Spanish speaking countries, and that the messages were generally more understandable than persuasive. We adapted and revised the recommendations based on the findings of the first Wave and held a second iteration in the Spanish speaking countries. We observed a better understanding of most messages in Wave 2. CONCLUSION The LAC Code Against Cancer is a valuable tool of well understood messages for the public, with concrete actions everyone can take to prevent cancer. Further research should assess particularities of the region for further efficient dissemination of these important health messages, identify key messages for certain population groups and future interventions that strengthen health literacy in rural and less educated populations to increase behavior change.
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Affiliation(s)
- Mariantonia Lemos
- Escuela de Artes y Humanidades, Universidad EAFIT, Medellín, Colombia
| | - Julia Restrepo
- Escuela de Artes y Humanidades, Universidad EAFIT, Medellín, Colombia
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Catterina Ferreccio
- Facultad de Medicina, Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile. Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | | | - Claudia Jurberg
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation and Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State (FAPERJ), Rio de Janeiro, Brazil
| | | | | | - Silvina Arrossi
- Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
| | - Raúl Murillo
- Centro Javeriano de Oncología - Hospital Universitario San Ignacio - Facultad de Medicina - Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Gino Venegas
- Clínica Angloamericana Lima-Peru - Facultad de medicina, Universidad de Piura, Lima, Peru
| | - Carolyn Finck
- Departamento de Psicología Universidad de los Andes, Bogotá, Colombia.
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Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, Herrero R, Dommarco JR, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Mohar A, Murillo R, Santamaría J, Tortolero-Luna G, Cazap E, Gabriel OO, Paonessa D, Zoss JW, Luciani S, Carvalho A, Schüz J. Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol 2023; 86 Suppl 1:102402. [PMID: 37852725 DOI: 10.1016/j.canep.2023.102402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France.
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Maribel Almonte
- World Health Organization (WHO), Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | | | - Liz Maria de Almeida
- National Cancer Institute of Brazil (INCA), Prevention and Surveillance, Rio de Janeiro, Brazil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad (CEDES), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Alejandro Mohar
- Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas (UNAM), Tlalpan, Mexico
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Eduardo Cazap
- Sociedad Latinoamercia y del Caribe de Oncología Médica (SLACOM), Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Buenos Aires, Argentina
| | - Owen O Gabriel
- Owen King EU Hospital, Department of Oncology, Saint Lucia
| | - Diego Paonessa
- Asociación Latina e Ibérica Contra el Cáncer (ALICC), Buenos Aires, Argentina
| | - J Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Rio de Janeiro, Brazil
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Andre Carvalho
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
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Batman S, Varon ML, San Miguel-Majors SL, Benitez Majano S, Pontremoli Salcedo M, Montealegre J, Arrossi S, Oliveira MTDC, Oliveira LHD, Luciani S, Milan J, Trimble EL, Schmeler KM, Maza M. Elimination of cervical cancer in Latin America (Project ECHO-ELA): lessons from phase one of implementation. Rev Panam Salud Publica 2023; 47:e113. [PMID: 37489237 PMCID: PMC10361421 DOI: 10.26633/rpsp.2023.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/02/2023] [Indexed: 07/26/2023] Open
Abstract
We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program's purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization's (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO's non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 - 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccination. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals.
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Affiliation(s)
- Samantha Batman
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Melissa Lopez Varon
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Sandra L. San Miguel-Majors
- US National Cancer InstituteBethesdaUnited States of AmericaUS National Cancer Institute, Bethesda, United States of America.
| | - Sara Benitez Majano
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Mila Pontremoli Salcedo
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Jane Montealegre
- Baylor College of MedicineHoustonUnited States of AmericaBaylor College of Medicine, Houston, United States of America.
| | - Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y TécnicasCentro de Estudios de Estado y SociedadBuenos AiresArgentinaConsejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.
| | - Maria Tereza da Costa Oliveira
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Lucia H. De Oliveira
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Silvana Luciani
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Jessica Milan
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Edward L. Trimble
- US National Cancer InstituteBethesdaUnited States of AmericaUS National Cancer Institute, Bethesda, United States of America.
| | - Kathleen M. Schmeler
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Mauricio Maza
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
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Paolino M, Sánchez Antelo V, Kohler RE, Viswanath K, Arrossi S. Implementation of an mHealth intervention to increase adherence to triage among HPV positive women with HPV-self-collection (ATICA study): post-implementation evaluation from the women's perspective. BMC Womens Health 2023; 23:332. [PMID: 37353835 PMCID: PMC10288763 DOI: 10.1186/s12905-023-02475-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/10/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. METHODS We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage. RESULTS We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages. CONCLUSION The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.
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Affiliation(s)
- Melisa Paolino
- Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina.
| | - Victoria Sánchez Antelo
- Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina
| | - Racquel E Kohler
- Cancer Health Equity, Cancer Institute of New Jersey, Rutgers - the State University of New Jersey, New Jersey, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Silvina Arrossi
- Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina
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Lucas E, Murillo R, Arrossi S, Bárcena M, Chami Y, Nessa A, Perera S, Silva P, Sangrajrang S, Muwonge R, Basu P. Quantification of impact of COVID-19 pandemic on cancer screening programmes - a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand. eLife 2023; 12:e86527. [PMID: 37191660 PMCID: PMC10188105 DOI: 10.7554/elife.86527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
It is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income countries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) categories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the backlogs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.
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Affiliation(s)
- Eric Lucas
- International Agency for Research on CancerLyonFrance
| | - Raul Murillo
- Hospital Universitario San IgnacioBogotaColombia
| | | | | | - Youssef Chami
- Foundation Lalla Salma Cancer prevention and treatmentRabatMorocco
| | - Ashrafun Nessa
- Bangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | | | | | | | | | - Partha Basu
- International Agency for Research on CancerLyonFrance
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Straw C, Sanchez-Antelo V, Kohler R, Paolino M, Viswanath K, Arrossi S. Implementation and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): perceptions of health decision-makers and health-care providers. BMC Health Serv Res 2023; 23:47. [PMID: 36653775 PMCID: PMC9847147 DOI: 10.1186/s12913-023-09022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and health-care providers regarding the intervention implementation and scaling-up. METHODS A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n = 10) and health-care providers (n = 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. RESULTS Both health-care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women's needs, and relative priority. However, some potential barriers were also identified including: complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy's sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there was staff to take Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-tests. CONCLUSION Health decision-makers and health-care providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications not only for Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process.
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Affiliation(s)
- Cecilia Straw
- grid.7345.50000 0001 0056 1981Faculty of Social Sciences, University of Buenos Aires, Buenos Aires, Argentina ,Centre for the Study of State and Society, Buenos Aires, Argentina
| | - Victoria Sanchez-Antelo
- grid.423606.50000 0001 1945 2152Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
| | - Racquel Kohler
- grid.516084.e0000 0004 0405 0718Cancer Health Equity, Cancer Institute of New Jersey, Rutgers - the State University of New Jersey, New Brunswick, USA
| | - Melisa Paolino
- grid.423606.50000 0001 1945 2152Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
| | - Kasisomayajula Viswanath
- grid.38142.3c000000041936754XDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Silvina Arrossi
- grid.423606.50000 0001 1945 2152Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
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Paolino M, Sánchez Antelo V, Cuberli M, Curotto M, Le Pera A, Binder F, Mazzadi JD, Firmenich B, Arrossi S. Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina. Implement Sci Commun 2023; 4:4. [PMID: 36635749 PMCID: PMC9836335 DOI: 10.1186/s43058-022-00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/01/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity-in relation to the core components proposed by the National Program on Cervical Cancer Prevention-with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. METHODS This descriptive study used a multi-method approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data from the National Screening Information System. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. RESULTS Our results showed that the core components with highest fidelity were training, sample handling, and transportation. Regarding the offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the follow-up and treatment core component, we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers. CONCLUSIONS Our study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle-income settings.
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Affiliation(s)
- Melisa Paolino
- grid.423606.50000 0001 1945 2152Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Victoria Sánchez Antelo
- grid.423606.50000 0001 1945 2152Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Milca Cuberli
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, 1067 Buenos Aires, Argentina
| | - Mariana Curotto
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, 1067 Buenos Aires, Argentina
| | - Anabella Le Pera
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Fernando Binder
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Juan David Mazzadi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Beatriz Firmenich
- Dirección de Formación Capacitación y Planificación de Recursos Humanos en Salud. Secretaría de Salud Pública de La Matanza, Hipolito Yrigoyen 2562, 1754 Buenos Aires, San Justo Argentina
| | - Silvina Arrossi
- grid.423606.50000 0001 1945 2152Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
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Sánchez Antelo V, Szwarc L, Le Pera A, Fredjkes P, Saimovici D, Massaccesi S, Paolino M, Viswanath K, Arrossi S. Ten Steps to Design a Counseling App to Reduce the Psychosocial Impact of Human Papillomavirus Testing on the Basis of a User-Centered Design Approach in a Low- and Middle-Income Setting. JCO Glob Oncol 2022; 8:e2200168. [PMID: 36252163 PMCID: PMC9812480 DOI: 10.1200/go.22.00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This study describes the 10 steps followed to produce the information architecture of a user-centered design (UCD) counseling mobile application, the first phase to develop an app. The app aims to reduce the psychosocial impact of the human papillomavirus test result and improve women's knowledge of human papilloma virus and cervical cancer. METHODS We used a UCD approach to produce the information architecture of the app (ie, how to organize contents into features). We analyzed field notes, meeting agendas, and documentation produced during each stage of the design process. We described the goals, methods, and outcomes of each step. We also discussed the critical challenges and the strategies to address them. RESULTS The steps are (1) knowledge, attitudes, and beliefs mapping: reanalysis of team's research findings from prior studies; (2) environmental scanning of apps available on the market; (3) stakeholders' point of view: The International Advisory Committee; (4) potential user's profile: building archetypes through the Persona method; (5) women's interviews: user's preferences and experiences; (6) effective features: scoping review to select app's features that address psychosocial impact; (7) the user journey: ideal interaction with the gynecological service and the counseling app; (8) women's focus groups: using Personas and Scenarios to discuss app's mock-up; (9) women's design sessions: prototype test and card-sorting techniques; and (10) team's design session: translating results into visual objects and features. CONCLUSION We provide here detailed descriptions of the UCD process of an app for human papillomavirus-tested women for those venturing into the area of mHealth strategies work. Our experience can be used as a guide for future mHealth app development for a low- and middle-income setting.
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Affiliation(s)
- Victoria Sánchez Antelo
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Lucila Szwarc
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Anabella Le Pera
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Paula Fredjkes
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Diana Saimovici
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Silvia Massaccesi
- Instituto Provincial del Cáncer, Ministerio de Salud de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Melisa Paolino
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA,Dana-Farber Cancer Institute, Harvard University, Boston, MA
| | - Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina,Silvina Arrossi, PhD, Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, C1173 AAA, Buenos Aires, Argentina; Twitter: @silvi2020twit; e-mail:
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Antelo VS, Paolino M, Frejdkes P, Correa S, Furia A, Lopez de Degani G, Arrossi S. Formative Research to Design SMS Messages to Increase Breast Cancer Screening Uptake in Argentina. JCO Glob Oncol 2022. [DOI: 10.1200/go.22.32000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a need for interventions to promote breast cancer screening among high-risk population. This formative research is part of a pragmatic randomized trial being conducted in Santa Fe, Argentina, in which we are evaluating whether SMS messages sent to women aged 50-69 increases breast cancer screening uptake. Here, we describe the formative results used to design the content of the SMS messages to be tested in the trial. METHODS We conducted four on-line focus groups with women aged 50+ (n = 14). Participatory techniques were used to debate the advantages and disadvantages of different options for the five structural elements -i.e., greeting, recipient, sender, message's topic, and closing line-of the SMS message. We openly coded the discussions for agreements and preferences regarding the SMS message content. RESULTS SMS messages as reminders to increase breast cancer screening were highly accepted. Women argued that the greeting line should provide clear information about the topic of the SMS message (eg, Health information). SMS messages should also include the woman's name, because this inclusion would be an indicator that it was a personal SMS message. Most women considered that the sender of the SMS messages should be a health institution as this would legitimize the content. Regarding the topic of the message, women preferred an imperative tone and they mentioned that the SMS message should include information about how to get a mammogram (eg, “Women aged 50-69 should have a mammogram done every two years. Do you have an appointment? WhatsApp to xxxxx”). The closing line should encourage women to get a mammogram (eg, “Ask for your appointment now! It is important!”). CONCLUSION Our findings have some implications for the design of mHealth interventions targeted at improving breast cancer screening. A personalized SMS could be a good way of inviting women, although its content must be carefully designed to provide clear information about how to get a mammogram.
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Affiliation(s)
- Victoria Sanchez Antelo
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas (CEDES/CONICET), Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas (CEDES/CONICET), Buenos Aires, Argentina
| | - Paula Frejdkes
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | | | - Anabel Furia
- Agencia de Control del Cáncer—Ministerio de Salud de Santa Fe, Santa Fe, Argentina
| | | | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas (CEDES/CONICET), Buenos Aires, Argentina
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Arrossi S, Paolino M, Sánchez Antelo V, Thouyaret L, Kohler RE, Cuberli M, Flores L, Serra V, Viswanath K, Orellana L. Effectiveness of an mHealth intervention to increase adherence to triage of HPV DNA positive women who have performed self-collection (the ATICA study): A hybrid type I cluster randomised effectiveness-implementation trial. The Lancet Regional Health - Americas 2022; 9. [PMID: 35655914 PMCID: PMC9159703 DOI: 10.1016/j.lana.2022.100199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Straw C, Antelo VS, Paolino M, Murillo R, Espina C, Arrossi S. Acceptability, appropriateness and feasibility of the Latin American and Caribbean Code against Cancer: perceptions of decision-makers and health professionals in Argentina. Ecancermedicalscience 2022; 16:1375. [PMID: 35702416 PMCID: PMC9116998 DOI: 10.3332/ecancer.2022.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Cancer is an important public health problem. In Latin America and the Caribbean, there were approximately 1,500,000 new cases of cancer and 700,000 deaths due to cancer in 2020. These figures will increase by 78% by 2040 to more than 2.5 million people diagnosed with cancer each year, who will require medical attention, care and support. However, it is estimated that at least 40% of cancers could be prevented by adopting a healthier lifestyle, reducing risky behaviours and implementing recommended health interventions. Objective To evaluate the perceptions of health decision-makers and professionals regarding the Latin American and Caribbean Code against Cancer (CLCC) as a support tool for designing and implementing public policies for cancer prevention and control (acceptability, appropriateness and feasibility) in Argentina. Methods A qualitative study was conducted using individual, semi-structured interviews with health decision-makers and professionals (n = 30). The questions and thematic analysis of the information gathered have been guided by the principles of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting and characteristics of individuals. Results Health professionals and health decision-makers broadly accepted the proposal of the CLCC as a tool for supporting the design and implementation of public policies for cancer prevention and control, and considered it to be appropriate. Additionally, from the interviewees' perspective, factors should be ensured to guarantee the implementation of the CLCC as a viable public health policy. They also felt it was right to take the CECC as a model and to adapt its content to the specific characteristics of the Latin American population, customs, lifestyle habits, epidemiological characteristics and, in particular, the Argentinian socio-economic context. Interviewees perceived the CLCC as a health intervention whose complexity varied depending on the recommendation, although most of them were feasible. The broad consensus among the interviewees was that the development of the CLCC could yield numerous advantages in improving cancer prevention and control policy, and responding to the needs of the population. It was also considered to be an opportunity to introduce fundamental changes. With regard to the implementation of the CLCC, interviewees reported a favourable institutional climate, since they perceived that it would receive a priority equal to or greater than the ongoing prevention measures, and that it would have the commitment of the health authorities. They also felt that the implementation of the CLCC in their work environment would not be very complicated, and that the decision-makers and professionals had the necessary capacity to implement it. Finally, they felt that the implementation would be facilitated by the participation and consensus of health decision-makers at the primary care level, and negotiation with industrial and environmental sectors. Conclusions Our study shows that health professionals and decision-makers consider the CLCC to be highly acceptable, appropriate and feasible. This would facilitate its implementation as a tool that could enhance current cancer prevention and control policies in Argentina. The results of the study indicate the necessity for the CLCC to be adapted to the socio-economic context of Argentina, and highlight that population adherence to the CLCC recommendations will depend on complex and diverse factors, especially those involving changing unhealthy behaviours linked to cancer risk.
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Affiliation(s)
- Cecilia Straw
- Faculty of Social Sciences, University of Buenos Aires, Santiago del Estero 1029, Buenos Aires 1075, Argentina
- Centre for the Study of State and Society, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Victoria Sánchez Antelo
- Centre for the Study of State and Society/National Council for Scientific and Technical Research, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Melisa Paolino
- Centre for the Study of State and Society/National Council for Scientific and Technical Research, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Raúl Murillo
- San Ignacio University Hospital, Kra 7 40-62, Bogotá, Colombia
| | - Carolina Espina
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Silvina Arrossi
- Centre for the Study of State and Society/National Council for Scientific and Technical Research, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
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Sanchez Antelo V, Szwarc L, Paolino M, Saimovici D, Massaccesi S, Viswanath K, Arrossi S. A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina. JMIR Form Res 2022; 6:e32610. [PMID: 35023843 PMCID: PMC8796044 DOI: 10.2196/32610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective This study aims to understand HPV-tested women’s perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users’ needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions Providing information that meets women’s needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women.
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Affiliation(s)
- Victoria Sanchez Antelo
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucila Szwarc
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
| | - Diana Saimovici
- Centro de Estudios de Estado y Sociedad, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Massaccesi
- Secretaria de Salud de Ituzaingó, Instituto Provincial del Cáncer, Ministerio de Salud de la Provincia de Buenos Aires, Ituzaingo, Argentina
| | - Kasisomayajula Viswanath
- McGraw-Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
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Szwarc L, Sánchez Antelo V, Paolino M, Arrossi S. "I'm neither here, which would be bad, nor there, which would be good": the information needs of HPV+ women. A qualitative study based on in-depth interviews and counselling sessions in Jujuy, Argentina. Sex Reprod Health Matters 2021; 29:1991101. [PMID: 34779742 PMCID: PMC8604540 DOI: 10.1080/26410397.2021.1991101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The objective of this qualitative study was to explore the information needs of HPV+ women. We conducted 38 in-depth interviews with HPV+ women in the province of Jujuy, Argentina. The interviews included a counselling session to respond to women’s concerns and questions. Women perceived the information provided as good, despite having several doubts and misconceptions after receiving results of an HPV+ test. They expressed difficulties in formulating questions during the consultation due to shame, excess of information provided or lack of familiarity with technical language. They valued emotional support and being treated kindly by professionals. The perceived information needs that emerged as most important were: (1) the meaning of an HPV+ result and its relationship with cervical cancer evolution and severity; (2) continuity and timing of the care process; (3) information on the sexual transmission of the virus; (4) explanation of the presence or absence of symptoms. Women’s primary unperceived information needs were: (1) detailed information about colposcopy, biopsy and treatments and their effects (including fertility consequences); and (2) deconstructing the association of sexual transmission with infidelity. Sources of information included: (1) the health care system; (2) the internet; and (3) social encounters (close friends and relatives). It is crucial to strengthen the processes for delivering results, with more thorough information, improved emotional support and active listening focused on the patient, as well as to conceive new formats to provide information in stages and/or gradually, in order to facilitate women’s access to the health care system and the information they need.
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Affiliation(s)
- Lucila Szwarc
- Research Fellow, Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina. Correspondence:
| | | | - Melisa Paolino
- Researcher, Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Silvina Arrossi
- Senior Researcher, Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Bouvard V, Wentzensen N, Mackie A, Berkhof J, Brotherton J, Giorgi-Rossi P, Kupets R, Smith R, Arrossi S, Bendahhou K, Canfell K, Chirenje ZM, Chung MH, Del Pino M, de Sanjosé S, Elfström M, Franco EL, Hamashima C, Hamers FF, Herrington CS, Murillo R, Sangrajrang S, Sankaranarayanan R, Saraiya M, Schiffman M, Zhao F, Arbyn M, Prendiville W, Indave Ruiz BI, Mosquera-Metcalfe I, Lauby-Secretan B. The IARC Perspective on Cervical Cancer Screening. N Engl J Med 2021; 385:1908-1918. [PMID: 34758259 DOI: 10.1056/nejmsr2030640] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Véronique Bouvard
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Nicolas Wentzensen
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Anne Mackie
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Johannes Berkhof
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Julia Brotherton
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Paolo Giorgi-Rossi
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Rachel Kupets
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Robert Smith
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Silvina Arrossi
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Karima Bendahhou
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Karen Canfell
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Z Mike Chirenje
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Michael H Chung
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Marta Del Pino
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Silvia de Sanjosé
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Miriam Elfström
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Eduardo L Franco
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Chisato Hamashima
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Françoise F Hamers
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - C Simon Herrington
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Raúl Murillo
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Suleeporn Sangrajrang
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Rengaswamy Sankaranarayanan
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Mona Saraiya
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Mark Schiffman
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Fanghui Zhao
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Marc Arbyn
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Walter Prendiville
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Blanca I Indave Ruiz
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Isabel Mosquera-Metcalfe
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Béatrice Lauby-Secretan
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
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Paolino M, Firmenich B, Antelo VS, Cuberli M, Curotto M, Le Pera A, Arrossi S. Abstract 100: Implementation Fidelity of a HPV Self-Collection Strategy in Buenos Aires, Argentina. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: HPV self-collection (SC) has been proposed as a strategy to increase cervical cancer (CC) screening coverage among hard-to-reach women. However, evaluations of the implementation fidelity of this strategy in real-world contexts are scarce. The aim of the study was to evaluate the implementation fidelity of the core components of SC strategy (EMA strategy) in La Matanza, Buenos Aires, Argentina. We report preliminary results.
Methods: We carried out a descriptive study. The core components included: 1) Training: Two workshops delivered to health promoters (HP) including scientific data on CC prevention; 2) Offer of SC during home visits: HP provide women with information about CC prevention, and a 10-minute step-by-step explanation on how to perform SC, 3) Sample handling and transportation (SH&T): Sample collectors labeled with the woman's name and identifying number are transported at room temperature to the HPV laboratory (within 14 days) and 4) Follow-up of HPV+ women: cytology triage for HPV+ women. Data sources included: selfadministered questionnaires to evaluate knowledge acquired in the training (n=171), a structured checklist to evaluate offer of self-collection and SH&T (74 observations), and secondary data from the national screening information system (SITAM) to evaluate follow-up.. Quantitative analyses assessed whether activities were implemented as planned, using descriptive statistics.
Results: Training: 95% of HP participated in the two workshops. More than 90% had adequate knowledge about the strategy (score of more than 70% on questionnaire). Offer of self-collection: 47% offered SC during home visit and 53% in community health meetings and waiting rooms of primary health care centers. HP had less time than stipulated in the training to offer self-collection (mean: 8 minutes; range: 1-17 minutes), so fewer pieces of information were provided. 79% of eligible women accepted self-collection. Sample handling and transportation: More than 96% adhered to the standardized protocol. Follow-up of HPV+ women: 57% of HPV+ women had a triage test registered in SITAM.
Conclusion: The core components with the highest fidelity were Training and SH&T. We found adaptations in the offer of SC. Our results suggest that these adaptations do not affect the acceptability of SC. In addition, adherence to triage in the context of the SC strategy is a challenge.
Research for this publication was funded by National Cancer Institute (Argentina)- Asistencia Financiera a Proyectos
de Investigación en Cáncer de Origen Nacional IV. This protocol has been approved by the COMUBI Review Board
(Protocol number 36, Acta 3, Folio 150)
Citation Format: Melisa Paolino, Beatriz Firmenich, Victoria Sánchez Antelo, Milca Cuberli, Mirana Curotto, Anabella Le Pera, Silvina Arrossi. Implementation Fidelity of a HPV Self-Collection Strategy in Buenos Aires, Argentina [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 100.
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Affiliation(s)
- Melisa Paolino
- 1Centro de Estudios de Estado y Sociedad,
- 2Consejo Nacional de Investigaciones Científicas y Técnicas,
| | - Beatriz Firmenich
- 3Dirección de Formación Capacitación y Planificación de Recursos Humanos en Salud. Secretaría de Salud Pública de La Matanza,
| | | | - Milca Cuberli
- 4Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Ministerio de Salud de la Nació
| | - Mirana Curotto
- 4Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Ministerio de Salud de la Nació
| | | | - Silvina Arrossi
- 1Centro de Estudios de Estado y Sociedad,
- 2Consejo Nacional de Investigaciones Científicas y Técnicas,
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Antelo VS, Szwarc L, Frejdkes P, Paolino M, Saimovici D, Massaccesi S, Arrossi S. Abstract 97: Designing a Counseling App to Reduce the Psycho-Social Impact of HPV-Testing: A User-Centered Design Approach. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: HPV-testing detects sexually transmitted infection with oncogenic types of HPV. For many HPV+ women, this result has negative connotations, it produces anxiety, fear of cancer or death, and disease denial. While face-to-face counseling could present many difficulties in its implementation, a counseling mobile-app may help HPV+ women reduce the psychosocial impact of the result, improve their knowledge about HPV and CC and increase adherence to follow-up.
Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV+ women aged 30 and over, and four focus groups (FG) with a total of 19 participants through a virtual platform. We used a focus group guide to produce data for the information architecture (i.e., how to organize contents into features). We carried out thematic analysis using constructs from the Health Belief Model and Integrative Behavioral Model to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing.
Results: Preliminary results showed that participants needed more information regarding the procedures they had received; about what HPV+ means; what are the causes of HPV; if the HPV is present only in females; and if HPV has consequences on their sexuality. Also, we found that women's fear of the disease and death could increase after medical consultations. They had complaints when they had left the consultation with unanswered questions and misconceptions, such as believing that HPV+ is a synonym for cancer. Women accepted the App as a tool to get information and they agreed it can be useful to reduce fears related to HPV-positive results. They would use a mobile-app if the doctor or a health authority recommends it. They believe the app should provide information through videos, illustrations, or infographics, but not by pictures or only text. The app has to offer information on the next steps in the follow-up and medical appointment reminders.
Conclusion: Providing information that meets women's needs and counseling could be a way of reducing fears. A mobile-app seems to be an acceptable and suitable tool to provide support to HPV+ women.
Funding: This work was supported by a Conquer Cancer International Innovation Grant. Any opinions, findings, and conclusions expressed in this material are those of the author(s) and do not necessarily reflect those of the American Society of Clinical Oncology® or Conquer Cancer®.
Citation Format: Victoria Sanchez Antelo, Lucila Szwarc, Paula Frejdkes, Melisa Paolino, Diana Saimovici, Silvia Massaccesi, Silvina Arrossi. Designing a Counseling App to Reduce the Psycho-Social Impact of HPV-Testing: A User-Centered Design Approach [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 97.
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Affiliation(s)
| | - Lucila Szwarc
- 1Centro de Estudios de Estado y Sociedad,
- 2Consejo Nacional de Investigaciones Científicas y Técnicas,
| | | | - Melisa Paolino
- 1Centro de Estudios de Estado y Sociedad,
- 2Consejo Nacional de Investigaciones Científicas y Técnicas,
| | | | | | - Silvina Arrossi
- 1Centro de Estudios de Estado y Sociedad,
- 2Consejo Nacional de Investigaciones Científicas y Técnicas,
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Miguel-Majors SLS, Trimble EL, Lowy D, Lopez-Varon M, Baker E, Schmeler K, Arrossi S, Oliveira MTDC, Maza M, Montealegre JR, Salcedo MP, de Oliveira LH, Luciani S. Abstract 53: Promoting WHO's Cervical Cancer Elimination Goals ‘90-70-90' by Developing, Implementing, and Evaluating the ECHO Latin America (ECHO ELA) Program. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Cervical cancer is one of the leading causes of cancer deaths among women in some countries in the Region of the Americas.1 Cervical cancer is preventable through HPV vaccination, screening and treatment of precancerous lesions, and can be effectively treated if diagnosed early.2
Methods: Under the framework of the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, the US National Cancer Institute (NCI), the University of Texas MD Anderson Cancer Center (MD Anderson) and the Pan American Health Organization/World Health Organization (PAHO/WHO) partnered to develop ECHO Latin America (ECHO ELA). ECHO ELA is modeled on Project ECHO® (Extension of Community Healthcare Outcomes) a hub-and-spoke knowledge-sharing approach where expert teams lead virtual didactic lectures and case discussions, amplifying the capacity for participants to deliver best practice programs to their regions. ECHO ELA consists of monthly, Spanish-language telementoring conferences about cervical cancer prevention and control. The program targets Ministries of Health, Immunization Program Managers and key cervical cancer stakeholders in Latin American (LA) countries. Its primary goal is to assist countries in reaching their WHO cervical cancer elimination goals “90-70-90:” vaccinating 90 percent of girls against HPV by the age of 15, screening 70 percent of women for cervical cancer at ages 35 and 45, and treating 90 percent of women diagnosed with pre-invasive cervical lesions or cervical cancer.
Results: To date, 222 participants from 21 countries have registered. Seven sessions have been held averaging 93 participants per session. 85 participants completed the baseline survey addressing priorities, capacity, and desired outcomes. Baseline, mid-year evaluation results, within the COVID-19 context, and learned lessons will be presented.
Conclusion: ECHO ELA is potentially an effective tool to convene participants from multiple countries to enhance collaboration and support countries' progress towards the elimination of cervical cancer in the Americas.
Citation Format: Sandra L. San Miguel-Majors, Edward L. Trimble, Doug Lowy, Melissa Lopez-Varon, Ellen Baker, Kathleen Schmeler, Silvina Arrossi, Maria Tereza da Costa Oliveira, Mauricio Maza, Jane R. Montealegre, Mila P. Salcedo, Lucia Helena de Oliveira, Silvana Luciani. Promoting WHO's Cervical Cancer Elimination Goals ‘90-70-90' by Developing, Implementing, and Evaluating the ECHO Latin America (ECHO ELA) Program [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 53.
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Affiliation(s)
| | | | | | | | - Ellen Baker
- 2The University of Texas MD Anderson Cancer Center,
| | | | - Silvina Arrossi
- 3Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnica,
| | | | | | | | | | | | - Silvana Luciani
- 4the Pan American Health Organization/World Health Organization,
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Arrossi S, Paolino M, Laudi R, Thouyaret L. Changing the paradigm of cervical cancer prevention through introduction of HPV-testing: evaluation of the implementation process of the Jujuy Demonstration Project in Argentina. Ecancermedicalscience 2021; 15:1199. [PMID: 33889208 PMCID: PMC8043686 DOI: 10.3332/ecancer.2021.1199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The Jujuy Demonstration Project (JDP) was a project carried out over the course of 4 years (2011–2014) to develop, implement and evaluate the programmatic components of a Human Papilloma Virus (HPV)-based screening programme in Argentina. The aim of this paper is to present a qualitative evaluation of the context and implementation process of the JDP. Methods We used an adaptation of the Health System Framework (HSF), which includes interconnected contextual factors that are considered key drivers for successful health interventions. We reviewed secondary documents, which included scientific reports, norms and regulations, information sheets, power point presentations and manuals and recommendations published by the National Programme for Cervical Cancer Prevention. We also carried out semi-structured interviews with key informants to explore their views about technology acceptability. Results Key components of the JDP implementation process were: a high level of political support and consensus among stakeholders, the demonstrated effectiveness of the technology and its acceptability by health authorities and providers, the funding of tests and diagnosis/treatment services, the implementation of an information system for monitoring and evaluation and the reorganisation of the network of screening, diagnosis and treatment services. Conclusion This analysis examines the policy context in which the JDP was implemented and the system components that were key for the demonstrated effectiveness of the strategy. Such analyses provide useful insights into core components of HPV testing implementation that are needed to guarantee its potential effectiveness to reduce cervical cancer incidence and mortality.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Rosa Laudi
- Hospital Ramos Mejía, Urquiza 609, Buenos Aires 1221, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Buenos Aires 1067, Argentina
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Gravitt PE, Silver MI, Hussey HM, Arrossi S, Huchko M, Jeronimo J, Kapambwe S, Kumar S, Meza G, Nervi L, Paz-Soldan VA, Woo YL. Achieving equity in cervical cancer screening in low- and middle-income countries (LMICs): Strengthening health systems using a systems thinking approach. Prev Med 2021; 144:106322. [PMID: 33678230 DOI: 10.1016/j.ypmed.2020.106322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 01/01/2023]
Abstract
The World Health Organization (WHO) is leading a call to action to eliminate cervical cancer by the end of the century through global implementation of two effective evidence-based preventive interventions: HPV vaccination and cervical screening and management (CSM). Models estimate that without intervention, over the next 50 years 12.2 million new cases of cervical cancer will occur, nearly 60% of which are preventable only through CSM. Given that more than 80% of the cervical cancer occurs in low- and middle-income countries (LMICs), scaling up sustainable CSM programs in these countries is a top priority for achieving the global elimination goals. Multiple technologies have been developed and validated to meet this need. Now it is critical to identify strategies to implement these technologies into complex, adaptive health care delivery systems. As part of the coordinated cervical cancer elimination effort, we applied a systems thinking lens to reflect on our experiences with implementation of HPV-based CSM programs using the WHO health systems framework. While many common health system barriers were identified, the effectiveness of implementation strategies to address them was context dependent; often reflecting differences in stakeholder's belief in the quality of the evidence supporting a CSM algorithm, the appropriateness of the evidence and algorithm to context, and the 'implementability' of the algorithm under realistic assessments of resource availability and constraints. A structured planning process, with early and broad stakeholder engagement, will ensure that shared-decisions in CSM implementation are appropriately aligned with the culture, values, and resource realities of the setting.
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Affiliation(s)
- Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Heather M Hussey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Megan Huchko
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | | | - Graciela Meza
- Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | - Laura Nervi
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Valerie A Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Paolino M, Gago J, Pera AL, Cinto O, Thouyaret L, Arrossi S. Adherence to triage among women with HPV-positive self-collection: a study in a middle-low income population in Argentina. Ecancermedicalscience 2020; 14:1138. [PMID: 33281930 PMCID: PMC7685770 DOI: 10.3332/ecancer.2020.1138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Screening for cervical cancer (CC) prevention has substantially changed with the introduction of human papillomavirus (HPV) tests. This technology compared to cytology has increased the detection of pre-malignant and malignant cervical lesions in real-world programmes in different settings. Very importantly, through self-collection, HPV testing can reduce barriers to screening and increase coverage. However, when using HPV self-collection, triage tests are a key step in the CC prevention process, and high adherence to triage has been difficult to obtain in low-middle income settings. The aim of this study was to measure adherence to triage among women with HPV+ self-collection and analysed factors associated with this adherence in a middle-low resource setting in Argentina. We also evaluated key indicators related to the implementation of the HPV self-collection strategy. Methods We analysed data on screening/triage/diagnosis/treatment from women aged 30+ who performed self-collection between 2015 and 2017 (n = 15,763), in the public health system in Tucuman, Argentina. We analysed secondary data from the national screening information system. The primary outcomes were: 1) adherence to cytology triage within the recommended timeframe (120 days) and 2) overall adherence to cytology triage including data at 18 months after screening. Multivariable regression was used to examine the association between age group, year of the screening test, record of the previous Pap-based screening and health insurance status with adherence to triage test as a primary outcome. We reported odds ratios, 95% confidence intervals and p-value of 0.05, which was considered the threshold for p-values). Results We analysed data of 2,389 HPV+ women. The overall adherence to triage at 18 months was 42.9%. The percentage of women completing cytology triage within the recommended timeframe of 120 days was lower (25.2%). Women with the record of a previous Pap-based screening had 1.86 times the odds of having a triage compared to women without a record of a previous Pap-based screening (95% CI: 1.64–2.64, p <0.001). Furthermore, the probability of having triage at the recommended timeframe was higher among women who were older and women with public health insurance. Conclusions Our results showed that adherence to triage in the recommended timeframe was low. In addition, the probability of having triage at the recommended timeframe was higher among women with a record of a previous Pap-based screening, a proxy of the use of health services. Our results showed that adherence to triage in the context of the HPV-self-collection strategy is challenging. The implementation of alternative approaches that might facilitate adherence to triage should be further investigated.
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Affiliation(s)
- Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-8649-1570
| | - Juan Gago
- Department of Population Health, School of Medicine, New York University (NYU), 550 1st Avenue, New York, NY 10016, USA
| | - Anabella Le Pera
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Oscar Cinto
- Ministerio de Salud Pública de Tucumán, Av. República del Líbano 956, San Miguel de Tucumán, Tucumán, Argentina.,Retired
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Piso 9, Buenos Aires 1067, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-5071-0938
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Burrone MS, Reginatto G, Solís-Soto MT, Basagoitia A, Irarrázaval M, Rincón P, Ramos S, Arrossi S. Coronavirus e impacto psicosocial en Chile. Rev Med Chil 2020; 148:1224-1226. [DOI: 10.4067/s0034-98872020000801224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arrossi S, Almonte M, Herrero R, Gago J, Sánchez Antelo V, Szwarc L, Thouyaret L, Paolino M, Wiesner C. Psycho-social impact of positive human papillomavirus testing in Jujuy, Argentina results from the Psycho-Estampa study. Prev Med Rep 2020; 18:101070. [PMID: 32257775 PMCID: PMC7113430 DOI: 10.1016/j.pmedr.2020.101070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Human papillomavirus (HPV) testing can have a negative impact on women's lives which might also result in abandoning the follow-up and treatment process. This study measured the psycho-social impact of HPV-positivity among HPV-tested women from Jujuy, Argentina, a middle-low income setting. In this cross-sectional study (2015-2016), the psycho-social impact of HPV-positivity was measured using the Psycho-Estampa Scale, specifically designed and validated to be used in screening contexts. We measured mean scores for each of the five scale domains, and the Overall Impact score (Values from 1: No impact to 4: Heavy impact). We compared scores according to cytology triage diagnosis using ordinal logistic regression. A total of 163 HPV-positive women were recruited at the Centro Carlos Alvarado hospital and included in the study sample; of these, 124 (76.1%) had normal triage cytologies. The overall Impact score was between low and moderate (mean:2.56, SD:0.65). The highest psycho-social impact was measured in the Worries about cancer and treatment domain (mean score:3.60, SD:0.60), followed by Sexuality domain (mean:2.50; SD:1.00). The Uncertainty about information provided by health providers domain had the lowest mean score (mean:2.14, SD:0.73). Compared to women with normal cytologies (n = 124), women with abnormal cytologies (n = 39) had a higher likelihood of greater overall Psycho-social Impact (OR: 2.91; p = 0.0036). No statistically significant differences were found in scores of specific domains according to cytology results. It is important to devise specific counseling interventions to reduce the psycho-social impact of HPV-Testing as primary screening and its potential effect on completion of the diagnosis/ treatment process.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Maribel Almonte
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Rolando Herrero
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Juan Gago
- New York University-NYU, School of Medicine, USA
| | | | - Lucila Szwarc
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Av. Julio A. Roca 781, Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Carolina Wiesner
- Instituto Nacional de Cancerología, Calle 1 No.9-85, Bogotá, Colombia
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Arrossi S. Abstract IA13: Introduction of HPV self-collection in Argentina, main results, and lessons. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-ia13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV self-collection could increase screening coverage, but implementation of this technology is difficult in countries with low-income settings. In Argentina, during 2012-2014 we implemented the Jujuy Demonstration (JDP) to introduce HPV testing as primary screening. As part of the JDP, we investigated whether offering HPV self-collection during routine home visits by community health workers could increase cervical screening.
Methods: We describe the programmatic components developed for each phase of HPV self-collection implementation as well as present data about its performance to detect CIN2+ lesions. For that we analyzed data from the national screening information system (SITAM); we reviewed program documents, presentations, and reports; and we also analyzed qualitative/quantitative data about HPV self-collection acceptability by women and health providers.
Results: Acceptability and effectiveness of HPV self-collection to increase screening-uptake was evaluated in a research project (The EMA Project) carried out in 2012 in the province of Jujuy. The project combined qualitative research with a Cluster Randomized Trial. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). Results showed that HPV-self collection was accepted by women and health providers, and effective to increase screening uptake (risk ratio 4·02, 95% CI 3·44–4·71). HPV-testing CIN2+ detection rate was 1.15%. Results from the EMA Project were used to design and develop key components of the scaling-up phase (training and communication materials, protocols, and guidelines). In 2014 HPV self-collection was extended to the whole province as a strategy to increase screening among socially vulnerable women. It was offered by 70% of the 700 provincial community health workers. Facilitators of self-collection scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. In 2014, self-collection represented 38% of total HPV testing and, if we consider the whole JDP, 10% of screening in the target population was achieved through self-collection. CIN2+ detection rate of HPV self-collection when used as a programmatic strategy was 0.6%; this decrease in relation to the detection rate found in the EMA Project is probably explained by a loss to follow-up.
Conclusion: HPV self-collection was successfully scaled up, with a high level of adoption among health providers, which resulted in increased screening among socially vulnerable underscreened women.
Citation Format: Silvina Arrossi. Introduction of HPV self-collection in Argentina, main results, and lessons [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA13.
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Almonte M, Murillo R, Sánchez GI, González P, Ferrera A, Picconi MA, Wiesner C, Cruz-Valdez A, Lazcano-Ponce E, Jerónimo J, Ferreccio C, Kasamatsu E, Mendoza L, Rodríguez G, Calderón A, Venegas G, Villagra V, Tatti S, Fleider L, Terán C, Baena A, Hernández MDLL, Rol ML, Lucas E, Barbier S, Ramírez AT, Arrossi S, Rodríguez MI, González E, Celis M, Martínez S, Salgado Y, Ortega M, Beracochea AV, Pérez N, Rodríguez de la Peña M, Ramón M, Hernández-Nevarez P, Arboleda-Naranjo M, Cabrera Y, Salgado B, García L, Retana MA, Colucci MC, Arias-Stella J, Bellido-Fuentes Y, Bobadilla ML, Olmedo G, Brito-García I, Méndez-Herrera A, Cardinal L, Flores B, Peñaranda J, Martínez-Better J, Soilán A, Figueroa J, Caserta B, Sosa C, Moreno A, Mural J, Doimi F, Giménez D, Rodríguez H, Lora O, Luciani S, Broutet N, Darragh T, Herrero R. Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol. BMJ Open 2020; 10:e035796. [PMID: 32448795 PMCID: PMC7252979 DOI: 10.1136/bmjopen-2019-035796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT01881659.
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Affiliation(s)
- Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Raúl Murillo
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Paula González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | | | | | | | | | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Silvio Tatti
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - María de la Luz Hernández
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- SMS-Oncology, Amsterdam, The Netherlands
| | - Mary Luz Rol
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Sylvaine Barbier
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Arianis Tatiana Ramírez
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - María Isabel Rodríguez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Andrea Verónica Beracochea
- Centro de Salud Ciudad de la Costa, ASSE, Ciudad de la Costa, Uruguay
- Hospital Policial, DNASS, Montevideo, Uruguay
| | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
| | | | | | | | | | - Yessy Cabrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - María Celeste Colucci
- Instituto Nacional de Enfermedades Infecciosas - ANLIS Malbrán, Buenos Aires, Argentina
| | | | | | | | - Gladys Olmedo
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Betsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Jhacquelin Peñaranda
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | | | - Benedicta Caserta
- Departamento de Anatomía Patológica y Citología, Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Carlos Sosa
- Hospital Monseñor Víctor Manuel Sanabria Martínez, CCSS, Puntarenas, Costa Rica
| | - Adrián Moreno
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Juan Mural
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Hernando Rodríguez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
- Hospital Gineco-Obstétrico y Neonatal "Dr Jaime Sánchez Porcel", Sucre, Bolivia
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, District of Columbia, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, California, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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Arrossi S. Access to treatment in the Jujuy Demonstration Project. Lancet Glob Health 2020; 7:e1015-e1016. [PMID: 31303291 DOI: 10.1016/s2214-109x(19)30269-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Silvina Arrossi
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires 1173, Argentina.
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Sanchez Antelo V, Kohler RE, Curotto M, Viswanath KV, Paolino M, Arrossi S. Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study. JMIR Form Res 2020; 4:e14652. [PMID: 32032940 PMCID: PMC7084289 DOI: 10.2196/14652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage.
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Affiliation(s)
| | - Racquel E Kohler
- Cancer Health Equity, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Mariana Curotto
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Kasisomayajula Vish Viswanath
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States.,McGraw-Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Arrossi S, Paolino M, Laudi R, Gago J, Campanera A, Marín O, Falcón C, Serra V, Herrero R, Thouyaret L. Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study. Lancet Glob Health 2019; 7:e772-e783. [PMID: 31097279 DOI: 10.1016/s2214-109x(19)30048-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011-14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection was introduced as a programmatic strategy in 2014. We aimed to evaluate the effectiveness of programmatic HPV testing to detect cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) in comparison with cytology-based screening. METHODS We did a population-based, before-and-after retrospective cohort study using data from the National Cervical Cancer Prevention Program for the Jujuy province in northwest Argentina. We obtained data for the cytology-based screening period from Jan 1, 2010, until Dec 31, 2011, and for the HPV-based screening period from Jan 1, 2012, until Dec 31, 2014. The primary outcome was detection of histologically diagnosed CIN2+ among women aged 30 years and older. To assess the outcomes in all individuals included in the study, we used multivariable logistic regression and propensity score matching. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used for the before-and-after analysis of programmatic dimensions. FINDINGS Of the 29 631 women who underwent cytology-based screening in 2010-11, CIN2+ was detected in 236 (0·8%) individuals. Of the 49 565 women HPV tested in 2012-14 (clinician-collected tests, n=44 700; self-collection tests, n=4865), 693 (1·4%; 658 clinician-collected tests; 35 self-collection tests) were found to have CIN2+ after the first round of screening. Compared with cytology-based screening, the odds ratio of being diagnosed with a CIN2+ lesion was 2·34 (95% CI 2·01-2·73; p<0·0010) with clinician-collected tests, and 1·08 (0·74-1·52; p=0·68) when screened with self-collection tests, after controlling for age and health insurance status. Screening coverage was similar in both periods (52·7% vs 53·2%); improvements of programmatic indicators were observed in the HPV testing period in relation to laboratory centralisation, lower overscreening (6·6% vs 0·0%), higher adherance to age recommendations (79·3% vs 98·8%), and a decrease of inadequate samples (3·6% vs 0·2%). INTERPRETATION HPV testing in middle-income settings increases detection of CIN2+ lesions and allows for improvement of programmatic indicators. Evidence suggests that the introduction of HPV testing will accelerate the reduction of cervical cancer burden. FUNDING Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Rosa Laudi
- Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Juan Gago
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy, Argentina
| | - Oscar Marín
- Hospital Pablo Soria, San Salvador de Jujuy, Argentina
| | | | - Verónica Serra
- Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy, Argentina
| | | | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
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Cazap E, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Gil E, Hassel T, Mayorga R, Mohar A, Murillo R, Owen GO, Paonessa D, Santamaría J, Tortolero-Luna G, Zoss W, Herrero R, Luciani S, Schüz J, Espina C. Latin America and the Caribbean Code Against Cancer: Developing Evidence-Based Recommendations to Reduce the Risk of Cancer in Latin America and the Caribbean. J Glob Oncol 2019; 5:1-3. [PMID: 31246551 PMCID: PMC6613664 DOI: 10.1200/jgo.19.00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/21/2023] Open
Affiliation(s)
- Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Liz Maria de Almeida
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | | | - María Luisa Garmendia
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Enrique Gil
- Subregional Program for South America Pan-American Health Organization, Lima, Perú
| | - Trevor Hassel
- Healthy Caribbean Coalition, Caribbean Catalyst, St Michael, Barbados
| | - Rubén Mayorga
- Subregional Program for South America Pan-American Health Organization, Lima, Perú
| | - Alejandro Mohar
- Unidad de Investigación Biomédica, Instituto Nacional de Cancerología UNAM, Tlalpan, México
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Gabriel O. Owen
- Healthy Caribbean Coalition, Caribbean Catalyst, St Michael, Barbados
| | - Diego Paonessa
- Liga Argentina de Lucha Contra el Cáncer, Buenos Aires, Argentina
| | | | | | - Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cancer, Rio de Janeiro, Brasil
| | - Rolando Herrero
- Agencia Internacional para la Investigación del Cáncer, International Agency for Research on Cancer/WHO, Lyon, France
| | | | - Joachim Schüz
- Agencia Internacional para la Investigación del Cáncer, International Agency for Research on Cancer/WHO, Lyon, France
| | - Carolina Espina
- Agencia Internacional para la Investigación del Cáncer, International Agency for Research on Cancer/WHO, Lyon, France
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Gago J, Paolino M, Arrossi S. Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina. BMC Cancer 2019; 19:367. [PMID: 31014287 PMCID: PMC6480915 DOI: 10.1186/s12885-019-5583-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cervical Cancer is still a major public health challenge in low and middle-income countries. HPV testing has been an innovative approach, which was introduced in Argentina for women aged 30+ through the Jujuy Demonstration Project (JDP) carried out between 2012 and 2014. After a positive HPV-test, cytology is used as triage method. Under this protocol, the group of women with HPV+ and normal cytology are recommended to repeat the test within 12-18 months. Studies have shown that this group has increased risk of CIN2+, however, assuring high levels of repeating test among these women is difficult to achieve. We analyze those factors associated with lower re-test attendance among HPV+/ cytology negative women at a programmatic level in low-middle income settings. METHODS We used data of women aged 30+ HPV-tested in the JDP and followed until 2018 (n = 49,565). We performed a set of different adjusted logistic regression models. Primary outcomes were re-test attendance and re-test attendance within recommended timeframe. We assessed as covariates age, health insurance status, year of HPV-testing, Pap testing in the past 3 years, HPV-testing modality (clinician-collected (CC) tests/self-collected (SC) tests), and span between HPV-test collection and report of results. RESULTS Forty nine thousand five hundred sixty five women were HPV-tested and 6742 had a positive HPV-test. Among HPV+ women, a total of 4522 were HPV+/Cytology negative (67.1%). In total, 3172 HPV+/Cytology negative women (70.1%) had a record of a second HPV test as of March 2018. Only 1196 women (26%) completed the second test within the timeframe. Women with no record of a previous Pap (OR: 0.46, 95% CI: 0.4-0.53, p < 0.001), aged 64+ (OR: 0.46, 95% CI: 0.31-0.68, p < 0.001) were less likely to be retested; while women with clinician-collected samples had higher odds of being re-tested (OR: 1.42, 95% CI: 1.06-1.91, p < 0.001). CONCLUSIONS Low re-test rates were found in HPV +/ normal cytology women. Tailored interventions are needed to increase the effectiveness of the screening in this group, especially for those women with characteristics associated to lower attendance.
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Affiliation(s)
- Juan Gago
- Programa Nacional de Prevención de Cancer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 7, Buenos Aires, Argentina
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, Argentina
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Arrossi S, Paolino M, Orellana L, Thouyaret L, Kohler RE, Viswanath K. Mixed-methods approach to evaluate an mHealth intervention to increase adherence to triage of human papillomavirus-positive women who have performed self-collection (the ATICA study): study protocol for a hybrid type I cluster randomized effectiveness-implementation trial. Trials 2019; 20:148. [PMID: 30808379 PMCID: PMC6390557 DOI: 10.1186/s13063-019-3229-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/29/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer is one of the leading causes of cancer death among women worldwide, with more than 85% of cases occurring in low- and middle-income countries. Human papillomavirus (HPV) screening allows for self-collection with the potential to increase coverage, but still requires triage to identify which HPV+ women need diagnostic and treatment procedures. However, achieving high levels of triage adherence can be challenging, especially among socially vulnerable women. This paper describes the ATICA protocol (Application of Communication and Information Technologies to Self-Collection, for its initials in Spanish), aimed at evaluating the implementation strategy and the effectiveness of a multi-component mobile health (mHealth) intervention to increase adherence to triage among women with HPV+ self-collected tests. METHODS We will use an effectiveness-implementation hybrid type I trial with a mixed-methods evaluation approach. A cluster randomized trial design including 200 community health workers (CHWs) will evaluate whether the mHealth intervention increases adherence to triage among HPV+ women who self-collected at home during a CHW visit within 120 days after a positive result. The intervention includes an initial mobile phone text message (SMS) alert and subsequent reminders sent to HPV+ women. For those who do not adhere to triage within 60 days of a positive HPV test, an email and SMS will be sent to the CHWs to promote contact with these women during home visits. We will use the Consolidated Framework for Implementation Research (CFIR) as an organizing and analytic framework to evaluate the implementation of the intervention while also drawing on Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM). We will conduct a self-administered, semi-structured survey of CHWs, semi-structured interviews with local health authorities, and a survey of HPV+ women. Combining both qualitative and quantitative data will provide rich insights into local implementation challenges and successes. DISCUSSION Findings from the implementation evaluation will be applicable to programs that use or are planning to incorporate HPV self-collection and/or mHealth interventions in different settings and countries. This innovative study will also serve as a model for using implementation science in the region. TRIAL REGISTRATION ClinicalTrials.gov, NCT03478397 . Registered on 20 March 2018.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas Sociedad, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, 1067 Buenos Aires, Argentina
| | - Racquel E. Kohler
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
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Arrossi S. El impacto de la prueba de VPH en los programas de tamizaje en América Latina: el caso de Argentina. ACTA ACUST UNITED AC 2018; 61:86-94. [DOI: 10.21149/9257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 09/04/2018] [Indexed: 11/06/2022]
Abstract
Objetivo. Evaluar el impacto de la prueba de VPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba de VPH en Jujuy (PDJ), Argentina. Material y métodos. Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. Resultados. El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de tamizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. Conclusiones. La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.
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Curotto M, Zalacaín-Colombo J, Paolino M, Arrossi S. [Adoption and implementation of HPV self-collection sampling by CHWs in Jujuy, Argentina]. Salud Publica Mex 2018; 60:674-682. [PMID: 30138554 DOI: 10.21149/8854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/08/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered doorto-door by Community Health Workers CHWs) in Jujuy, Argentina. MATERIALS AND METHODS A self-administered questionnaire was applied to 478 CHWs.RE-AIM model was used to evaluate adoption and implementation dimensions. RESULTS Adoption:81.8% offered SC and 86.4% were satis- fied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%).Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. CONCLUSIONS The adoption of SC strategy was high among CHWs.Program strategiesshould be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.
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Affiliation(s)
- Mariana Curotto
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Ministerio de Salud de la Nación. Buenos Aires, Argentina
| | - Julieta Zalacaín-Colombo
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Ministerio de Salud de la Nación. Buenos Aires, Argentina
| | - Melisa Paolino
- Consejo Nacional de Investigaciones Científicas yTécnicas, Centro de Estudios de Estado y Sociedad. Buenos Aires, Argentina
| | - Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas yTécnicas, Centro de Estudios de Estado y Sociedad. Buenos Aires, Argentina
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Arrossi S, Temin S, Garland S, Eckert LO, Bhatla N, Castellsagué X, Alkaff SE, Felder T, Hammouda D, Konno R, Lopes G, Mugisha E, Murillo R, Scarinci IC, Stanley M, Tsu V, Wheeler CM, Adewole IF, de Sanjosé S. Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline. J Glob Oncol 2017; 3:611-634. [PMID: 29094100 PMCID: PMC5646902 DOI: 10.1200/jgo.2016.008151] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To provide resource-stratified (four tiers), evidence-based recommendations on the primary prevention of cervical cancer globally. METHODS The American Society of Clinical Oncology convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (consensus ratings group) for one round of formal ratings. RESULTS Existing sets of guidelines from five guideline developers were identified and reviewed; adapted recommendations formed the evidence base. Five systematic reviews, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75%. RECOMMENDATIONS In all resource settings, two doses of human papillomavirus vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. Individuals with HIV positivity should receive three doses. Maximal and enhanced settings: if girls are age ≥ 15 years and received their first dose before age 15 years, they may complete the series; if no doses were received before age 15 years, three doses should be administered; in both scenarios, vaccination may be through age 26 years. Limited and basic settings: if sufficient resources remain after vaccinating girls age 9 to 14 years, girls who received one dose may receive additional doses between age 15 and 26 years. Maximal, enhanced, and limited settings: if ≥ 50% coverage in the priority female target population, sufficient resources, and cost effectiveness, boys may be vaccinated to prevent other noncervical human papillomavirus-related cancers and diseases. Basic settings: vaccinating boys is not recommended. It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
- Silvina Arrossi
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Sarah Temin
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Suzanne Garland
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Linda O'Neal Eckert
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Neerja Bhatla
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Xavier Castellsagué
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Sharifa Ezat Alkaff
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Tamika Felder
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Doudja Hammouda
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Ryo Konno
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Gilberto Lopes
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Emmanuel Mugisha
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Rául Murillo
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Isabel C Scarinci
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Margaret Stanley
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Vivien Tsu
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Cosette M Wheeler
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Isaac Folorunso Adewole
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
| | - Silvia de Sanjosé
- , Instituto Nacional del Cancer, Buenos Aires, Argentina; , American Society of Clinical Oncology, Alexandria, VA; , University of Melbourne, Melbourne, Victoria, Australia; , University of Washington; , PATH, Seattle, WA; , All India Institute of Medical Sciences, New Delhi, India; and , Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; , Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; , Cervivor, Upper Marlboro, MD; , Institut National de Santé Publique, Algiers, Algeria; , Jichi Medical University, Saitama Medical Center, Saitama, Japan; , Sylvester Comprehensive Cancer Center, Miami, FL; , PATH, Kampala, Uganda; , International Agency for Research on Cancer, Lyon, France; , University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; , University of Cambridge, Cambridge, United Kingdom; , University of New Mexico, Albuquerque, NM; and , Ministry of Health, Abuja, Nigeria
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Drummond JL, Were MC, Arrossi S, Wools-Kaloustian K. Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities. Int J Gynaecol Obstet 2017; 138 Suppl 1:33-40. [DOI: 10.1002/ijgo.12192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer L. Drummond
- National Foundation for the Centers for Disease Control and Prevention; Atlanta GA USA
| | - Martin C. Were
- Department of Biomedical Informatics; Vanderbilt University; Nashville TN USA
- Department of Medicine; Vanderbilt University; Nashville TN USA
- Vanderbilt Institute for Global Health; Nashville TN USA
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y técnicas; Buenos Aires Argentina
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Curotto M, Barletta P, Paolino M, Arrossi S. [Health agents' perspective on the incorporation of self-collected samples in HPV screening programs]. CAD SAUDE PUBLICA 2017; 33:e00138515. [PMID: 28591374 DOI: 10.1590/0102-311x00138515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 06/13/2016] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to analyze health agents' perception of self-collecting of samples for HPV testing among women and the degree of agreement by the agents to incorporate this approach into their daily tasks. A self-administered questionnaire was applied to 127/191 health agents that participated in the EMA Project (Proyecto Evaluación Modalidad Autotoma) in the province of Jujuy, Argentina, in 2012-2013. The health agents with and without the experience of offering self-collected sampling expressed a high degree of agreement towards adoption of the strategy (78.7%), given its potential to prevent cervical cancer and its contribution to health care for the women under their coverage. However, the health agents identified the extra work and problems linking to the formal health system as the main barriers to offering this modality in the future. The study found that self-collecting of samples is a practice that can be adopted by health agents in the province of Jujuy, but that it should be accompanied by support measures from the formal health system.
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Affiliation(s)
- Mariana Curotto
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Paula Barletta
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Melisa Paolino
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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de Sanjosé S, Temin S, Garland S, Eckert LO, Arrossi S. Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline Summary. J Oncol Pract 2017; 13:452-457. [PMID: 28541789 DOI: 10.1200/jop.2017.021949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Silvia de Sanjosé
- CIBER Epidemiología y Salud Pública, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; American Society of Clinical Oncology, Alexandria, VA; University of Melbourne, Melbourne, Australia; University of Washington, Seattle, WA; and Instituto Nacional del Cancer, Buenos Aires, Argentina
| | - Sarah Temin
- CIBER Epidemiología y Salud Pública, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; American Society of Clinical Oncology, Alexandria, VA; University of Melbourne, Melbourne, Australia; University of Washington, Seattle, WA; and Instituto Nacional del Cancer, Buenos Aires, Argentina
| | - Suzanne Garland
- CIBER Epidemiología y Salud Pública, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; American Society of Clinical Oncology, Alexandria, VA; University of Melbourne, Melbourne, Australia; University of Washington, Seattle, WA; and Instituto Nacional del Cancer, Buenos Aires, Argentina
| | - Linda O'Neal Eckert
- CIBER Epidemiología y Salud Pública, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; American Society of Clinical Oncology, Alexandria, VA; University of Melbourne, Melbourne, Australia; University of Washington, Seattle, WA; and Instituto Nacional del Cancer, Buenos Aires, Argentina
| | - Silvina Arrossi
- CIBER Epidemiología y Salud Pública, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; American Society of Clinical Oncology, Alexandria, VA; University of Melbourne, Melbourne, Australia; University of Washington, Seattle, WA; and Instituto Nacional del Cancer, Buenos Aires, Argentina
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Arrossi S, Paolino M, Thouyaret L, Laudi R, Campanera A. Evaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentina. Implement Sci 2017; 12:17. [PMID: 28193227 PMCID: PMC5307871 DOI: 10.1186/s13012-017-0548-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/03/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Self-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women. METHODS We used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy. RESULTS HPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% (n = 5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period (p < 0.0001). IMPLEMENTATION Training about the strategy was provided to 84.2% (n = 609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% (n = 320) had follow-up procedures. Of 113 women with positive triage, 66.4% (n = 75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women (n = 21/26). Adoption: Of trained CHWs, 69.3% (n = 422/609) had at least one woman with self-collection; 85.2% (n = 315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection. CONCLUSIONS The strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, 1193 Argentina
| | - Melisa Paolino
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Julio A. Roca 781, Buenos Aires, 1067 Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Julio A. Roca 781, Buenos Aires, 1067 Argentina
| | - Rosa Laudi
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Julio A. Roca 781, Buenos Aires, 1067 Argentina
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, Av. Italia esq. Independencia, San Salvador de Jujuy, 4600 Argentina
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Arrossi S, Ramos S, Straw C, Thouyaret L, Orellana L. HPV testing: a mixed-method approach to understand why women prefer self-collection in a middle-income country. BMC Public Health 2016; 16:832. [PMID: 27538390 PMCID: PMC4990977 DOI: 10.1186/s12889-016-3474-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 08/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background HPV test self-collection has been shown to reduce barriers to cervical screening and increase uptake. However, little is known about women’s preferences when given the choice between self-collected and clinician-collected tests. This paper aims to describe experiences with HPV self-collection among women in Jujuy, the first Argentinean province to have introduced HPV testing as the primary screening method, provided free of cost in all public health centers. Methods Between July and December 2012, data on acceptability of HPV self-collection and several social variables including past screening were collected from 2616 self-collection accepters and 433 non-accepters, and were analyzed using multivariate regression. In addition, in-depth interviews (n = 30) and 2 focus groups were carried out and analyzed using thematic analysis. Results Quantitative findings indicate that main reasons for choosing self-collection are those reducing barriers related to women’s roles of responsibility for domestic work and work/family organization, and to health care services’ organization. No social variables were significantly associated with acceptability. Among those who preferred clinician-collection, the main reasons were trust in health professionals and fear of hurting themselves. Qualitative findings also showed that self-collection allows women to overcome barriers related to the health system (i.e. long wait times), without sacrificing time devoted to work/domestic responsibilities. Conclusions Findings have implications for self-collection recommendations, as they show it is the preferred method when women are given the choice, even if they are not screening non-attenders. Findings also highlight the importance of incorporating women’s needs/preferences in HPV screening recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3474-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas/(CEDES/CONICET), Sánchez de Bustamante 27, C1173AAA, Buenos Aires, Argentina.
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad (CEDES), Sánchez de Bustamante 27, C1173AAA, Buenos Aires, Argentina
| | - Cecilia Straw
- Universidad de Buenos Aires, Facultad de Ciencias Sociales (Buenos Aires, Argentina)/ Centro de Estudios de Estado y Sociedad (CEDES), Sánchez de Bustamante 27, C1173AAA, Buenos Aires, Argentina
| | - Laura Thouyaret
- Instituto Nacional del Cáncer- Ministerio de Salud de la Nación (INC-MSAL), Av. Julio A. Roca 781, C1067ABP, Buenos Aires, Argentina
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, 3148, VIC, Australia
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Herrero MB, Arrossi S, Ramos S, Braga JU. Social determinants of nonadherence to tuberculosis treatment in Buenos Aires, Argentina. CAD SAUDE PUBLICA 2015; 31:1983-94. [PMID: 26578022 DOI: 10.1590/0102-311x00024314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/30/2015] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify the individual and environmental determinants of nonadherence to tuberculosis (TB) treatment in selected districts in the Buenos Aires Metropolitan Area, in Argentina. We conducted a cross-sectional study using a hierarchical model. Using primary and secondary data, logistic regression was performed to analyze two types of determinants. The likelihood of nonadherence to treatment was greatest among male patients. The following factors led to a greater likelihood of nonadherence to treatment: patients living in a home without running water; head of household without medical insurance; need to use more than one means of transport to reach the health center; place of residence in an area with a high proportion of households connected to the natural gas network; place of residence in an area where a large proportion of families fall below the minimum threshold of subsistence capacity; place of residence in an area where a high proportion of households do not have flushing toilets and basic sanitation. Our results show that social and economic factors - related to both individual and environmental characteristics - influence adherence to TB treatment.
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Affiliation(s)
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Jose Ueleres Braga
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Arrossi S, Thouyaret L, Laudi R, Marín O, Ramírez J, Paolino M, Herrero R, Campanera A. Implementation of HPV-testing for cervical cancer screening in programmatic contexts: The Jujuy demonstration project in Argentina. Int J Cancer 2015; 137:1709-18. [PMID: 25807897 DOI: 10.1002/ijc.29530] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/12/2015] [Indexed: 11/11/2022]
Abstract
The aim of this article is to present results of programmatic introduction of HPV testing with cytologic triage among women 30 years and older in the province of Jujuy, Argentina, including description of the planning phase and results of program performance during the first year. We describe the project implementation process, and calculate key performance indicators using SITAM, the national screening information system. We also compare disease detection rates of HPV testing in 2012 with cytology as performed during the previous year. HPV testing with cytology triage was introduced through a consensus-building process. Key activities included establishment of algorithms and guidelines, creating the HPV laboratory, training of health professionals, information campaigns for women and designing the referral network. By the end of 2012, 100% (n = 270) of public health care centers were offering HPV testing and 22,834 women had been HPV tested, 98.5% (n = 22,515) were 30+. HPV positivity among women over 30 was 12.7%, 807 women were HPV+ and had abnormal cytology, and 281 CIN2+ were identified. CIN2+ detection rates was 1.25 in 2012 and 0.62 in 2011 when the program was cytology based (p = 0.0002). This project showed that effective introduction of HPV testing in programmatic contexts of low-middle income settings is feasible and detects more disease than cytology.
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Affiliation(s)
- Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y Técnicas/Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, Buenos Aires, Argentina
| | - Rosa Laudi
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Rivadavia 875, Buenos Aires, Argentina
| | - Oscar Marín
- Hospital Pablo Soria, Güemes 1345, San Salvador de Jujuy, Argentina
| | - Josefina Ramírez
- Ministerio de Salud de la provincia de Jujuy, Av. Italia Esq, Independencia, San Salvador de Jujuy, Argentina
| | - Melisa Paolino
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, Buenos Aires, Argentina
| | - Rolando Herrero
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, Av. Italia Esq, Independencia, San de Salvador de Jujuy, Argentina
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Herrero MB, Arrossi S, Ramos S, Braga JU. Spatial analysis of the tuberculosis treatment dropout, Buenos Aires, Argentina. Rev Saude Publica 2015; 49:49. [PMID: 26270011 PMCID: PMC4544507 DOI: 10.1590/s0034-8910.2015049005391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 11/02/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Identify spatial distribution patterns of the proportion of nonadherence to tuberculosis treatment and its associated factors. METHODS We conducted an ecological study based on secondary and primary data from municipalities of the metropolitan area of Buenos Aires, Argentina. An exploratory analysis of the characteristics of the area and the distributions of the cases included in the sample (proportion of nonadherence) was also carried out along with a multifactor analysis by linear regression. The variables related to the characteristics of the population, residences and families were analyzed. RESULTS Areas with higher proportion of the population without social security benefits (p = 0.007) and of households with unsatisfied basic needs had a higher risk of nonadherence (p = 0.032). In addition, the proportion of nonadherence was higher in areas with the highest proportion of households with no public transportation within 300 meters (p = 0.070). CONCLUSIONS We found a risk area for the nonadherence to treatment characterized by a population living in poverty, with precarious jobs and difficult access to public transportation.
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Affiliation(s)
- María Belén Herrero
- Área de Relaciones Internacionales, Facultad Latinoamericana de Ciencias Sociales, Buenos Aires, Argentina
| | - Silvina Arrossi
- Área Salud, Economía y Sociedad, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Silvina Ramos
- Área Salud, Economía y Sociedad, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Jose Ueleres Braga
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Herrero MB, Ramos S, Arrossi S. Determinants of non adherence to tuberculosis treatment in Argentina: barriers related to access to treatment. Rev bras epidemiol 2015; 18:287-98. [DOI: 10.1590/1980-5497201500020001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 08/08/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To identify the association between non-adherence to tuberculosis treatment and access to treatment. METHODS: A cross-sectional study was carried out in the Metropolitan Area of Buenos Aires, Argentina. One hundred twenty three patients notified in 2007 (38 non adherent and 85 adherents) were interviewed regarding the health care process and socio-demographic characteristics. Factors associated to non-adherence were assessed through logistic regression analysis. RESULTS: An increased risk of non-adherence with to treatment was found in male patients (OR = 2.8; 95%CI 1.2 - 6.7), patients who had medical check-ups at hospitals (OR = 3.4; 95%CI 1.1 - 10.0) and those who had difficulties with transportation costs (OR = 2.5; 95%CI 1.1 - 5.9). CONCLUSION: Risk of non-adherence increases as a result of economic barriers in accessing health care facilities. Decentralization of treatment to primary health care centers and social protection measures for patients should be considered as priorities for disease control strategies in order to lessen the impact of those barriers on adherence to treatment.
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Affiliation(s)
- María Belén Herrero
- Centro de Estudios de Estado y Sociedad, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | | | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
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Arrossi S, Thouyaret L, Herrero R, Campanera A, Magdaleno A, Cuberli M, Barletta P, Laudi R, Orellana L. Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial. Lancet Glob Health 2015; 3:e85-94. [PMID: 25617202 DOI: 10.1016/s2214-109x(14)70354-7] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV DNA self-collection could increase screening coverage, but implementation of this technology is difficult in countries of middle and low income. We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening. METHODS We did a population-based cluster-randomised trial in the province of Jujuy, Argentina, between July 1, 2012, and Dec 31, 2012. Community health workers were eligible for the study if they scored highly on a performance score, and women aged 30 years or older were eligible for enrolment by the community health worker. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). The primary outcome was screening uptake, measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02095561. FINDINGS 100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group; nine did not take part. 191 participating community health workers (94 in the intervention group and 97 in the control group) initially contacted 7650 women; of 3632 women contacted by community health workers in the intervention group, 3049 agreed to participate; of 4018 women contacted by community health workers in the control group, 2964 agreed to participate. 2618 (86%) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit, compared with 599 (20%) of 2964 in the control group (risk ratio 4·02, 95% CI 3·44-4·71). INTERPRETATION Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake, showing that this strategy is effective to improve cervical screening coverage. This intervention reduces women's barriers to screening and results in a substantial and rapid increase in coverage. Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage. FUNDING Instituto Nacional del Cáncer (Argentina).
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Affiliation(s)
- Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y Técnicas, and Centro de Estudios de Estado y Sociedad, Buenos Aires 1193, Argentina.
| | - Laura Thouyaret
- Instituto Nacional del Cáncer (Argentina), Buenos Aires 1067, Argentina
| | - Rolando Herrero
- International Agency for Research on Cancer, Lyon 69372, France
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy 4600, Argentina
| | - Adriana Magdaleno
- Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy 4600, Argentina
| | - Milca Cuberli
- Instituto Nacional del Cáncer (Argentina), Buenos Aires 1067, Argentina
| | - Paula Barletta
- Instituto Nacional del Cáncer (Argentina), Buenos Aires 1067, Argentina
| | - Rosa Laudi
- Programa Nacional de Prevención de Cáncer Cervicouterino, Buenos Aires 1002, Argentina
| | - Liliana Orellana
- Instituto Nacional del Cáncer (Argentina), Buenos Aires 1067, Argentina
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von Karsa L, Arrossi S. Development and implementation of guidelines for quality assurance in breast cancer screening: the European experience. Salud Publica Mex 2014; 55:318-28. [PMID: 23912545 DOI: 10.21149/spm.v55i3.7215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/06/2022] Open
Abstract
In Europe, as in many other regions of the world, breast cancer is a major cause of suffering and death. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. Comprehensive quality assurance guidelines for breast cancer screening based on mammography have been developed in the Europe Against Cancer programme with the aim of maximising screening benefits while minimising adverse effects, such as unnecessary examination or treatment resulting from false-positive screening tests. The present report provides an overview of the European experience in developing and implementing quality assurance guidelines for breast cancer screening. It highlights implications relevant to those regions of the world in which the burden of breast cancer in the coming years will make population-based screening an option for cancer control.
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Affiliation(s)
- Lawrence von Karsa
- Quality Assurance Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
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Paolino M, Sankaranarayanan R, Arrossi S. [Social determinants of dropout from diagnosis and treatment by women with abnormal Pap smears in Buenos Aires, Argentina]. Rev Panam Salud Publica 2013; 34:437-445. [PMID: 24569973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Determine the extent and reasons why women with abnormal Pap smears drop out from diagnosis and treatment, and the relationship between women's socioeconomic characteristics and dropping out. METHODS Cross-sectional retrospective study. Analysis of secondary sources and household interviews with women with abnormal Pap smears seen in the public municipal system from 2009 to 2011. RESULTS Confirmed dropout in the study population was 18.3%. Women with the greatest probability of dropping out lived in homes where there were children under five (probability ratio [PR]: 2.4; 95% confidence interval [95%CI]: 1.2-4.8) and where there was overcrowding (PR: 2.9; 95%CI: 1.2-7.3). Women whose initial Pap smear was done in a primary care center had a 4.6 times greater probability of dropping out than those seen in a hospital (95%CI: 1.7-12.3). The main reasons reported for dropping out were problems with health services organization and domestic workload. CONCLUSIONS Women's living conditions and the organization and quality of health services affect dropout from diagnosis and treatment of precancerous lesions. Strategies need to be developed that address social determinants of dropping out as a way to ensure effectiveness of cervical cancer screening programs.
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Affiliation(s)
- Melisa Paolino
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina,
| | | | - Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina,
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Mazzadi A, Paolino M, Arrossi S. [HPV vaccine acceptability and knowledge among gynecologists in Argentina]. Salud Publica Mex 2013; 54:515-22. [PMID: 23011503 DOI: 10.1590/s0036-36342012000500008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 04/16/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate HPV vaccine acceptability and prescription; knowledge about HPV vaccine; and knowledge about HPV infection and cervical cancer among Argentinean gynecologists. MATERIALS AND METHODS Between November 2009 and March 2010 we carried out an internet survey of 686 gynecologists. RESULTS More than 80% of gynecologists prescribed HPV vaccine, knew characteristics of HPV vaccines, and knew that women will still need regular cervical cancer screening after HPV vaccination; 37% had global knowledge about relationship between vaccine, detection and treatment of cervical cancer; 25% underestimated the epidemiological extent of HPV infections, ≈30% was not aware of the causative relationship between HPV infection and cervical cancer and ≈40% had global knowledge about management of HPV infection. CONCLUSIONS HPV vaccine acceptability is high. Physicians need to be fully informed on HPV vaccination and cervical cancer as well as HPV infection management.
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Affiliation(s)
- Alejandro Mazzadi
- Escuela de Ciencia y Tecnología, Centro de Estudios en Salud y Medio Ambiente, Universidad Nacional de General San Martín, San Martín, Buenos Aires, Argentina
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von Karsa L, Patnick J, Segnan N, Atkin W, Halloran S, Lansdorp-Vogelaar I, Malila N, Minozzi S, Moss S, Quirke P, Steele RJ, Vieth M, Aabakken L, Altenhofen L, Ancelle-Park R, Antoljak N, Anttila A, Armaroli P, Arrossi S, Austoker J, Banzi R, Bellisario C, Blom J, Brenner H, Bretthauer M, Camargo Cancela M, Costamagna G, Cuzick J, Dai M, Daniel J, Dekker E, Delicata N, Ducarroz S, Erfkamp H, Espinàs JA, Faivre J, Faulds Wood L, Flugelman A, Frkovic-Grazio S, Geller B, Giordano L, Grazzini G, Green J, Hamashima C, Herrmann C, Hewitson P, Hoff G, Holten I, Jover R, Kaminski MF, Kuipers EJ, Kurtinaitis J, Lambert R, Launoy G, Lee W, Leicester R, Leja M, Lieberman D, Lignini T, Lucas E, Lynge E, Mádai S, Marinho J, Maučec Zakotnik J, Minoli G, Monk C, Morais A, Muwonge R, Nadel M, Neamtiu L, Peris Tuser M, Pignone M, Pox C, Primic-Zakelj M, Psaila J, Rabeneck L, Ransohoff D, Rasmussen M, Regula J, Ren J, Rennert G, Rey J, Riddell RH, Risio M, Rodrigues V, Saito H, Sauvaget C, Scharpantgen A, Schmiegel W, Senore C, Siddiqi M, Sighoko D, Smith R, Smith S, Suchanek S, Suonio E, Tong W, Törnberg S, Van Cutsem E, Vignatelli L, Villain P, Voti L, Watanabe H, Watson J, Winawer S, Young G, Zaksas V, Zappa M, Valori R. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45:51-9. [PMID: 23212726 PMCID: PMC4482205 DOI: 10.1055/s-0032-1325997] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.
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Affiliation(s)
| | - L. von Karsa
- International Agency for Research on Cancer, Lyon, France
| | - J. Patnick
- NHS Cancer Screening Programmes Sheffield, United Kingdom,Oxford University Cancer Screening Research Unit, Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - N. Segnan
- International Agency for Research on Cancer, Lyon, France,CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - W. Atkin
- Imperial College London, London, United Kingdom
| | - S. Halloran
- Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom,University of Surrey, Guildford, United Kingdom
| | | | - N. Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - S. Minozzi
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - S. Moss
- The Institute of Cancer Research, Royal Cancer Hospital, Sutton, United Kingdom
| | - P. Quirke
- Leeds Institute of Molecular Medicine, St James’ University Hospital, Leeds, United Kingdom
| | - R. J. Steele
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - M. Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - L. Aabakken
- Department of Medical Gastroenterology, Stavanger University Hospital, Stavanger, Norway
| | - L. Altenhofen
- Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | | | - N. Antoljak
- Croatian National Institute of Public Health, Zagreb, Croatia,University of Zagreb School of Medicine, Zagreb, Croatia
| | - A. Anttila
- Finnish Cancer Registry, Helsinki, Finland
| | - P. Armaroli
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | | | - J. Austoker
- University of Oxford, Oxford, United Kingdom
| | - R. Banzi
- Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C. Bellisario
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - J. Blom
- Karolinska Institutet, Stockholm, Sweden
| | - H. Brenner
- German Cancer Research Center, Heidelberg, Germany
| | - M. Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - M. Camargo Cancela
- National Cancer Registry, Cork, Ireland,Formerly International Agency for Research on Cancer, Lyon, France
| | | | - J. Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - M. Dai
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - J. Daniel
- Formerly International Agency for Research on Cancer, Lyon, France,American Cancer Society, Atlanta, Georgia, United States of America
| | - E. Dekker
- Academic Medical Centre, Amsterdam, the Netherlands
| | - N. Delicata
- National Health Screening Services, Ministry of Health, Elderly & Community Care, Valletta, Malta
| | - S. Ducarroz
- International Agency for Research on Cancer, Lyon, France
| | - H. Erfkamp
- University of Applied Sciences FH Joanneum, Graz, Austria
| | - J. A. Espinàs
- Catalan Cancer Strategy, L’Hospitalet de Llobregat, Spain
| | - J. Faivre
- Digestive Cancer Registry of Burgundy, INSERM U866, University and CHU, Dijon, France
| | - L. Faulds Wood
- Lynn’s Bowel Cancer Campaign, Twickenham, United Kingdom
| | - A. Flugelman
- National Israeli Breast and Colorectal Cancer Detection, Haifa, Israel
| | - S. Frkovic-Grazio
- Department of Gynecological Pathology and Cytology, University Medical Center Ljubljana, Slovenia
| | - B. Geller
- University of Vermont, Burlington, Vermont, United States of America
| | - L. Giordano
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - G. Grazzini
- Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | - J. Green
- University of Oxford, Oxford, United Kingdom
| | | | - C. Herrmann
- Formerly International Agency for Research on Cancer, Lyon, France,Cancer League of Eastern Switzerland, St. Gallen, Switzerland
| | - P. Hewitson
- University of Oxford, Oxford, United Kingdom
| | - G. Hoff
- Cancer Registry of Norway, Oslo, Norway,Telemark Hospital, Skien, Norway
| | - I. Holten
- Danish Cancer Society, Copenhagen, Denmark
| | - R. Jover
- Hospital General Universitario de Alicante, Alicante, Spain
| | - M. F. Kaminski
- Maria Sklodowska-Curie Memorial Cancer Centre and Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | | | - R. Lambert
- International Agency for Research on Cancer, Lyon, France
| | - G. Launoy
- U1086 INSERM – UCBN, CHU Caen, France
| | - W. Lee
- The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | | | - M. Leja
- University of Latvia, Riga, Latvia
| | - D. Lieberman
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - T. Lignini
- International Agency for Research on Cancer, Lyon, France
| | - E. Lucas
- International Agency for Research on Cancer, Lyon, France
| | - E. Lynge
- University of Copenhagen, Copenhagen, Denmark
| | - S. Mádai
- MaMMa Healthcare Institute, Budapest, Hungary
| | - J. Marinho
- Health Administration Central Region Portugal, Aveiro, Portugal
| | | | - G. Minoli
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - C. Monk
- GlaxoSmithKline Pharma Europe, London, United Kingdom
| | - A. Morais
- Regional Health Administration, Coimbra, Portugal
| | - R. Muwonge
- International Agency for Research on Cancer, Lyon, France
| | - M. Nadel
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - L. Neamtiu
- Prof. Dr Ion Chiricuţă, Cluj-Napoca, Romania
| | - M. Peris Tuser
- Catalan Institute of Oncology, L’Hospitalet de Llobregat, Spain
| | - M. Pignone
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - C. Pox
- Ruhr Universität, Bochum, Germany
| | - M. Primic-Zakelj
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Slovenia
| | - J. Psaila
- National Health Screening Services, Ministry of Health, Elderly & Community Care, Valletta, Malta
| | - L. Rabeneck
- University of Toronto and Cancer Care Ontario, Toronto, Canada
| | - D. Ransohoff
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - M. Rasmussen
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - J. Regula
- Maria Sklodowska-Curie Memorial Cancer Centre and Medical Centre for Postgraduate Education, Warsaw, Poland
| | - J. Ren
- Formerly International Agency for Research on Cancer, Lyon, France
| | - G. Rennert
- National Israeli Breast and Colorectal Cancer Detection, Haifa, Israel
| | - J. Rey
- Institut Arnault Tzanck, St Laurent du Var, France
| | | | - M. Risio
- Institute for Cancer Research and Treatment, Candiolo-Torino, Italy
| | - V. Rodrigues
- Faculdade de Medicina – Universidade de Coimbra, Coimbra, Portugal
| | - H. Saito
- National Cancer Centre, Tokyo, Japan
| | - C. Sauvaget
- International Agency for Research on Cancer, Lyon, France
| | | | | | - C. Senore
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - M. Siddiqi
- Cancer Foundation of India, Kolkata, India
| | - D. Sighoko
- Formerly International Agency for Research on Cancer, Lyon, France,The University of Chicago, Department of Medicine, Hematology–Oncology Section, Center for Clinical Cancer Genetics, Global Health, Chicago, United States of America
| | - R. Smith
- American Cancer Society, Atlanta, Georgia, United States of America
| | - S. Smith
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - S. Suchanek
- Charles University and Military University Hospital, Prague, Czech Republic
| | - E. Suonio
- International Agency for Research on Cancer, Lyon, France
| | - W. Tong
- Chinese Academy of Medical Sciences, Beijing, China
| | - S. Törnberg
- Department of Cancer Screening, Stockholm Gotland Regional Cancer Centre, Stockholm, Sweden
| | | | - L. Vignatelli
- Agenzia Sanitaria e Sociale Regionale–Regione Emilia-Romagna, Bologna, Italy
| | - P. Villain
- University of Oxford, Oxford, United Kingdom
| | - L. Voti
- Formerly International Agency for Research on Cancer, Lyon, France,University of Miami, Miami, Florida, United States of America
| | | | - J. Watson
- University of Oxford, Oxford, United Kingdom
| | - S. Winawer
- Memorial Sloan–Kettering Cancer Center, New York, United States of America
| | - G. Young
- Gastrointestinal Services, Flinders University, Adelaide, Australia
| | - V. Zaksas
- State Patient Fund, Vilnius, Lithuania
| | - M. Zappa
- Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | - R. Valori
- NHS Endoscopy, Leicester, United Kingdom
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Paolino M, Arrossi S. Análisis de los motivos del abandono del proceso de seguimiento y tratamiento por parte de mujeres con lesiones precursoras de cáncer de cuello uterino en la provincia de Jujuy: implicancias para la gestión. Salud Colect 2012; 8:247-61. [DOI: 10.1590/s1851-82652012000400003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/28/2012] [Indexed: 11/22/2022] Open
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