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Mwandacha N, Dau H, AboMoslim M, Naguti P, Sheehan M, Booth A, Smith L, Orem J, Ogilvie G, Nakisige C. Investigating the healthcare-seeking behaviors of mobile phone users to improve cervical cancer screening in rural Uganda. Int J Gynaecol Obstet 2024. [PMID: 38702957 DOI: 10.1002/ijgo.15577] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/30/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Cervical cancer is the leading cause of cancer in low- and middle-income countries, despite being preventable. Uganda, which lacks an effective screening program, has one of the highest global cervical cancer incidence rates. Mobile health (mHealth) technology has the potential to improve healthcare-seeking behaviors and access. The present study describes the connection between mobile phone access and healthcare-seeking behaviors in rural Uganda. METHODS Women were eligible for this cross-sectional study if they had no prior screening or treatment for cervical cancer in the past 5 years, were aged 30 to 49 years old, and were residents of the South Busoga Forest reserve. Survey data was analyzed using descriptive statistics and chi-square tests. RESULTS Of the 1434 participants included in the analysis, 91.4% reported having access to a mobile phone. Most respondents were aged 30-40 years, had a partner, had ≤primary education, and were farmers. Participants with mobile phone access were significantly more likely to report attending a healthcare outreach visit (access = 87.3%, no access = 72.6%, P < 0.001) or visiting a health center (access = 96.9%, no access = 93.5%, P < 0.001). Participants in both groups had largely positive attitudes around and good knowledge of cervical cancer screening. CONCLUSION While attendance to healthcare services was high amongst participants, those with mobile phone access were more likely to seek healthcare services. Further inquiry into this association between mobile phone access and healthcare-seeking behavior is needed to optimize the improvements to cervical cancer screening when implementing interventions such as mHealth technology.
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Affiliation(s)
- Nelly Mwandacha
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Hallie Dau
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mia Sheehan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Amy Booth
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | | | - Gina Ogilvie
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Center for Disease Control, Vancouver, British Columbia, Canada
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Dau H, Nankya E, Naguti P, Basemera M, Payne BA, Vidler M, Singer J, McNair A, AboMoslim M, Smith L, Orem J, Nakisige C, Ogilvie G. The economic burden of cervical cancer on women in Uganda: Findings from a cross-sectional study conducted at two public cervical cancer clinics. PLOS Glob Public Health 2024; 4:e0002554. [PMID: 38489259 PMCID: PMC10942052 DOI: 10.1371/journal.pgph.0002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda. This analysis aimed to describe the economic impact of cervical cancer treatment, including how it differs by socio-economic status (SES) in Uganda. We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a survey that included questions about their out-of-pocket costs, unpaid labor, and family's economic situation. A wealth index was constructed to determine their SES. Descriptive statistics were reported. Of the 338 participants, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Over 90% of participants in both groups reported paying out-of-pocket for cervical cancer. Only 15 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (higher SES n = 47, 30.5%; lower SES n = 84, 46.4%; p-value = 0.004) and selling possessions (higher SES n = 47, 30.5%; lower SES n = 90, 49.7%; p-value = 0.006) to pay for care. Both SES groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis (higher SES n = 34, 31.2%; lower SES n = 36, 29.8%). Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further economic support could help alleviate the financial burden of cervical cancer care in Uganda.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Miriam Basemera
- Cancer Unit, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Beth A. Payne
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Avery McNair
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | | | | | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
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Dau H, Zhou C, Nankya E, Naguti P, Basemera M, Payne BA, Vidler M, Singer J, McNair A, AboMoslim M, Mithani N, Smith L, Orem J, Nakisige C, Ogilvie G. The burden of travelling for cervical cancer treatment in Uganda: A mixed-method study. Trop Med Int Health 2024; 29:137-143. [PMID: 38069532 DOI: 10.1111/tmi.13958] [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] [Indexed: 02/07/2024]
Abstract
BACKGROUND Uganda has one of the highest rates of cervical cancer in the world. Many women are diagnosed and treated with advanced stages of the disease. With only one facility offering comprehensive cervical cancer care in Uganda, many women are required to travel significant distances and spend time away from their homes to receive cervical cancer care. It is important to understand the burden of time away from home while attending treatment because it can inform the expansion of cervical cancer treatment programmes. The aim of this mixed-methods paper is to describe how the distance to cervical cancer treatment locations impacts women in Uganda. METHODS Women were recruited from 19 September, 2022, to 17 January, 2023, at the Uganda Cancer Institute (UCI) and the cancer clinic at Jinja Regional Referral Hospital (JRRF). Women were eligible for the study if they were (i) aged ≥18 years with a histopathologic diagnosis of cervical cancer; (ii) being treated at the UCI or JRRF for cervical cancer; and (iii) able to provide consent to participate in the study in English, Luganda, Lusoga, Luo, or Runyankole. All participants completed a quantitative survey and a selected group was sampled for semi-structured interviews. Data were analysed using the convergent parallel mixed-methods approach. Descriptive statistics were reported for the quantitative data and qualitative data using an inductive-deductive thematic analysis approach. RESULTS In all, 351 women participated in the quantitative section of the study and 24 in the qualitative. The quantitative and qualitative findings largely aligned and supported one another. Women reported travelling up to 14 h to receive treatment and 20% noted that they would spend three or more nights away from home during their current visit. Major themes of the qualitative include means of transportation, spending the night away from home, and financial factors. CONCLUSION Our findings show that travelling to obtain cervical cancer care can be a significant burden for women in Uganda. Approaches should be considered to reduce this burden such as additional satellite cervical cancer clinics or subsidised transportation options.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, Canada
| | - Chuanlin Zhou
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, Canada
| | | | | | - Miriam Basemera
- Cancer Unit, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Beth A Payne
- Women's Health Research Institute, Vancouver, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, Canada
| | - Avery McNair
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, Canada
| | - Maryam AboMoslim
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, Canada
| | - Nadia Mithani
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, Canada
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, Canada
- BC Cancer, Vancouver, Canada
| | | | | | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, Canada
- BC Centre for Disease Control, Vancouver, Canada
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Gill R, Ogilvie G, Norman WV, Fitzsimmons B, Maher C, Renner R. Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study. JMIR Form Res 2024; 8:e46284. [PMID: 38194252 PMCID: PMC10807380 DOI: 10.2196/46284] [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: 02/05/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. OBJECTIVE This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. METHODS People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women's and Children's Research Ethics Board. RESULTS Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. CONCLUSIONS This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion.
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Affiliation(s)
- Roopan Gill
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Gina Ogilvie
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Brian Fitzsimmons
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Ciana Maher
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Regina Renner
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
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Closson K, Zharima C, Kuchena M, Dietrich JJ, Gadermann A, Zulu B, Ogilvie G, Beksinska M, Kaida A. " It's a 50/50 Thing You Know": Exploring the Multileveled Intersections of Gender and Power Within the Relationships of Young South African Men and Women. J Sex Res 2024; 61:144-159. [PMID: 36260421 DOI: 10.1080/00224499.2022.2129561] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Efforts to advance sexual health globally require greater understandings of youth intimate relationship dynamics. Among 38 South African youth (21 women/17 men aged 21-30 from Durban and Soweto) we conducted qualitative cognitive interviews to explore how gender and power intersect to shape intimate relationship dynamics (October 2019-March 2021). Participants discussed perceptions and relevance of each of 13 items comprising the Sexual Relationship Power (SRP) scale, a widely used measure of gender equity, and the influence of SRP on youth sexual health. Data analysis was guided by constructivist grounded theory. The findings were organized using the socio-ecological model, revealing how gender and power intersected at multiple levels to influence youth intimate relationships. Key influencing factors included individual-level gender attitudes, male partner expectations, and women's resistance to dominance; intimate relationship-level power dynamics, consent, and intimacy; family-level household configurations and parental monitoring of daughters; and societal-level traditional gender norms. At all levels, women discussed resisting power inequities through communication and rejection of inequitable relationships. While men also displayed resistance to inequitable power structures, most upheld traditional gender norms through institutional affiliation (e.g. church) and deep-rooted socialized beliefs and attitudes. Efforts to improve youth sexual health require multileveled approaches that address inequitable power dynamics.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
- Centre for Health Policy, School of Public Health, University of the Witwatersrand
| | - Michelle Kuchena
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia
| | - Bongiwe Zulu
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia
| | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University
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Barreto D, Deering K, Krüsi A, Ranville F, Safford H, Pooyak S, Braschel M, Kestler M, Ogilvie G, Shoveller J, Shannon K. HIV disclosure without consent linked to increased violence against women living with HIV in a Canadian setting. AIDS Care 2024; 36:98-106. [PMID: 37217168 PMCID: PMC10663381 DOI: 10.1080/09540121.2023.2209304] [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: 03/08/2022] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
Our study examined the association between HIV disclosure without consent and verbal and/or physical violence due to HIV status among women living with HIV (WLWH). This study draws on baseline data of a sample (N = 316) from SHAWNA, a longitudinal community-based open cohort with WLWH in Metro Vancouver, Canada (2010-2019). Bivariate and multivariable logistic regression was used to investigate factors associated with physical and/or verbal violence due to HIV status. Adjusted odds ratios (AOR) and 95% confidence intervals [95%CIs] are reported. In total, 46.5% experienced non-consensual disclosure of HIV status without consent and 34.2% experienced physical and/or verbal violence related to HIV status in their lifetime. In multivariable analysis, HIV disclosure without consent was associated with increased odds of experiencing HIV-related physical and/or verbal violence (AOR: 7.46[4.21-13.21]). Lifetime exposure to homelessness was also associated with increased odds of physical and/or verbal violence due to HIV status (AOR: 2.15[1.03-4.49]). This research underscores the reality of HIV stigmatization and criminalization and suggests a critical need to remove HIV disclosure from the reach of criminal law and ensure women's rights to confidentiality. Governments and organizations must work to identify and address the drivers of various levels of stigma and gender-based violence and invest in inclusive, trauma-informed, culturally safe support and care programs and policies designed in collaboration with WLWH.
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Affiliation(s)
- Daniella Barreto
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
| | - Heidi Safford
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
| | | | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Mary Kestler
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
- Oak Tree Clinic, BC Women’s Hospital
and Health Centre, Vancouver, Canada
| | - Gina Ogilvie
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
- Oak Tree Clinic, BC Women’s Hospital
and Health Centre, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, BC,
Canada
| | - Jeannie Shoveller
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
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Mezei A, Trawin J, Payne B, Rawat A, Naguti P, Orem J, Murray MC, Nakisige C, Ogilvie G. Acceptability of Integrated Community-Based HIV and Cervical Cancer Screening in Mayuge District, Uganda. JCO Glob Oncol 2024; 10:e2200324. [PMID: 38237095 PMCID: PMC10805429 DOI: 10.1200/go.22.00324] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/24/2023] [Accepted: 10/31/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To assess the acceptability of integrated screening for cervical cancer and HIV in the community setting. METHODS We developed surveys for patients and community health workers (CHWs) who participated in the Advances in Screening and Prevention in Reproductive Cancers (ASPIRE) Mayuge trial that compared self-collected human papillomavirus testing at home versus community health meetings in Mayuge district, Uganda. Quantitative data were summarized using descriptive statistics. Open-ended questions were analyzed using an inductive approach with thematic content analysis. RESULTS We conducted 102 patient surveys and 31 CHW surveys between June and August 2021. Ninety-nine percent of patients and 100% of CHWs indicated that they would find the addition of an HIV test to their self-collected cervical cancer test acceptable. The most frequently stated reasons in favor of adding an HIV test to the ASPIRE Mayuge cervical cancer screening pathways were time-saving, privacy, and support from other women and CHWs. The most frequently stated reasons against integrated screening were related to concerns about confidentiality, most often in reference to women's family members and other women in their village. CONCLUSION Integrated community-based cervical cancer and HIV testing would be highly acceptable to both women and CHWs.
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Affiliation(s)
- Alex Mezei
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Trawin
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Beth Payne
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Angeli Rawat
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Priscilla Naguti
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Jackson Orem
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Melanie C.M. Murray
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Carolyn Nakisige
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Gina Ogilvie
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
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8
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McClymont E, Atkinson A, Albert A, Av-Gay G, Andrade J, Barrett J, Bogler T, Boucoiran I, Castillo E, D'Souza R, El-Chaâr D, Fadel S, Fell DB, Korchinski I, Kuret V, Ogilvie G, Poliquin V, Sadarangani M, Scott H, Snelgrove JW, Tunde-Byass M, Money D. Reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy in Canada: A national prospective cohort study. Vaccine 2023; 41:7183-7191. [PMID: 37865598 DOI: 10.1016/j.vaccine.2023.10.032] [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: 06/21/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To describe self-reported reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy. DESIGN National, prospective cohort study. SETTING Participants across Canada were enrolled from July 2021 until June 2022. POPULATION Individuals pregnant during the COVID-19 pandemic, regardless of vaccination status, were included. METHODS The Canadian COVID-19 Vaccine Registry for Pregnant and Lactating Individuals (COVERED) was advertised through traditional and social media. Surveys were administered at baseline, following each vaccine dose if vaccinated, pregnancy conclusion, and every two months for 14 months. Changes to pregnancy or vaccination status, SARS-CoV-2 infections, or significant health events were recorded. MAIN OUTCOME MEASURES Reactogenicity (local and systemic adverse events, and serious adverse events) within 1 week post-vaccination, pregnancy and neonatal outcomes, and subsequent SARS-CoV-2 infection. RESULTS Among 2868 participants who received 1-2 doses of a COVID-19 vaccine during pregnancy, adverse events described included: headache (19.5-33.9%), nausea (4.8-13.8%), fever (2.7-10.2%), and myalgia (33.4-42.2%). Reactogenicity was highest after the 2nd dose of vaccine in pregnancy. Compared to 1660 unvaccinated participants, there were no statistically significant differences in adverse pregnancy or infant outcomes, aside from an increased risk of NICU admission ≥ 24 h among the unvaccinated group. During follow-up, there was a higher rate of participant-reported SARS-CoV-2 infection in the unvaccinated compared to the vaccinated group (18[47.4%] vs. 786[27.3%]). CONCLUSIONS Participant-reported reactogenicity was similar to reports from non-pregnant adults. There was no increase in adverse pregnancy and birth outcomes among vaccinated vs. unvaccinated participants and lower rates of SARS-CoV-2 infection were reported in vaccinated participants. TWEETABLE ABSTRACT No significant increase in adverse pregnancy or infant outcomes among vaccinated versus unvaccinated pregnant women in Canada.
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Affiliation(s)
- E McClymont
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - A Atkinson
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - A Albert
- Women's Health Research Institute, Vancouver, Canada
| | - G Av-Gay
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - J Andrade
- Women's Health Research Institute, Vancouver, Canada
| | - J Barrett
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
| | - T Bogler
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - I Boucoiran
- Department of Obstetrics & Gynecology and School of Public Health, Université de Montréal, Montreal, Canada
| | - E Castillo
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada
| | - R D'Souza
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - D El-Chaâr
- Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Canada
| | - S Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - D B Fell
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - I Korchinski
- Women's Health Research Institute, Vancouver, Canada
| | - V Kuret
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada
| | - G Ogilvie
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - V Poliquin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Manitoba, Winnipeg, Canada
| | - M Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - H Scott
- Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Canada
| | - J W Snelgrove
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - M Tunde-Byass
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - D Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada; Women's Health Research Institute, Vancouver, Canada.
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Nair V, Dau H, Vidler M, AboMoslim M, Mutamba B, Scott M, Nesbitt Z, Deodatha J, Byiringiro SD, Niyotwiringiye C, Mithani N, Smith L, Ogilvie G, Rulisa S. Understanding the cervical cancer self-collection preferences of women living in urban and rural Rwanda. PLOS Glob Public Health 2023; 3:e0002135. [PMID: 37768884 PMCID: PMC10538759 DOI: 10.1371/journal.pgph.0002135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Cervical cancer is a leading cause of cancer among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in other low-resource settings similar to Rwanda has shown that HPV-based self-collection is an effective cervical cancer screening method. This study aims to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from one urban and one rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. We reported descriptive statistics stratified by urban and rural sites. In total, 169 urban and 205 rural women completed the survey. The majority of respondents at both sites had a primary school or lower education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value<0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value<0.001). Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value = 0.731). Rwandan women in both urban and rural areas largely support self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services in Rwanda.
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Affiliation(s)
- Varun Nair
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- Integrated Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hallie Dau
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Zoey Nesbitt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Nadia Mithani
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, Canada
| | - Gina Ogilvie
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, Canada
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
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10
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Raveinthiranathan N, Simkin J, Donken R, Ogilvie G, Smith L, Van Niekerk D, Lee M, Woods RR. Age-Specific Trends of Invasive Cervical Cancer Incidence in British Columbia, Canada, 1971-2017. Curr Oncol 2023; 30:7692-7705. [PMID: 37623038 PMCID: PMC10453046 DOI: 10.3390/curroncol30080557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
This study examined invasive cervical cancer (ICC) incidence trends in British Columbia (BC) by age and stage-at-diagnosis relative to World Health Organization ICC elimination targets (4 per 100,000 persons). Incident ICC cases (1971-2017) were obtained from the BC Cancer Registry. Annual age-standardized incidence rates (ASIRs) per 100,000 persons were generated using the direct method. ASIRs were examined among all ages 15+ years and eight age groups using Joinpoint Regression with the Canadian 2011 standard population. Standardized rate ratios (SRRs) compared stage II-IV (late) versus stage I (early) ASIRs by age (2010-2017). ICC ASIRs did not reach the elimination target. ASIRs declined from 18.88 to 7.08 per 100,000 persons (1971-2017). Stronger declines were observed among ages 45+ years, with the largest decline among ages 70-79 years (AAPC = -3.2%, 95% CI = -3.9% to -2.6%). Among ages 25-69 years, varying levels of attenuation in declining trends and stabilization were observed since the 1980s. SRRs indicated higher rates of late-stage ICC among ages 55+ years (SRR-55-69 years = 1.34, 95% CI = 1.08-1.71). Overall, ICC incidence declined in BC since 1971 but did not reach the elimination target. The pace of decline varied across age groups and increased with age. Continued efforts are needed to progress cervical cancer elimination among all age groups.
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Affiliation(s)
- Nivedha Raveinthiranathan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Jonathan Simkin
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Robine Donken
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Service, Vancouver, BC V6H 3N1, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Gina Ogilvie
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Service, Vancouver, BC V6H 3N1, Canada
| | - Laurie Smith
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Service, Vancouver, BC V6H 3N1, Canada
| | - Dirk Van Niekerk
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Cervical Cancer Screening Program, BC Cancer, Vancouver, BC V5Z 1G1, Canada
| | - Marette Lee
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Service, Vancouver, BC V6H 3N1, Canada
| | - Ryan R. Woods
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
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11
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Closson K, Zharima C, Kuchena TM, Dietrich JJ, Ogilvie G, Raj A, Beksinska M, Kaida A. Relationship impacts of the COVID-19 pandemic and lockdown restrictions on young women and men in Durban and Soweto, South Africa. Cult Health Sex 2023:1-13. [PMID: 37584715 DOI: 10.1080/13691058.2023.2243300] [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] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
To deepen our understanding of the impact of the COVID-19 pandemic on intimate and/or sexual relationships, we conducted a qualitative study among 26 South African women and men aged 21-30 years in Durban and Soweto between September 2020 and March 2021. Overall, 13 women and 12 men who had been in an intimate and/or sexual relationship since the start of the COVID-19 pandemic were asked about the impact of COVID-19 on their relationships with their current or most recent primary partners. Data were analysed using reflexive thematic analysis. The three most common impacts of the COVID-19 pandemic on relationships were on (i) communication and connection; (ii) strained relationships; and (iii) job and economic loss. Both women and men discussed how COVID-19-related lockdowns provided opportunities to foster better communication, connection and support to one another. However, too little or too much time together strained relationships. Finally, income loss among young men meant that some young women became the primary income earner, changing relationship power dynamics. Findings highlight the importance of young people's relationships and the need for action to support young people in building positive relationships in challenging times.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Campion Zharima
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - T Michelle Kuchena
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Janan J Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anita Raj
- Center on Gender Equity and Health, University of CA, San Diego, CA, US
- Newcomb Institute, Tulane University, New Orleans, LA, US
| | - Mags Beksinska
- Maternal, Adolescent and Child Health Research Unit, University of the Witwatersrand, Durban, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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12
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Racey CS, Donken R, Fox E, Porter I, Bettinger JA, Mark J, Bonifacio L, Dawar M, Gagel M, Kling R, Mema S, Mitchell H, Roe I, Ogilvie G, Sadarangani M. Characterization of vaccine confidence among teachers in British Columbia, Canada: A population-based survey. PLoS One 2023; 18:e0288107. [PMID: 37437041 DOI: 10.1371/journal.pone.0288107] [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] [Received: 05/14/2022] [Accepted: 06/19/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES Teachers are an important occupational group to consider when addressing vaccine confidence and uptake for school-aged children due to their proximate role within school-based immunization programs. The objectives of this study were to characterize and identify sociodemographic factors associated with vaccine confidence and describe teachers' knowledge of and perceived role in the school-based immunization program, with the aim of informing public health policy and identifying opportunities for supporting teachers in their role in school-based immunization programs. METHODS A cross-sectional survey of elementary and secondary public-school teachers in British Columbia was completed from August to November 2020. Respondents provided sociodemographic information, as well as past vaccination experience, vaccine knowledge, and perceived role in the school-based immunization program. Vaccine confidence was measured using the Vaccine Hesitancy Scale (VHS). Characteristics associated with the VHS sub-scales 'lack of confidence in vaccines' and 'perceived risk of vaccines', were explored using ANOVA. Descriptive analysis was completed for teachers' perceived role in the immunization program. RESULTS 5,095 surveys were included in this analysis. Overall vaccine confidence was high, with vaccine hesitancy being related to the perceived risk of vaccines rather than a lack of confidence in the effectiveness of vaccines. ANOVA found significant differences for both VHS-sub-scales based on sociodemographic factors, however, the strength of the association was generally small. High general vaccine knowledge and never having delayed or refused a vaccine in the past were associated with higher vaccine confidence. Overall, teachers reported a lack of clarity in their role within the school-based immunization program. CONCLUSIONS This large population-based observational study of teachers highlights a number of key engagement opportunities between public health and the education sector. Using a validated scale, we found that overall, teachers are highly accepting of vaccines, and well situated as potential partners with public health to address vaccine hesitancy.
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Affiliation(s)
- C Sarai Racey
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Robine Donken
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ellie Fox
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Imogen Porter
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Mark
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Lizl Bonifacio
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Meena Dawar
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Costal Health Authority, Vancouver, BC, Canada
| | - Mike Gagel
- Northern Health Authority, Prince George, BC, Canada
| | - Rakel Kling
- Northern Health Authority, Prince George, BC, Canada
| | - Silvina Mema
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Hana Mitchell
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ian Roe
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Gina Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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13
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [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: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
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Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Gottschlich A, Payne BA, Trawin J, Albert A, Jeronimo J, Mitchell-Foster S, Mithani N, Namugosa R, Naguti P, Orem J, Rawat A, Simelela PN, Singer J, Smith LW, van Niekerk D, Nakisige C, Ogilvie G. Experiences with thermal ablation for cervical precancer treatment after self-collection HPV-based screening in the ASPIRE Mayuge randomized trial. Int J Cancer 2023; 152:1630-1639. [PMID: 36408923 DOI: 10.1002/ijc.34369] [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: 06/16/2022] [Revised: 10/04/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
Cervical cancer remains a significant public health burden in low-resourced countries. Thus, the WHO prioritized cervix screening, and recently recommended thermal ablation treatment for cervical precancer. However, there is limited information on side effects during treatment and recovery, and acceptability among those treated. The ASPIRE Mayuge trial recruited women to participate in self-collection cervix screening between 2019 and 2020 (N = 2019). Screen-positive women (N = 531, 26.3%) were referred for visual inspection with acetic acid and thermal ablation treatment, per Uganda Ministry of Health recommendations; 71.2% of those referred attended follow-up. Six months post-screening, a subset of trial participants were recontacted. Those who received thermal ablation completed a survey assessing side effects during and after the procedure, and willingness to recommend the treatment to others. We summarized the results to describe the side effects and acceptability of thermal ablation treatment. Of 2019 participants, 349 (17%) received thermal ablation. A subset of 135 completed the follow-up survey, where 90% reported pain during treatment; however, intensity and duration were low. Over a third of women reported problems with recovery for reasons including pain, discharge and bleeding. Regardless, 98% reported they would recommend the treatment to others. The use of thermal ablation to treat cervical precancer appears to be highly acceptable in this population. While many women reported side effects during the procedure and recovery, the majority said they would recommend the treatment to others. However, given the substantial proportion who reported problems with recovery, efforts should be made to provide additional resources to women after receiving thermal ablation treatment for cervical precancer.
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Affiliation(s)
- Anna Gottschlich
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Beth A Payne
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Jessica Trawin
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada
| | - Arianne Albert
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada
| | | | - Sheona Mitchell-Foster
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada.,Northern Medical Program, University of British Columbia, Prince George, Canada
| | - Nadia Mithani
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada
| | | | | | | | - Angeli Rawat
- University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | | | - Joel Singer
- University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Laurie W Smith
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada.,BC Cancer Agency, Vancouver, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Vancouver, Canada
| | | | - Gina Ogilvie
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
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15
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Rawat A, Mithani N, Sanders C, Namugosa R, Payne B, Mitchell-Foster S, Orem J, Ogilvie G, Nakisige C. "We Shall Tell them with Love, Inform them what we have Learnt and then Allow them to go" - Men's Perspectives of Self-Collected Cervical Cancer Screening in Rural Uganda: A Qualitative Inquiry. J Cancer Educ 2023; 38:618-624. [PMID: 35384556 DOI: 10.1007/s13187-022-02163-x] [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] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 05/20/2023]
Abstract
Uganda has high incidence rates of cervical cancer (47.5/100,000/year) due to limited screening access. In settings where men hold most of the decision-making power, they play an important role in women's uptake of cervical cancer screening. We aimed to capture men's knowledge, beliefs and perspectives about cervical cancer, community-based screening and health system barriers. Focus group discussions were conducted with men in rural Uganda. Data were verbatim translated and transcribed into English. Transcripts were analysed in ATLAS.ti using a deductive approach of thematic content analysis and applied to an implementation research framework. Twenty-three men participated in focus groups. Men held poor knowledge of cervical cancer, its causes and treatment. Men felt screening would be acceptable by women if men and women were educated. Men highlighted health system barriers to accessing screening including: 1) poor-quality health services, 2) large distances to facilities/lack of affordable transportation and 3) lack of health workers/mistreatment by health workers. Men described supporting women through assisting with transportation, psychosocial support and sharing information. They requested services for men to be decentralized alongside community outreaches for cervical cancer screening. Engaging men in the implementation, education and planning of community-based cervical cancer screening programs is critical. Not engaging men is a missed opportunity to provide them with services and education. Concerted efforts must be made in educating men and reducing health system barriers to ensure rural women receive cervical cancer screening and follow-up care in low-income settings. Clinicaltrials.gov, NCT04000503; Registered 27 June 2019.
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Affiliation(s)
- Angeli Rawat
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada.
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada.
| | - Nadia Mithani
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Catherine Sanders
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Ruth Namugosa
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Beth Payne
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Sheona Mitchell-Foster
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Gina Ogilvie
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Carolyn Nakisige
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
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16
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Gottschlich A, Payne BA, Trawin J, Albert A, Jeronimo J, Mitchell-Foster S, Mithani N, Namugosa R, Naguti P, Pedersen H, Rawat A, Simelela PN, Singer J, Smith LW, van Niekerk D, Orem J, Nakisige C, Ogilvie G. Community-integrated self-collected HPV-based cervix screening in a low-resource rural setting: a pragmatic, cluster-randomized trial. Nat Med 2023; 29:927-935. [PMID: 37037880 DOI: 10.1038/s41591-023-02288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/17/2022] [Accepted: 03/02/2023] [Indexed: 04/12/2023]
Abstract
Effective approaches to improve coverage of self-collected human papillomavirus (HPV)-based cervix screening (SCS) as well as attendance at treatment for HPV-positive participants are needed to inform policy on optimal integration of cervical cancer screening programs within existing infrastructure in low-resource settings. ASPIRE Mayuge was a pragmatic cluster-randomized trial in rural Mayuge district, Uganda, comparing the superiority of two recruitment implementation strategies for SCS: Door-to-Door versus Community Health Day. Villages were randomized (unblinded) to a strategy, and participants aged 25-49 years with no previous history of hysterectomy or treatment for cervical cancer or pre-cancer were eligible. Participants completed a survey and participated in SCS. The primary outcome was rate of attendance at treatment after a positive SCS. The trial randomized 31 villages and 2,019 participants included in these analyses (Door-to-Door: 16 clusters, 1,055 participants; Community Health Day: 15 clusters, 964 participants). Among HPV-positive participants, attendance at treatment rates were 75% (Door-to-Door) and 67% (Community Health Day) (P = 0.049). Participants in the Community Health Day intervention were less likely to attend treatment compared to Door-to-Door (risk ratio = 0.78, 95% confidence interval: 0.64-0.96). No adverse events were reported. Policymakers in low-resource settings can use these results to guide implementation of SCS programs. ISRCTN registration: 12767014 . ClinicalTrials.gov registration: NCT04000503 .
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Affiliation(s)
- Anna Gottschlich
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada.
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
| | - Beth A Payne
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jessica Trawin
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Arianne Albert
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Sheona Mitchell-Foster
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Northern Medical Program, University of British Columbia, Prince George, British Columbia, Canada
| | - Nadia Mithani
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Heather Pedersen
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Angeli Rawat
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Joel Singer
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Gina Ogilvie
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
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17
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Dau H, Gottschlich A, Metz L, Pineda N, Pineda A, Alvarez CS, Bevliacqua K, Mendoza-Montano C, Ogilvie G, Rivera-Andrade A, Gharzouzi E, Meza R. The role of daughters in relation to their mother's cervical cancer diagnosis and treatment in Guatemala: a descriptive study. BMC Womens Health 2023; 23:142. [PMID: 36991461 PMCID: PMC10053719 DOI: 10.1186/s12905-023-02305-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE There is currently no information on how caregivers for women diagnosed with cervical cancer in Guatemala, particularly daughters, are affected by their supportive role. This study's objective was to describe the support role of caregivers in the country, with a focus on daughters with a mother diagnosed with cervical cancer. METHODS This analysis utilizes data from a cross-sectional study which aimed to understand pathways to cervical cancer care. Women seeking cervical cancer treatment at the Instituto de Cancerologia (INCAN) in Guatemala City, Guatemala and their companions were surveyed. Descriptive statistics were calculated. RESULTS One hundred forty-five women seeking treatment and 71 companions participated in the study. Patient's daughters were most frequently reported as the person who provided the most support (51%) and as the most reported to have encouraged the patient to seek care. Furthermore, daughters were noted as the person most reported to fulfill the major household and livelihood roles of the patient while they were seeking or receiving treatment (38.0%). Most daughters reported that they were missing housework (77%), childcare (63%), and income-earning activities (60%) to attend the appointment with their mothers. CONCLUSION Our study suggests that in Guatemala cervical cancer patient's daughters have a significant support role in their mother's cancer diagnosis. Furthermore, we found that while caring for their mothers, daughters in Guatemala are often unable to participate in their primary labor activities. This highlights the additional burden that cervical cancer has on women in Latin America.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Anna Gottschlich
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lynn Metz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Natalia Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Andres Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Kristin Bevliacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Mendoza-Montano
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Gina Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Alvaro Rivera-Andrade
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Rafael Meza
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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18
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Gilbert M, Ablona A, Chang HJ, Grennan T, Irvine MA, Sarai Racey C, Salway T, Naus M, Dawar M, Ogilvie G. Uptake of Mpox vaccination among transgender people and gay, bisexual and other men who have sex with men among sexually-transmitted infection clinic clients in Vancouver, British Columbia. Vaccine 2023; 41:2485-2494. [PMID: 36894397 PMCID: PMC9990897 DOI: 10.1016/j.vaccine.2023.02.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 12/05/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES As the primary public health strategy for controlling the 2022 Mpox outbreak, it is critical to evaluate the impact of Mpox vaccination campaigns for transgender people and gay, bisexual and other men who have sex with men (T/GBM). We measured vaccine uptake and associated factors among T/GBM clients of an urban STI clinic in British Columbia (BC). METHODS We conducted a cross-sectional online survey between August 8-22, 2022 of clients who had attended the STI clinic, 5-7 weeks following the first-dose Mpox vaccination campaign in BC. We drew on a systematic review of factors associated with vaccine uptake to develop survey questions, and measured vaccine uptake among vaccine-eligible T/GBM. RESULTS Overall, 51% of T/GBM had received the first dose of the vaccine. The sample (331 participants) was majority White and university educated, identified as a man and gay, 10% had trans experience, and 68% met eligibility criteria for vaccination. Among vaccine-eligible participants identifying as T/GBM, 66% had been vaccinated; being unvaccinated was more common among participants identifying as bisexual or heteroflexible/mostly straight, and who spent less time with other T/GBM. Eligible yet unvaccinated participants had lower perceived susceptibility, and reported fewer cues to action (e.g., fewer saw information promoting the vaccine), and increased constraints to vaccine access; vaccine barriers related to accessing clinics and privacy were common. The majority (85%) of those eligible and unvaccinated at time of survey were willing to receive the vaccine. CONCLUSION In this sample of STI clinic clients, vaccine uptake among eligible T/GBM was high in the initial weeks following a Mpox vaccination campaign. However, uptake was patterned on social gradients with lower uptake among T/GBM who may be less effectively engaged by available promotion channels. We recommend early, intentional and diverse engagement of T/GBM populations in Mpox and other targeted vaccination programs.
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Affiliation(s)
- Mark Gilbert
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Aidan Ablona
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Hsiu-Ju Chang
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Department of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - C Sarai Racey
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Monika Naus
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meena Dawar
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Dau H, Kakaire O, Karim ME, Nakisige C, Vidler M, Payne BA, Ogilvie G. Understanding the association between informed choice and long-term reversible contraception among Ugandan women: Findings from the 2016 Demographic Health Survey. Int J Gynaecol Obstet 2023; 160:978-985. [PMID: 36052848 DOI: 10.1002/ijgo.14432] [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: 04/13/2022] [Revised: 07/11/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To understand the relationship between informed choice and long-acting reversible contraceptive (LARC) use among women aged 15-49 years in Uganda after adjusting for potential confounding. METHODS This cross-sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas-Rao corrections to a χ2 test were used for the bivariable analysis. A design-adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis. RESULTS In all, 3646 women were included in the analysis and 975 reported using a LARC. In the design-adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61-2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings. CONCLUSION Providing informed choice can help to increase the number of women who use LARC in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counseling as it could contribute to the reduction of unplanned pregnancies across Uganda with the use of LARC.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth A Payne
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
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20
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky NJ, Mah A, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DH, Yeung A, Burchell AN. Self-reported Human Papillomavirus Vaccination and Vaccine Effectiveness Among Men Who Have Sex with Men: A Quantitative Bias Analysis. Epidemiology 2023; 34:225-229. [PMID: 36722804 PMCID: PMC9891269 DOI: 10.1097/ede.0000000000001580] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Self-report of human papillomavirus (HPV) vaccination has ~80-90% sensitivity and ~75-85% specificity. We measured the effect of nondifferential exposure misclassification associated with self-reported vaccination on vaccine effectiveness (VE) estimates. METHODS Between 2017-2019, we recruited sexually active gay, bisexual, and other men who have sex with men aged 16-30 years in Canada. VE was derived as 1-prevalence ratio × 100% for prevalent anal HPV infection comparing vaccinated (≥1 dose) to unvaccinated men using a multivariable modified Poisson regression. We conducted a multidimensional and probabilistic quantitative bias analysis to correct VE estimates. RESULTS Bias-corrected VE estimates were relatively stable across sensitivity values but differed from the uncorrected estimate at lower values of specificity. The median adjusted VE was 27% (2.5-97.5th simulation interval = -5-49%) in the uncorrected analysis, increasing to 39% (2.5-97.5th simulation interval = 2-65%) in the bias-corrected analysis. CONCLUSION A large proportion of participants erroneously reporting HPV vaccination would be required to meaningfully change VE estimates.
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Affiliation(s)
- Catharine Chambers
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- From the University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University, Montréal, Québec, Canada
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada
| | | | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A. Hart
- From the University of Toronto, Toronto, Ontario, Canada
- Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver British Columbia, Canada
| | - Daniel Grace
- From the University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | | | - Ashley Mah
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | | | - Anna Yeung
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Ann N. Burchell
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
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21
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Dau H, Trawin J, Nakisige C, Payne BA, Vidler M, Singer J, Orem J, Smith L, Ogilvie G. The social and economic impacts of cervical cancer on women and children in low- and middle-income countries: A systematic review. Int J Gynaecol Obstet 2023; 160:751-761. [PMID: 35962711 DOI: 10.1002/ijgo.14395] [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: 01/20/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is limited knowledge on the social and economic impacts of a diagnosis of cervical cancer on women and children in low- and middle-income countries (LMICs). OBJECTIVES To determine the social and economic impacts associated with cervical cancer among women and children living in LMICs. SEARCH STRATEGY The MEDLINE, PsychInfo, CINAHL, Pais International, and CAB Global Health databases were systematically searched to retrieve studies up to June 2021. SELECTION CRITERIA Studies were included if they reported on either the social or economic impacts of women or children in a LMIC. DATA COLLECTION AND ANALYSIS Data was independently extracted by two co-authors. The authors performed a quality assessment on all included articles. MAIN RESULTS In all, 53 studies were included in the final review. Social impacts identified included social support, education, and independence. Economic impacts included employment and financial security. No study reported the economic impact on children. Studies that utilized quantitative methods typically reported more positive results than those that utilized qualitative methods. CONCLUSIONS Additional mixed-methods research is needed to further understand the social support needs of women with cervical cancer. Furthermore, research is needed on the impact of a mother's diagnosis of cervical cancer on her children.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jessica Trawin
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Beth A Payne
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Laurie Smith
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Cancer, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
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22
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Zamanpour A, Grennan T, Ablona A, Fairley CK, Estcourt C, Mema S, Hoyano D, Ogilvie G, Wong J, Gilbert M. Treatment and Partner Notification Outcomes for Clients Diagnosed With Chlamydia and Gonorrhea Through GetCheckedOnline Compared With Sexually Transmitted Infection Clinics in British Columbia, Canada. Sex Transm Dis 2023; 50:86-91. [PMID: 36367543 DOI: 10.1097/olq.0000000000001735] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A study comparing treatment and partner notification outcomes for people diagnosed with chlamydia or gonorrhea found no differences between clients of Internet-based and clinic-based testing services.
Background
Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of Internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline (GCO), an Internet-based testing service in British Columbia.
Methods
We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016 to 2017 was matched to 2 STI clinic cases by diagnosis, sex, age group, and specimen collection date. Data were collected through chart review, with outcomes compared using appropriate statistical tests.
Results
Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254 of 257 [98.9%]) and clinic (513 of 514 [99.8%]) cases, as was engagement in PN (250 of 257 [97.2%] vs. 496 of 514 [96.5%]). There was no difference in the proportion of notified partners between GCO (159 of 270 [58.9%]) and clinic (253 of 435 [58.2%]) cases, although a greater proportion of partners reported by clinic cases were notified by STI nurses (43 of 435 [9.9%]) versus GCO cases (6 of 270 [2.2%]).
Conclusions
GetCheckedOnline clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for PN among clinic clients may be related to having had an initial in-person testing visit.
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Affiliation(s)
| | | | | | | | - Claudia Estcourt
- School of Health & Life Science, Glasgow Caledonian University, Glasgow, Scotland
| | | | - Dee Hoyano
- Island Health Authority, Victoria, British Columbia, Canada
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23
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McClymont E, Tan DH, Bondy S, Albert A, Coutlée F, Lee M, Walmsley S, Ogilvie G, Money D. HSV-2 infection and HPV incidence, persistence, and precancerous lesions in a cohort of HPV-vaccinated women living with HIV. Int J STD AIDS 2023; 34:402-407. [PMID: 36702811 PMCID: PMC10133830 DOI: 10.1177/09564624231154298] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several co-factors for HPV oncogenesis have been proposed, including co-infection with HSV-2. We assessed the relationship between HSV-2 infection and HPV-related outcomes in quadrivalent HPV-vaccinated (qHPV) women living with HIV (WLWH). METHODS In this multi-site study of immunogenicity and efficacy of the qHPV vaccine in WLWH, visits took place at months -3, 0, 2, 6, 12, 18, 24, and annually thereafter. Participants provided clinical data and cervico-vaginal swabs for HPV DNA detection; baseline serum was tested for HSV-2 type-specific antibodies. We used non-parametric statistics to compare HPV-related outcomes by HSV-2 serostatus and use of anti-HSV medication. RESULTS 151 baseline serum samples underwent HSV-2 testing. At baseline, median age was 39 years, median CD4 count was 500 cells/mm3, and 70% had an HIV viral load of <50 copies/mL. Baseline HSV-2 seroprevalence was 76.2%. HSV-2 seropositivity was associated with increased age (p = 0.006). Controlling for age and median CD4 count, HSV-2 seropositivity was not associated with HPV incidence, persistence, and precancerous lesions. The use of anti-HSV medications was associated with higher odds of HSIL cytology (OR = 3.35, 95% CI = 1.03,11.26) and a greater number of HPV types detected (OR = 1.18, 95% CI = 1.00,1.39). Results were similar in sensitivity analyses using an index value of 3.5. The presence of HSV lesions during the study was not associated with HPV outcomes. CONCLUSIONS HSV-2 seropositivity was common in this cohort of WLWH in Canada but was not associated with multiple measures of HPV incidence, persistence, and precancerous lesions. However, the use of anti-HSV medications was associated with HSIL cytology and number of HPV types detected.
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Affiliation(s)
- Elisabeth McClymont
- Obstetrics & Gynecology, 8166University of British Columbia, Vancouver, BC, CA.,Canadian HIV Trials Network, Vancouver, BC, CA
| | - Darrell Hs Tan
- University of Toronto, Toronto, ON, CA.,7989University Health Network, Toronto, ON, CA.,Infectious Diseases, St Michael's Hospital, Toronto, ON, CA
| | - Suraya Bondy
- Obstetrics & Gynecology, 8166University of British Columbia, Vancouver, BC, CA.,574117British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, BC, CA
| | - Arianne Albert
- 574117British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, BC, CA
| | | | - Marette Lee
- Obstetrics & Gynecology, 8166University of British Columbia, Vancouver, BC, CA
| | - Sharon Walmsley
- University of Toronto, Toronto, ON, CA.,7989University Health Network, Toronto, ON, CA
| | - Gina Ogilvie
- Obstetrics & Gynecology, 8166University of British Columbia, Vancouver, BC, CA.,574117British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, BC, CA
| | - Deborah Money
- Obstetrics & Gynecology, 8166University of British Columbia, Vancouver, BC, CA.,574117British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, BC, CA
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24
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Gillis JL, Grennan T, Grewal R, Ogilvie G, Gaspar M, Grace D, Lofters A, Raboud JM, Saarela O, MacPherson P, Rosenes R, Salit IE, Burchell AN, Burchell A, Rueda S, Arbess G, Cohen J, Cooper C, Lavoie E, Crouzat F, Andany N, Walmsley S, Silverman M, Sandre R, Tharao W, Gauvin H, Smaill F. Influence of previous experience with and beliefs regarding anal cancer screening on willingness to be screened among men living with HIV. BMC Public Health 2022; 22:2444. [PMID: 36577960 PMCID: PMC9795733 DOI: 10.1186/s12889-022-14471-4] [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: 10/28/2021] [Accepted: 10/26/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementation of anal cancer screening requires the procedure to be acceptable to the target population. Our objective was to assess the beliefs of men living with HIV regarding anal cancer screening and identify factors associated with their willingness to participate in screening. METHODS We developed a cross-sectional questionnaire using the Theory of Planned Behavior to examine beliefs regarding prevention of human papillomavirus (HPV)-related diseases, administered to men living with HIV in 2016-2017 in a multi-site HIV clinical cohort. Correspondence analysis was used to examine the interrelationships between men's beliefs and willingness to undergo anal cancer screening. We used multivariable proportional odds models to identify factors associated with increasing willingness. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Among 1677 male participants, the vast majority (90%) would be willing to undergo screening by "anal Pap test"; willingness clustered with positive beliefs (e.g. confident they can get screened; disagree that they will feel pain) in the correspondence analysis. Higher self-perceived risk for anal cancer and positive beliefs regarding screening were associated with higher willingness to be screened. Gay, bisexual and other men who have sex with men had higher willingness (aOR = 1.62; 95% CI: 1.15, 2.29) than heterosexual men. Racialized men reported lower willingness (aOR = 0.68; 95% CI: 0.54, 0.89) than white men. CONCLUSIONS Men generally had positive beliefs and were willing to undergo screening, though there were differences by sexual orientation and racial identity. Tailored community-led initiatives could focus on men's understanding of their risk and expectations of anal cancer screening to facilitate participation.
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Affiliation(s)
- Jennifer L. Gillis
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Troy Grennan
- grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Ramandip Grewal
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Gina Ogilvie
- grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Mark Gaspar
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Aisha Lofters
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario Canada
| | - Janet M. Raboud
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Olli Saarela
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Paul MacPherson
- grid.412687.e0000 0000 9606 5108The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Ron Rosenes
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Irving E. Salit
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Ann N. Burchell
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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Chambers C, Gillis J, Lindsay J, Benoit AC, Kendall CE, Kroch A, Grewal R, Loutfy M, Mah A, O'Brien K, Ogilvie G, Raboud J, Rachlis A, Rachlis B, Yeung A, Yudin MH, Burchell AN. Low human papillomavirus vaccine uptake among women engaged in HIV care in Ontario, Canada. Prev Med 2022; 164:107246. [PMID: 36075492 DOI: 10.1016/j.ypmed.2022.107246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
Women living with HIV are at higher risk for human papillomavirus (HPV)-related dysplasia and cancers and thus are prioritized for HPV vaccination. We measured HPV vaccine uptake among women engaged in HIV care in Ontario, Canada, and identified socio-demographic, behavioural, and clinical characteristics associated with HPV vaccination. During annual interviews from 2017 to 2020, women participating in a multi-site, clinical HIV cohort responded to a cross-sectional survey on HPV vaccine knowledge and receipt. We used logistic regression to derive age-adjusted odds ratios and 95% confidence intervals (CI) for factors associated with self-reported vaccine initiation (≥1 dose) or series completion (3 doses). Among 591 women (median age = 48 years; interquartile range = 40-56 years), 13.2% (95%CI = 10.5-15.9%) had received ≥1 dose. Of those vaccinated, 64.6% had received 3 doses. Vaccine initiation (≥1 dose) was significantly higher among women aged 20-29 years at 31.0% but fell to 13.9% in those aged 30-49 years and < 10% in those aged ≥50 years. After age adjustment, vaccine initiation was significantly associated with being employed (vs. unemployed but seeking work), income $40,000-$59,999 (vs. <$20,000), being married/common-law (vs. single), living with children, immigrating to Canada >5 years ago (vs. immigrating ≤5 years ago), never smoking (vs. currently smoking), and being in HIV care longer (per 10 years). Similar factors were identified for series completion (3 doses). HPV vaccine uptake remains low among women living with HIV in our cohort despite regular engagement in care. Recommendations for improving uptake include education of healthcare providers, targeted community outreach, and public funding of HPV vaccination.
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Affiliation(s)
- Catharine Chambers
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Joanne Lindsay
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Anita C Benoit
- University of Toronto, Toronto, Canada; Women's College Research Institute, Toronto, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Abigail Kroch
- University of Toronto, Toronto, Canada; Ontario HIV Treatment Network, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Ramandip Grewal
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Mona Loutfy
- Women's College Research Institute, Toronto, Canada
| | - Ashley Mah
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Gina Ogilvie
- University of British Columbia, Vancouver, Canada
| | - Janet Raboud
- University of Toronto, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | | | - Beth Rachlis
- University of Toronto, Toronto, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Anna Yeung
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Mark H Yudin
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Ann N Burchell
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
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26
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Simkin J, Dummer TJB, Erickson AC, Otterstatter MC, Woods RR, Ogilvie G. Small area disease mapping of cancer incidence in British Columbia using Bayesian spatial models and the smallareamapp R Package. Front Oncol 2022; 12:833265. [PMID: 36338766 PMCID: PMC9627310 DOI: 10.3389/fonc.2022.833265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/26/2022] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION There is an increasing interest in small area analyses in cancer surveillance; however, technical capacity is limited and accessible analytical approaches remain to be determined. This study demonstrates an accessible approach for small area cancer risk estimation using Bayesian hierarchical models and data visualization through the smallareamapp R package. MATERIALS AND METHODS Incident lung (N = 26,448), female breast (N = 28,466), cervical (N = 1,478), and colorectal (N = 25,457) cancers diagnosed among British Columbia (BC) residents between 2011 and 2018 were obtained from the BC Cancer Registry. Indirect age-standardization was used to derive age-adjusted expected counts and standardized incidence ratios (SIRs) relative to provincial rates. Moran's I was used to assess the strength and direction of spatial autocorrelation. A modified Besag, York and Mollie model (BYM2) was used for model incidence counts to calculate posterior median relative risks (RR) by Community Health Service Areas (CHSA; N = 218), adjusting for spatial dependencies. Integrated Nested Laplace Approximation (INLA) was used for Bayesian model implementation. Areas with exceedance probabilities (above a threshold RR = 1.1) greater or equal to 80% were considered to have an elevated risk. The posterior median and 95% credible intervals (CrI) for the spatially structured effect were reported. Predictive posterior checks were conducted through predictive integral transformation values and observed versus fitted values. RESULTS The proportion of variance in the RR explained by a spatial effect ranged from 4.4% (male colorectal) to 19.2% (female breast). Lung cancer showed the greatest number of CHSAs with elevated risk (Nwomen = 50/218, Nmen = 44/218), representing 2357 total excess cases. The largest lung cancer RRs were 1.67 (95% CrI = 1.06-2.50; exceedance probability = 96%; cases = 13) among women and 2.49 (95% CrI = 2.14-2.88; exceedance probability = 100%; cases = 174) among men. Areas with small population sizes and extreme SIRs were generally smoothed towards the null (RR = 1.0). DISCUSSION We present a ready-to-use approach for small area cancer risk estimation and disease mapping using BYM2 and exceedance probabilities. We developed the smallareamapp R package, which provides a user-friendly interface through an R-Shiny application, for epidemiologists and surveillance experts to examine geographic variation in risk. These methods and tools can be used to estimate risk, generate hypotheses, and examine ecologic associations while adjusting for spatial dependency.
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Affiliation(s)
- Jonathan Simkin
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Trevor J. B. Dummer
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anders C. Erickson
- Office of the Provincial Health Officer, Government of British Columbia, Victoria, BC, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ryan R. Woods
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gina Ogilvie
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital + Health Centre, Vancouver, BC, Canada
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de Waal A, Racey CS, Donken R, Plotnikoff K, Dobson S, Smith L, Grennan T, Sadarangani M, Ogilvie G. Factors associated with intention to receive vaccines for bacterial sexually transmitted infections among young HPV-vaccinated Canadian women. Can J Public Health 2022; 113:776-785. [PMID: 35616872 PMCID: PMC9134722 DOI: 10.17269/s41997-022-00648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Abstract
Objective The aim of this study was to explore the acceptability of bacterial STI vaccines among young HPV-vaccinated Canadian women to inform future vaccine program implementation. Methods A 20-item cross-sectional questionnaire was administered from June 2019 to June 2020 to HPV-vaccinated participants of the pan-Canadian QUEST cohort. Multivariable logistic regression models assessed interest in chlamydia, syphilis, and gonorrhea vaccines using a priori variables and factors significant in bivariate analysis. Results Of the 1092 respondents analyzed, 82% indicated interest in receiving one or more future STI vaccines. Respondents had a median age of 19.6 years (range 16.9–23.4), and 75% of respondents identified as white/European descent. In adjusted analyses, intent to engage in positive health behaviours was associated with vaccine interest for syphilis (OR = 5.76, 95% CI 4.03–8.27), chlamydia (OR = 5.27, 95% CI 3.66–7.63), and gonorrhea (OR = 5.96, 95% CI 4.15–8.60). Willingness to pay for an STI vaccine was also associated with vaccine interest for syphilis (OR = 2.02, 95% CI 1.29–3.19), chlamydia (OR = 2.41, 95% CI 1.50–3.90), and gonorrhea (OR = 2.29, 95% CI 1.44–3.63). Ever having sexual intercourse and identifying as LGBTQ were significantly associated with vaccine interest for all infections, while age and ever being immunosuppressed were not significant in any adjusted models. Conclusion Findings indicate over 80% of participants in a cohort of young HPV-vaccinated Canadian women are interested in receiving future bacterial STI vaccines. Further exploration of STI vaccine acceptability among diverse populations is required to inform future bacterial STI vaccine program implementation. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-022-00648-2.
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Affiliation(s)
- Anna de Waal
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - C Sarai Racey
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robine Donken
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Plotnikoff
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | | | - Laurie Smith
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Troy Grennan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.
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Markowitz LE, Drolet M, Lewis RM, Lemieux-Mellouki P, Pérez N, Jit M, Brotherton JM, Ogilvie G, Kreimer AR, Brisson M. Human papillomavirus vaccine effectiveness by number of doses: Updated systematic review of data from national immunization programs. Vaccine 2022; 40:5413-5432. [PMID: 35965239 PMCID: PMC9768820 DOI: 10.1016/j.vaccine.2022.06.065] [Citation(s) in RCA: 6] [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: 11/22/2021] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines were first licensed as a three-dose series. Two doses are now widely recommended in some age groups; there are data suggesting high efficacy with one dose. We updated a systematic literature review of HPV vaccine effectiveness by number of doses in observational studies. METHODS We searched Medline and Embase databases from January 1, 2007, through September 29, 2021. Data were extracted and summarized in a narrative synthesis. We also conducted quality assessments for bias due to selection, information, and confounding. RESULTS Overall, 35 studies were included; all except one were conducted within the context of a recommended three-dose schedule. Evaluations were in countries that used bivalent HPV vaccine (seven), quadrivalent HPV vaccine (27) or both (one). Nine evaluated effectiveness against HPV infection, ten anogenital warts, and 16 cervical abnormalities. All studies were judged to have moderate or serious risk of bias. The biases rated as serious would likely result in lower effectiveness with fewer doses. Investigators attempted to control for or stratify by potentially important variables, such as age at vaccination. Eight studies evaluated impact of buffer periods (lag time) for case counting and 10 evaluated different intervals between doses for two-dose vaccine recipients. Studies that stratified by vaccination age found higher effectiveness with younger age at vaccination, although differences were not all formally tested. Most studies found highest estimates of effectiveness with three doses; significant effectiveness was found among 28/29 studies that evaluated three doses, 19/29 that evaluated two doses, and 18/30 that evaluated one dose. Some studies that adjusted or stratified analyses by age at vaccination found similar effectiveness with three, two and one doses. CONCLUSION Observational studies of HPV vaccine effectiveness have many biases. Studies examining persons vaccinated prior to sexual activity and using methods to reduce sources of bias are needed for valid effectiveness estimates.
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Affiliation(s)
- Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Rayleen M Lewis
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Synergy America, Inc, Duluth, GA, USA
| | - Philippe Lemieux-Mellouki
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Norma Pérez
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M Brotherton
- Population Health, VCS Foundation, East Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Gina Ogilvie
- University of British Columbia, British Columbia, Canada
| | - Aimée R Kreimer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marc Brisson
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
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Shastri SS, Temin S, Almonte M, Basu P, Campos NG, Gravitt PE, Gupta V, Lombe DC, Murillo R, Nakisige C, Ogilvie G, Pinder LF, Poli UR, Qiao Y, Woo YL, Jeronimo J. Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update. JCO Glob Oncol 2022; 8:e2200217. [PMID: 36162041 PMCID: PMC9812449 DOI: 10.1200/go.22.00217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally. METHODS American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus. RESULTS This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. RECOMMENDATIONS Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Nicole G Campos
- Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | | | - Dorothy C Lombe
- Regional Cancer Treatment Services, MidCentral District Health Board, Palmerston North, New Zealand
| | | | | | | | | | - Usha R Poli
- India Institute of Public Health, Hyderabad, India
| | - Youlin Qiao
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Prudden HJ, Achilles SL, Schocken C, Broutet N, Canfell K, Akaba H, Basu P, Bhatla N, Chirenje ZM, Delany-Moretlwe S, Denny L, Gamage DG, Herrero R, Hutubessy R, Villa LL, Murillo R, Schiller JT, Stanley M, Temmerman M, Zhao F, Ogilvie G, Kaslow DC, Dull P, Gottlieb SL. Understanding the public health value and defining preferred product characteristics for therapeutic human papillomavirus (HPV) vaccines: World Health Organization consultations, October 2021-March 2022. Vaccine 2022; 40:5843-5855. [PMID: 36008233 DOI: 10.1016/j.vaccine.2022.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
The World Health Organization (WHO) global strategy to eliminate cervical cancer (CxCa) could result in >62 million lives saved by 2120 if strategy targets are reached and maintained: 90% of adolescent girls receiving prophylactic human papillomavirus (HPV) vaccine, 70% of women receiving twice-lifetime cervical cancer screening, and 90% of cervical pre-cancer lesions and invasive CxCa treated. However, the cost and complexity of CxCa screening and treatment approaches has hampered scale-up, particularly in low- and middle-income countries (LMICs), and new approaches are needed. Therapeutic HPV vaccines (TxV), which could clear persistent high-risk HPV infection and/or cause regression of pre-cancerous lesions, are in early clinical development and might offer one such approach. During October 2021 to March 2022, WHO, in collaboration with the Bill and Melinda Gates Foundation, convened a series of global expert consultations to lay the groundwork for understanding the potential value of TxV in the context of current CxCa prevention efforts and for defining WHO preferred product characteristics (PPCs) for TxV. WHO PPCs describe preferences for vaccine attributes that would help optimize vaccine value and use in meeting the global public health need. This paper reports on the main discussion points and findings from the expert consultations. Experts identified several ways in which TxV might address challenges in current CxCa prevention programmes, but emphasized that the potential value of TxV will depend on their degree of efficacy and how quickly they can be developed and implemented relative to ongoing scale-up of existing interventions. Consultation participants also discussed potential use-cases for TxV, important PPC considerations (e.g., vaccine indications, target populations, and delivery strategies), and critical modelling needs for predicting TxV impact and cost-effectiveness.
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Affiliation(s)
| | | | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Australia
| | | | - Partha Basu
- International Agency for Research on Cancer, France
| | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Lynette Denny
- University of Cape Town, SA MRC Gynaecology Cancer Research, South Africa
| | | | | | | | | | | | | | | | | | - Fanghui Zhao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Gina Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Canada
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Zhu P, Tatar O, Haward B, Griffin-Mathieu G, Perez S, Smith L, Brotherton J, Ogilvie G, Rosberger Z. Assessing Canadian women's preferences for cervical cancer screening: A brief report. Front Public Health 2022; 10:962039. [PMID: 35968487 PMCID: PMC9366717 DOI: 10.3389/fpubh.2022.962039] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Human papillomavirus (HPV) testing is recommended for primary screening for cervical cancer by several health authorities. Several countries that have implemented HPV testing programs have encountered resistance against extended screening intervals and older age of initiation. As Canada prepares to implement HPV testing programs, it is important to understand women's preferences toward cervical cancer screening to ensure a smooth transition. The objective of this study was to assess Canadian women's current preferences toward cervical cancer screening. Using a web-based survey, we recruited underscreened ( > 3 years since last Pap test) and adequately screened (< 3 years since last Pap test) Canadian women aged 21–70 who were biologically female and had a cervix. We used Best-Worst Scaling (BWS) methodology to collect data on women's preferences for different screening methods, screening intervals, and ages of initiation. We used conditional logistic regression to estimate preferences in both subgroups. In both subgroups, women preferred screening every three years compared to every five or ten years, and initiating screening at age 21 compared to age 25 or 30. Adequately screened women (n = 503) most preferred co-testing, while underscreened women (n = 524) preferred both co-testing and HPV self-sampling over Pap testing. Regardless of screening status, women preferred shorter screening intervals, an earlier age of initiation, and co-testing. Adequate communication from public health authorities is needed to explain the extended screening intervals and age of initiation to prevent resistance against these changes to cervical cancer screening.
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Affiliation(s)
- Patricia Zhu
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- *Correspondence: Ovidiu Tatar
| | - Ben Haward
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
| | - Laurie Smith
- BC Women's Hospital, Women's Health Research Institute, Vancouver, BC, Canada
| | - Julia Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Australian Centre for the Prevention of Cervical Cancer, East Melbourne, VIC, Australia
| | - Gina Ogilvie
- BC Women's Hospital, Women's Health Research Institute, Vancouver, BC, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Departments of Psychology and Oncology, McGill University, Montreal, QC, Canada
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Closson K, Zharima C, Kuchena M, Dietrich JJ, Gadermann A, Ogilvie G, Beksinska M, Kaida A. "I feel like it is asking if he is a stalker … but I also feel like it is asking if he cares": exploring young South African women and men's perceptions of the Sexual Relationship Power Scale. BMC Public Health 2022; 22:1368. [PMID: 35842627 PMCID: PMC9288208 DOI: 10.1186/s12889-022-13686-9] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Gender inequity and the subsequent health impacts disproportionately affect communities in the Global South. However, most gender equity measures, such as Pulerwitz’ (2000) Sexual Relationship Power Scale (SRPS), are developed and validated in the Global North and then applied in Global South settings without investigation of context applicability or validity. This study examines the SRPS’ validity evidence, comprehensiveness, and contemporary relevance for young South African women and men. Methods Between 2019 and 2021, 38 cognitive interviews (CIs) were conducted among previous participants of a South African youth cohort study ‘AYAZAZI’ (2015–2017) to explore youth’s perceptions of the SRPS. The SRPS measures women’s perceptions of their partner’s controlling behaviours, and men’s perceptions of their own controlling behaviours. Using CIs, participants responded to a 13-item adaptation of the SRPS for use among South African youth (strongly agree-strongly disagree), and then were asked to think-aloud their reasoning for responses, their understanding and perceived relevance of each item, and made overall suggestions for scale adaptations. An item appraisal coding process was applied, whereby Cognitive Coding assessed the types of cognitive problems youth had with understanding the items, and Question Feature Coding assessed which item features caused problems for participant understandings. Finally, youth recommendations for scale adaptations were summarized. Results Overall, 21 women and 17 men aged 21–30 participated in CIs in Durban and Soweto, South Africa. Cognitive Coding revealed 1. Comprehension issues, and 2. Judgements related to items’ applicability to lived experiences and identities (e.g., being unmarried). Question Feature Coding revealed items’ 1. Lack of clarity or vagueness in wording and 2. Logical problems in assumptions leading to multiple interpretations (e.g., item ‘my partner always need to know where I am’ interpreted as both controlling and caring behaviour). Multiple, overlapping issues revealed how many items failed to “fit” within the present-day living realities of South African youth. Youth recommended several item adaptations and additions, including strength-based items, to existing measures of gender equity and relationship power. Conclusion Given identified issues, several adaptations including revising items to be more inclusive, contemporary, context specific, relational, and strength-based are needed to validly measure gender equity and power dynamics within the relationships of South African youth. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13686-9.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Kuchena
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,African Social Sciences Unit of Research and Evaluation (ASSURE), a division of the Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Closson K, Ndungu J, Beksinska M, Ogilvie G, Dietrich JJ, Gadermann A, Gibbs A, Nduna M, Smit J, Gray G, Kaida A. Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review. Trauma Violence Abuse 2022; 23:920-937. [PMID: 33353490 DOI: 10.1177/1524838020979676] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Ndungu
- School of Behavioural & Lifestyle Sciences, 56723Nelson Mandela University, Port Elizabeth, South Africa
- Office of Engagement and Transformation, 56723Nelson Mandela University, Port Elizabeth, South Africa
| | - Mags Beksinska
- MatCH Research Unit (MRU), 37708Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Gina Ogilvie
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute (WHRI), BC Women's Health Centre, Vancouver, British Columbia, Canada
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa
| | - Anne Gadermann
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
- The Human Learning Project, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Gibbs
- 59097South African Medical Research Council, Cape Town, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mzikazi Nduna
- Department of Psychology, 37707University of the Witwatersrand, Johannesburg, South Africa
| | - Jenni Smit
- MatCH Research Unit (MRU), 37708Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
- 59097South African Medical Research Council, Cape Town, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada
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Gottschlich A, Anderson JJ, Gondara L, Lee M, van Niekerk D, Smith LW, Cook D, Proctor L, Melnikow J, Stuart G, Martin RE, Peacock S, Franco EL, Krajden M, Ogilvie G. Abstract 6239: Colposcopy referral rates in an organized cytology-based cervix screening program after receipt of multiple rounds of HPV-based screening in the FOCAL trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-6239] [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]
Abstract
Abstract
Purpose: Due to the increased sensitivity but reduced specificity of HPV testing compared to cytology to detect cervical lesions, a shift from cytology to HPV-based screening will initially raise population colposcopy referrals rates, which could put a strain on the healthcare system. However, it is unclear if this increase persists past the initial round of HPV screening or if rates will subsequently decrease due to earlier detection of precancer using HPV screening, which once treated may not reoccur.
Methods: Participants of the HPV FOr CervicAL Cancer (FOCAL) randomized controlled trial (N = 25,223; 2008-2016) received up to two rounds of HPV-based cervix screening during the trial before returning to the cytology-based screening program in British Columbia, Canada (BC). After trial exit, participants were followed through the provincial screening program, which collects results from all screens received in BC, to detect any referral to colposcopy. A comparison cohort from the BC general screening population was created by selecting individuals who were eligible for FOCAL but not invited to participate and pulling their screening data from the provincial registry over the same time period. Post-trial colposcopy rates, calculated per-screen (not per participant), were calculated for the FOCAL population and comparison cohort overall and for those who received one round of HPV testing, those who received two rounds, those who received a negative result on their one round of testing, and those who received two negative results on their two rounds of testing.
Results: The post-trial colposcopy referral rate in the overall FOCAL population was lower than in the comparison cohort. FOCAL had 180 referrals out of 30654 screens (5.9 per 1000 screens, 95%CI: 5.1-6.8), whereas the comparison cohort had 1765/177880 (9.9/1000, 95%CI: 9.5-10.4). The rates between those who had one versus two HPV tests were similar: one test: 99/17599 (5.6/1000, 95%CI: 4.6-6.8); two tests: 100/16945 (5.9/1000, 95%CI: 4.9-7.2). Rates were much lower among those who received negative results: one negative result: 55/15551 (3.5/1000, 95%CI: 2.7-4.6); two negative results: 40/12438 (3.2/1000, 95%CI: 2.4-4.4).
Conclusions: After the first round of HPV-based cervix screening, colposcopy rates may decrease potentially below that seen in a cytology-based program. To avoid a surge in colposcopy referrals that could exceed health system capacity, the introduction of HPV-based screening should be done in waves, for example by inviting a new age group each year to HPV-based screening.
Citation Format: Anna Gottschlich, Jennifer J. Anderson, Lovedeep Gondara, Marette Lee, Dirk van Niekerk, Laurie W. Smith, Darrel Cook, Lily Proctor, Joy Melnikow, Gavin Stuart, Ruth E. Martin, Stuart Peacock, Eduardo L. Franco, Mel Krajden, Gina Ogilvie. Colposcopy referral rates in an organized cytology-based cervix screening program after receipt of multiple rounds of HPV-based screening in the FOCAL trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6239.
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Affiliation(s)
- Anna Gottschlich
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lovedeep Gondara
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marette Lee
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie W. Smith
- 3BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
| | - Darrel Cook
- 4British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Lily Proctor
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Gavin Stuart
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | - Ruth E. Martin
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- 6Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - Mel Krajden
- 4British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- 1University of British Columbia, Vancouver, British Columbia, Canada
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Piret EM, Payne BA, Smith LW, Trawin J, Orem J, Ogilvie G, Nakisige C. Side effects and acceptability measures for thermal ablation as a treatment for cervical precancer in low-income and middle-income countries: a systematic review and meta-synthesis. Fam Med Community Health 2022; 10:fmch-2021-001541. [PMID: 35523456 PMCID: PMC9083391 DOI: 10.1136/fmch-2021-001541] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective Understanding the side effects and acceptability of thermal ablation (TA) is necessary before large-scale application in screen-and-treat programmes can be justified in low-income and middle-income countries (LMICs). Design Articles were selected for inclusion by two independent reviewers. Risk of bias was assessed using the Downs and Black’s criteria. Summary data were extracted, and authors contacted for data when necessary. Proportions of interest and 95% CIs were estimated using a random effects model. Subgroup analysis was performed based on place of treatment and timing of post-treatment follow-up. Heterogeneity was estimated using the I2. Eligibility criteria Studies that reported one or more side effects or patient acceptability measures after treatment of the cervix using TA in women living in LMICs who completed a cervical cancer screening test. Included articles were clinical trials or observational studies available in English and published before 18 December 2020. Information sources Ovid MEDLINE, EMBASE, CINAHL, CAB Global Health and WHO Global Index Medicus were searched for this systematic review and meta-synthesis. Results A total of 1590 abstracts were screened, 84 full text papers reviewed and 15 papers selected for inclusion in the qualitative review, 10 for meta-synthesis (N=2039). Significant heterogeneity was found in screening tests used to identify women eligible for TA and in methods to ascertain side effects. The most commonly reported side effect during treatment was pain (70%, 95% CI 52% to 85%; I2=98.01%) (8 studies; n=1454). No women discontinued treatment due to pain. At treatment follow-up, common side effects included vaginal discharge (72%, 95% CI 18% to 100%; I2=99.55%) (5 studies; n=771) and bleeding (38%, 95% CI 15% to 64%; I2=98.14%) (4 studies; n=856). Satisfaction with treatment was high in 99% (95% CI 98% to 100%; I2=0.00%) of women (3 studies; n=679). Conclusions TA results in a number of common side effects, though acceptability remains high among women treated in LMICs. Standardised side effect and acceptability reporting are needed as TA becomes more readily available. PROSPERO registration number CRD42020197605.
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Affiliation(s)
- Evelyne Marie Piret
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada.,Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth A Payne
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada.,Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jessica Trawin
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jackson Orem
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Gina Ogilvie
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada.,Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn Nakisige
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
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Gottschlich A, Gondara L, Smith LW, Cook D, Martin RE, Lee M, Peacock S, Proctor L, Stuart G, Krajden M, Franco EL, van Niekerk D, Ogilvie G. HPV-based screening at extended intervals missed fewer cervical precancers than cytology in the HPV FOr CervicAL Cancer (HPV FOCAL) trial. Int J Cancer 2022; 151:897-905. [PMID: 35460070 PMCID: PMC9336650 DOI: 10.1002/ijc.34039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Abstract
While cervix screening using cytology is recommended at 2-3-year intervals, given the increased sensitivity of human papillomavirus (HPV)-based screening to detect precancer, HPV-based screening is recommended every 4-5-year. As organized cervix screening programs transition from cytology to HPV-based screening with extended intervals, there is some concern that cancers will be missed between screens. Participants in HPV FOr CervicAL Cancer (HPV FOCAL) trial received cytology (Cytology Arm) at 24-month intervals or HPV-based screening (HPV Arm) at 48-month intervals, and co-testing (cytology and HPV testing) at exit. We investigated the results of the co-test to identify participants with cervical intraepithelial neoplasia grade 2 or higher (CIN2+) who would not have had their precancer detected if they had only their arm's respective primary screen. In the Cytology Arm, 25/62 (40.3%) identified CIN2+s were missed by primary screen (i.e., normal cytology/positive HPV test) and all 25 had normal cytology at the prior 24-month screen. In the HPV arm, three CIN2+s (3/49, 6.1%) were missed by primary screen (i.e., negative HPV test/abnormal cytology). One of these three misses had low-grade cytology findings and would also not have been referred to colposcopy outside of the trial. Multiple rounds of cytology did not detect some precancerous lesions detected with one round of HPV-based screening. In our population, cytology missed more CIN2+, even at shorter screening intervals, than HPV-based screening. This assuages concerns about missed detection post-implementation of an extended interval HPV-based screening program. We recommend that policymakers consider a shift from cytology to HPV-based cervix screening. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna Gottschlich
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Lovedeep Gondara
- Department of Data and Analytics, BC Cancer Agency, Vancouver, Canada
| | - Laurie W Smith
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,BC Cancer Agency, Cancer Control Research, Vancouver, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Marette Lee
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Cervix Screening Program, Vancouver, Canada
| | - Stuart Peacock
- BC Cancer Agency, Cancer Control Research, Vancouver, Canada.,Simon Fraser University, Faculty of Health Sciences, Vancouver, Canada
| | - Lily Proctor
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Cervix Screening Program, Vancouver, Canada
| | - Gavin Stuart
- University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Mel Krajden
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Centre for Disease Control, Vancouver, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Cervix Screening Program, Vancouver, Canada
| | - Gina Ogilvie
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
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Fu W, Sivajohan B, McClymont E, Albert A, Elwood C, Ogilvie G, Money D. Systematic review of the safety, immunogenicity, and effectiveness of COVID-19 vaccines in pregnant and lactating individuals and their infants. Int J Gynaecol Obstet 2022; 156:406-417. [PMID: 34735722 PMCID: PMC9087489 DOI: 10.1002/ijgo.14008] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/02/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is significant risk of complications and vulnerability to severe COVID-19 disease in pregnancy, yet hesitancy exists around COVID-19 vaccination during pregnancy and lactation. OBJECTIVE To summarize the safety, immunogenicity, and effectiveness of COVID-19 vaccines in pregnancy and lactation. SEARCH STRATEGY A systematic search of MEDLINE, Embase, PubMed, medRxiv, and bioRxiv. SELECTION CRITERIA Identified original studies published on pregnant and/or lactating individuals who received one or more doses of a COVID-19 vaccine. DATA COLLECTION AND ANALYSIS A descriptive summary organized by safety, immunogenicity, and effectiveness outcomes of COVID-19 vaccination in pregnancy and lactation. MAIN RESULTS In total, 23 studies were identified. Humoral response and functional immunity were interrogated and found. Increasing placental transfer ratios in cord blood were associated with increasing time from the first vaccine dose to delivery. Safety data indicated that pregnant and lactating populations experienced vaccine-related reactions at similar rates to the general population. No increased risk of adverse obstetrical or neonatal outcomes were reported. One study demonstrated that pregnant individuals were less likely to experience COVID-19 when vaccinated. CONCLUSION COVID-19 vaccination in pregnant and lactating individuals is immunogenic, does not cause significant vaccine-related adverse events or obstetrical and neonatal outcomes, and is effective in preventing COVID-19 disease.
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Affiliation(s)
- Winnie Fu
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Brintha Sivajohan
- Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
| | - Elisabeth McClymont
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Canadian HIV Trials NetworkVancouverBritish ColumbiaCanada
| | - Arianne Albert
- Women’s Health Research InstituteVancouverBritish ColumbiaCanada
| | - Chelsea Elwood
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Gina Ogilvie
- Women’s Health Research InstituteVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Deborah Money
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Women’s Health Research InstituteVancouverBritish ColumbiaCanada
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Willemsma K, Barton L, Stimpson R, Pickell I, Ryan V, Yu A, Pederson A, Ogilvie G, Grennan T, Wong J. Characterizing female infectious syphilis cases in British Columbia to identify opportunities for optimization of care. Can Commun Dis Rep 2022; 48:68-75. [PMID: 35342372 PMCID: PMC8889918 DOI: 10.14745/ccdr.v48i23a03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The rate of infectious syphilis continues to increase among females in British Columbia (BC) and Canada, raising concerns of increased incidence of congenital syphilis. We characterized syphilis cases among females in BC to identify opportunities to prevent syphilis and optimize its care. METHODS All cases of infectious syphilis diagnosed in BC between March 13, 2018 and December 31, 2020 and reported as female gender were reviewed. Demographics, risk factors and concurrent conditions were collected from a provincial surveillance system. Subgroup analyses comparing cases with and without housing instability, substance use, mental illness and a recent sexually transmitted infection (STI) were conducted to understand differences between these subgroups. Statistical associations were calculated using chi-square or t-tests. RESULTS There were 226 reported cases of female infectious syphilis in BC during this period: 38 (16.8%) in 2018; 74 (32.7%) in 2019; and 114 (50.4%) in 2020. Mean age was 32 years (range 15-75 years). Of those who reported concurrent conditions, most cases had experiences with housing instability (71.1%), substance use (68.2%) and mental illness (83.9%), while 42.9% had a recent STI. Cases who reported housing instability or substance use were significantly more likely to have experiences with a recent STI, street involvement, transactional sex, mental illness and income assistance (all p<0.01). CONCLUSION Our findings highlight the importance of fostering an enabling environment for syphilis care. Concurrent services to support individuals with syphilis as well as housing instability, substance use and mental illness, may help prevent syphilis and improve wellbeing.
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Affiliation(s)
- Kaylie Willemsma
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | | | | | | | | | - Amanda Yu
- BC Centre for Disease Control, Vancouver, BC
| | - Ann Pederson
- Faculty of Medicine, University of British Columbia, Vancouver, BC
- BC Women’s Hospital, Vancouver, BC
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, Vancouver, BC
- BC Centre for Disease Control, Vancouver, BC
- BC Women’s Hospital, Vancouver, BC
| | - Troy Grennan
- Faculty of Medicine, University of British Columbia, Vancouver, BC
- BC Centre for Disease Control, Vancouver, BC
| | - Jason Wong
- Faculty of Medicine, University of British Columbia, Vancouver, BC
- BC Centre for Disease Control, Vancouver, BC
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Gottschlich A, Smith LW, Caird H, Gilbert M, Grennan T, Ogilvie G. Attitudes and Preferences Regarding Non-Clinic-Based Self-Collection for Sexually Transmitted Infection Testing Among Clinic Attendees in British Columbia, Canada. Sex Transm Dis 2022; 49:15-21. [PMID: 34264904 DOI: 10.1097/olq.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a global epidemic; although screening programs reduce transmission, barriers, including access and stigma, hinder success. The World Health Organization highlights the ability to maintain health without the direct support of a health care provider as one form of self-care, which can be applied to STI testing. Self-care through non-clinic-based self-collection for STI testing can address barriers while providing comprehensive care. Before implementation of innovative changes to screening approaches, it is important to understand if communities who rely on in-person care will self-collect outside of the clinic setting. This study investigated willingness to use non-clinic-based self-collection for STI testing among STI clinic attendees in British Columbia, Canada. METHODS Participants (n = 446) were recruited from STI clinics offering clinic-based self-collection for STI testing and completed a survey assessing self-care attitudes, including willingness to self-collect urine samples, throat swabs, and anogenital swabs outside of the clinic setting. Descriptive statistics, bivariable analyses, and multivariable models were conducted to investigate willingness to use non-clinic-based STI self-collection methods and associated correlates. RESULTS This population reported high willingness to use non-clinic-based self-collection methods for STI testing (urine samples, 73%; throat swabs, 67%; anogenital swabs, 65%). Those aged 35 to 54 years compared with 15 to 34 years were more likely to be willing (adjusted odds ratio, 1.87; 95% confidence interval, 1.03-3.50); those identifying as straight/mostly straight compared with gay/lesbian were less likely to be willing (adjusted odds ratio, 0.39; 95% confidence interval, 0.23-0.65). CONCLUSIONS Non-clinic-based self-collection for STI testing can address barriers to testing while maintaining quality care. Those currently receiving in-person care find these methods highly acceptable. These findings reinforce that self-collection for STI testing used in British Columbia clinics is acceptable to clients and may be extended to collection performed outside of the clinical setting.
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40
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities. Hum Vaccin Immunother 2021; 17:5413-5425. [PMID: 34856869 DOI: 10.1080/21645515.2021.1979379] [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] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
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Affiliation(s)
- R Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - T A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, McGill University.,Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - A De Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - T Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Lambert
- Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - D Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - F Coutlée
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada.,Department of Microbiology and Immunology, Université de Montréal, Montréal, Canada
| | - M Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C George
- Department of Exercise, Health, and Sport Sciences, University of Maine, Portland, USA
| | - D Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Jollimore
- Community-Based Research Centre, Vancouver, Canada
| | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Community-Based Research Centre, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Sauvageau
- Faculty of Medicine, Université Laval, Québec City, Canada.,Institut National de santé publique du Québec, Québec, Canada
| | - D H S Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - A Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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41
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Salway T, Ablona A, Chang HJ, Watt S, Worthington C, Grace D, Wong J, Ogilvie G, Grennan T, Gilbert M. Self-rated mental health among sexual health service clients during the first months of the COVID-19 pandemic, British Columbia, Canada. Prev Med 2021; 153:106789. [PMID: 34506815 PMCID: PMC8431968 DOI: 10.1016/j.ypmed.2021.106789] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/03/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
We investigated self-reported mental health during the first three months of the COVID-19 pandemic (March-May 2020), using a survey of HIV-testing and sexual health service clients from British Columbia, Canada (N = 1198). Over half (55%) reported their mental health as poor at the beginning of the COVID-19 pandemic, more than double that of the general Canadian population in the same time frame (22%). Acknowledging that this burden of poor mental health that is likely to persist in the coming years, we propose that sexual health clinics should facilitate access to mental health supports as a low-barrier point of primary care contact.
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Affiliation(s)
- Travis Salway
- Simon Fraser University, Canada; BC Centre for Disease Control, Canada; Centre for Gender and Sexual Health Equity, Canada.
| | | | | | - Sarah Watt
- Simon Fraser University, Canada; BC Centre for Disease Control, Canada
| | | | | | - Jason Wong
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Gina Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Canada; University of British Columbia, Canada.
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42
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McClymont E, Elwood C, Sekirov I, Morshed M, Levett P, Liu A, Jassem A, Sbihi H, Ogilvie G, Krajden M, Money D. Population SARS-CoV-2 Seroprevalence Using Antenatal Serum Samples in British Columbia, Canada. J Obstet Gynaecol Can 2021; 43:1242-1243. [PMID: 34758903 PMCID: PMC8572370 DOI: 10.1016/j.jogc.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Elisabeth McClymont
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC; CIHR Canadian HIV Trials Network, Vancouver, BC
| | - Chelsea Elwood
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC
| | - Inna Sekirov
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Muhammad Morshed
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Paul Levett
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Aaron Liu
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC
| | - Agatha Jassem
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Hind Sbihi
- School of Population & Public Health, University of British Columbia, Vancouver, BC
| | - Gina Ogilvie
- School of Population & Public Health, University of British Columbia, Vancouver, BC
| | - Mel Krajden
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Deborah Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC.
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43
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Gilbert M, Chang HJ, Ablona A, Salway T, Ogilvie G, Wong J, Campeau L, Worthington C, Grace D, Grennan T. Partner number and use of COVID-19 risk reduction strategies during initial phases of the pandemic in British Columbia, Canada: a survey of sexual health service clients. Can J Public Health 2021; 112:973-983. [PMID: 34731488 PMCID: PMC8565172 DOI: 10.17269/s41997-021-00566-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/30/2021] [Indexed: 11/24/2022]
Abstract
Objectives Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic. Methods In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p < 0.01). Results Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex). Conclusion Sexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-021-00566-9.
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Affiliation(s)
- Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Hsiu-Ju Chang
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Aidan Ablona
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, BC Women's, Vancouver, British Columbia, Canada
| | - Jason Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurence Campeau
- Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada.,Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
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44
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Zhang LJ, Shannon K, Tibashoboka D, Ogilvie G, Pick N, Kestler M, Logie C, Udall B, Braschel M, Deering KN. Prevalence and correlates of having sexual and reproductive health priorities met by HIV providers among women living with HIV in a Canadian setting. Sex Reprod Healthc 2021; 30:100666. [PMID: 34563858 DOI: 10.1016/j.srhc.2021.100666] [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: 02/04/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To: (1) describe the prevalence of key reproductive health outcomes (e.g., pregnancy, unintended pregnancy; abortion); and (2) examine social-structural correlates, including HIV stigma, of having key sexual and reproductive health (SRH) priorities met by participants' primary HIV provider, among women living with HIV. METHODS Data were drawn from a longitudinal community-based open cohort (SHAWNA) of women living with HIV. The associations between social-structural factors and two outcomes representing having SRH priorities met by HIV providers ('being comfortable discussing sexual health [SH] and/or getting a Papanicolaou test' and 'being comfortable discussing reproductive health [RH] and/or pregnancy needs') were analyzed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios (AOR) and 95% confidence intervals [95% CIs] are reported. RESULTS Of 314 participants, 77.1% reported having SH priorities met while 64.7% reported having RH priorities met by their primary HIV provider at baseline. In multivariable analysis, having SH priorities met was inversely associated with: sexual minority identity (AOR: 0.59, 95% CI: 0.37-0.94), gender minority identity (AOR: 0.52, 95% CI: 0.29-0.95) and recent verbal or physical violence related to HIV status (AOR: 0.55, 95% CI: 0.31-0.97) and positively associated with recently accessing women-centred services (Oak Tree Clinic) (AOR: 4.25, 95% CI: 2.20-8.23). Having RH priorities met was inversely associated with: sexual minority identity (AOR: 0.56, 95% CI: 0.40-0.79), gender minority identity (AOR: 0.45, 95% CI: 0.25-0.81) and being born in Canada (AOR: 0.29, 95% CI: 0.15-0.56) and positively associated with recently accessing women-centred services (AOR: 1.81, 95% CI: 1.29-2.53) and a history of pregnancy (AOR: 2.25, 95% CI: 1.47-3.44). CONCLUSION Our findings suggest that there remain unmet priorities for safe SRH care and practice among women living with HIV, and in particular, for women living with HIV with sexual and/or gender minority identity and those who experience enacted HIV stigma. HIV providers should create safe, non-judgmental environments to facilitate discussions on SRH. These environments should be affirming of all sexual orientations and gender identities, culturally safe, culturally humble and use trauma-informed approaches.
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Affiliation(s)
- L J Zhang
- Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada
| | - K Shannon
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada; Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - D Tibashoboka
- Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - G Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada; BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, BC, Canada
| | - N Pick
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada
| | - M Kestler
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada
| | - C Logie
- Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, Canada
| | - B Udall
- Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - M Braschel
- Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - K N Deering
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada; Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada.
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45
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Dick A, Holyk T, Taylor D, Wenninger C, Sandford J, Smith L, Ogilvie G, Thomlinson A, Mitchell-Foster S. Highlighting strengths and resources that increase ownership of cervical cancer screening for Indigenous communities in Northern British Columbia: Community-driven approaches. Int J Gynaecol Obstet 2021; 155:211-219. [PMID: 34496052 PMCID: PMC9293094 DOI: 10.1002/ijgo.13915] [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: 06/08/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
Objective To examine the unique and diverse strengths held by rural and remote Indigenous communities in northern British Columbia, including multi‐generational support systems in health and wellness, profound connections to the land, and strong cultural foundations, and harness these strengths, allowing communities to engage in innovative and empowering health and wellness programs. Methods Building on these pre‐existing and fundamental strengths, an alternative option to cervical cancer screening was introduced to nine Carrier Sekani health centers located in northern interior British Columbia in response to disparities in screening rates. Introduced in 2019, CervixCheck uses a self‐collection approach that is private, safe, convenient, and offered at local community health centers by trained and supportive health staff. Results Using a strengths‐based and community directed and descriptive approach, the process was outlined for a successful and ongoing health screening opportunity that is put into the hands of community members within Indigenous communities in the region of northern British Columbia. Conclusion Through collaborative partnerships, in‐person engagement sessions, and the utilization of pre‐existing infrastructure and health and wellness teams, this project was successfully integrated into primary care centers using culturally safe and community‐based approaches. Building on inherent strengths within rural and remote Indigenous communities leads to successful development and implementation of cervical cancer screening alternatives.
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Affiliation(s)
- Alexanne Dick
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Travis Holyk
- Carrier Sekani Family Services, Prince George, British Columbia, Canada.,First Nations Studies, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Darlene Taylor
- BC Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Judith Sandford
- Carrier Sekani Family Services, Prince George, British Columbia, Canada
| | - Laurie Smith
- BC Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Cancer, Cancer Control Research, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Thomlinson
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Sheona Mitchell-Foster
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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46
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Racey CS, Donken R, Porter I, Albert A, Bettinger JA, Mark J, Bonifacio L, Dawar M, Gagel M, Kling R, Mema S, Mitchell H, Roe I, Ogilvie G, Sadarangani M. Intentions of public school teachers in British Columbia, Canada to receive a COVID-19 vaccine. Vaccine X 2021; 8:100106. [PMID: 34222854 PMCID: PMC8240436 DOI: 10.1016/j.jvacx.2021.100106] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 06/23/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To control the COVID-19 pandemic high vaccine acceptability and uptake will be needed. Teachers represent a priority population to minimize social disruption and ensure continuity in education, which is vital for the well-being and healthy development of youth during the pandemic. The objective of this analysis was to measure public school teachers' intentions to receive a COVID-19 vaccine in British Columbia (BC), Canada. METHODS A population-wide cross-sectional online survey from August to November 2020 asked all BC public school teachers with an available email address how likely they were to receive a COVID-19 vaccine. Two multivariable logistic regression models explored separately sociodemographic and vaccine hesitancy predictors for intention to receive a COVID-19 vaccine. RESULTS A total of 5,076 teachers participated. The majority, 89.7%, reported they were likely or very likely to accept a COVID-19 vaccine. In multivariable regression, sociodemographic predictors of intention to be vaccinated included being male, having an educational background in science or engineering, and using reliable information sources on vaccination such as public health and health care providers. Teachers who reported lower levels of vaccine hesitancy, higher general vaccine knowledge, and belief that COVID-19 was a serious illness were more likely to intend to receive a COVID-19 vaccine. CONCLUSION A high proportion of public-school teachers in BC intend to receive a COVID-19 vaccine. Continued monitoring of vaccine intentions will be important to inform public health vaccine implementation.
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Affiliation(s)
- C. Sarai Racey
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Robine Donken
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Imogen Porter
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Arianne Albert
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Mark
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Lizl Bonifacio
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Meena Dawar
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Costal Health Authority, Vancouver, BC, Canada
| | - Mike Gagel
- Northern Health Authority, Prince George, BC, Canada
| | - Rakel Kling
- Northern Health Authority, Prince George, BC, Canada
| | - Silvina Mema
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Hana Mitchell
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Ian Roe
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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47
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Litwin C, Smith L, Donken R, Krajden M, van Niekerk D, Naus M, Cook D, Albert A, Ogilvie G. High-risk HPV prevalence among women undergoing cervical cancer screening: Findings a decade after HPV vaccine implementation in British Columbia, Canada. Vaccine 2021; 39:5198-5204. [PMID: 34344555 DOI: 10.1016/j.vaccine.2021.07.009] [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: 03/24/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND British Columbia (BC) introduced a publicly funded, school-based human papillomavirus (HPV) immunization program in 2008 with the quadrivalent vaccine. In 2010/2011, a baseline evaluation of HPV prevalence was conducted among women undergoing cervical cancer screening. After 10 years of publicly funded HPV vaccination, HPV-type prevalence was re-evaluated. METHODS From August 2017 to March 2018, 1107 physicians were invited to return cytobrushes used during routine Pap screening to the Cervical Cancer Screening Laboratory for HPV testing. Only age or year of birth was collected. Specimens were screened for high-risk HPV (hrHPV) and positive samples were genotyped. HPV type prevalence was compared for females 15-22 yrs (those eligible for the school-based vaccination) and 23+ yrs (ineligible for school-based vaccination) for the 2010/2011 and the 2017/2018 data. RESULTS There were 3309 valid samples received for testing; of these, 3107 were included in the analysis. The overall hrHPV prevalence was 12.2% (95% CI 11.3-13.3) in 2010/11, and 12.0% (95% CI 10.9-13.2) in 2017/18. For the 15-22 age group, the prevalence for any hrHPV was 26.8% (95% CI 23.1-30.8) in 2010/11 and 25.4% (95% CI 15.3-37.9) in 2017/18. For those aged 15-22, HPV16 prevalence in 2010/11 was 8.8% (95% CI 6.5-11.5) and in 2017/18 was 6.3% (95% CI 1.8-15.5), with corresponding figures for HPV18 3.7% (95% CI 2.3-5.7) and 0% (95% CI 0.0-5.7), respectively. For all hrHPV types, there were no statistically significant differences between the 2010/11 and 2017/18 periods. CONCLUSIONS This study illustrates the prevalence of hrHPV in BC over time in women undergoing cervical cancer screening, where an indication of a decline in HPV16/18 is seen in vaccine eligible women.
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Affiliation(s)
- Charles Litwin
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada.
| | - Laurie Smith
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; BC Cancer, Vancouver, British Columbia, Canada
| | - Robine Donken
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Vaccine Evaluation Centre, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Amsterdam UMC, Vrije Universiteit, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Mel Krajden
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Cancer, Vancouver, British Columbia, Canada
| | - Monika Naus
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
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Hategeka C, Ogilvie G, Nisingizwe MP, Rulisa S, Law MR. Effect of human papilloma virus vaccination on sexual behaviours among adolescent women in Rwanda: a regression discontinuity study. Health Policy Plan 2021; 35:1021-1028. [PMID: 32830261 DOI: 10.1093/heapol/czaa083] [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] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023] Open
Abstract
Increasing human papilloma virus (HPV) vaccination coverage is one of the key approaches to preventing cervical cancer globally. However, some argue that HPV vaccine recipients may engage in risky compensatory sexual behaviours because of perceived protection afforded by the vaccine. Therefore, we investigated the impact of a wide-scale HPV vaccination programme on sexual behaviours among adolescent women in Rwanda-the first African country to implement a national HPV vaccination. We identified a cohort of women who were eligible for the HPV vaccination and those who were not eligible from the most recent Rwanda Demographic and Health Survey. We used a quasi-experimental regression discontinuity design, exploiting the quasi-random change in HPV vaccination eligibility in 2011, to compare sexual behaviours among vaccinated and unvaccinated adolescent women. We studied the impact of the vaccination on reported sexual intercourse, average number of sexual partners and teenage pregnancy across the vaccination eligibility threshold. Our analysis included 3052 adolescent women (mean age: 18.6 years), of whom 58% were eligible for HPV vaccination. Nearly one in five adolescents reported having had sexual intercourse (18.5%). The average reported lifetime number of sexual partners was 1.41. The proportion of teenage pregnancy was 5.3%. We found no evidence that HPV vaccination was associated with any significant changes across the eligibility threshold in reported sexual behaviours we studied: no significant increase in the proportion of having sexual intercourse [odds ratio (OR): 0.80, 95% confidence interval (CI): 0.57-1.12; P = 0.19], in lifetime number of sexual partners (rate ratio 0.99, 95% CI: 0.83-1.17, P = 0.91) and in the proportion of teen pregnancies (OR 1.05, 95% CI: 0.50 to 2.20, P = 0.89) at the eligibility threshold. The Rwandan national HPV vaccination programme did not increase sexual behaviours among adolescent women, assuaging concerns of engaging in risky compensatory sexual behaviours some have feared.
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Affiliation(s)
- Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T1Z3, Canada
| | - Gina Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marie Paul Nisingizwe
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T1Z3, Canada
| | - Stephen Rulisa
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T1Z3, Canada
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Brisson M, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019. Vaccine 2021; 39:3756-3766. [PMID: 34074547 DOI: 10.1016/j.vaccine.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/12/2021] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.
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Affiliation(s)
- R Grewal
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - S L Deeks
- University of Toronto, Canada; Public Health Ontario, Canada
| | - T A Hart
- University of Toronto, Canada; Ryerson University, Canada
| | - J Cox
- McGill University, Canada; Direction régionale de santé publique - Montréal, Canada
| | | | - T Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - G Lambert
- Direction régionale de santé publique - Montréal, Canada
| | - D Moore
- University of British Columbia, Canada; BC Centre for Excellence in HIV/AIDS, Canada
| | | | - F Coutlée
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - C George
- University of Southern Maine, United States
| | - D Grace
- University of Toronto, Canada
| | | | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Canada; Community-Based Research Centre, Canada; University of Victoria, Canada
| | - R Nisenbaum
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - C Sauvageau
- Université Laval, Canada; Institut national de santé publique du Québec, Canada
| | - D H S Tan
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - A Yeung
- Unity Health Toronto, Canada
| | - A N Burchell
- Unity Health Toronto, Canada; University of Toronto, Canada.
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50
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Cromwell I, Smith LW, van der Hoek K, Hedden L, Coldman AJ, Cook D, Franco EL, Krajden M, Martin R, Lee MH, Stuart G, van Niekerk D, Ogilvie G, Peacock S. Cost-effectiveness analysis of primary human papillomavirus testing in cervical cancer screening: Results from the HPV FOCAL Trial. Cancer Med 2021; 10:2996-3003. [PMID: 33811457 PMCID: PMC8085916 DOI: 10.1002/cam4.3864] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
Abstract
The Human Papillomavirus FOr CervicAL cancer (HPV FOCAL) trial is a large randomized controlled trial comparing the efficacy of primary HPV testing to cytology among women in the population-based Cervix Screening Program in British Columbia, Canada. We conducted a cost-effectiveness analysis based on the HPV FOCAL trial to estimate the incremental cost per detected high-grade cervical intraepithelial neoplasia of grade 2 or worse lesions (CIN2+). A total of 19,009 women aged 25 to 65 were randomized to one of two study groups. Women in the intervention group received primary HPV testing with reflex liquid-based cytology (LBC) upon a positive finding with a screening interval of 48 months. Women in the control group received primary LBC testing, and those negative returned at 24 months for LBC and again at 48 months for exit screening. Both groups received HPV and LBC co-testing at the 48-month exit. Incremental costs during the course of the trial were comparable between the intervention and control groups. The intervention group had lower overall costs and detected a larger number of CIN2+ lesions, resulting in a lower mean cost per CIN2+ detected ($7551) than the control group ($8325), a difference of -$773 [all costs in 2018 USD]. Cost per detected lesion was sensitive to the costs of sample collection, HPV testing, and LBC testing. The HPV FOCAL Trial results suggest that primary HPV testing every 4 years produces similar outcomes to LBC-based testing every 2 years for cervical cancer screening at a lower cost.
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Affiliation(s)
- Ian Cromwell
- Canadian Centre for Applied Research in Cancer ControlBC Cancer Research InstituteVancouverBCCanada
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
- Canadian Agency for Drugs and Technologies in HealthOttawaONCanada
| | - Laurie W. Smith
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
| | - Kim van der Hoek
- Canadian Centre for Applied Research in Cancer ControlBC Cancer Research InstituteVancouverBCCanada
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
| | - Lindsay Hedden
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBCCanada
- BC Academic Health Sciences NetworkVancouverBCCanada
| | - Andrew J. Coldman
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
| | - Darrel Cook
- British Columbia Centre for Disease ControlVancouverBCCanada
| | | | - Mel Krajden
- British Columbia Centre for Disease ControlVancouverBCCanada
| | - Ruth Martin
- British Columbia Cancer AgencyCervical Cancer Screening ProgramVancouverBCCanada
| | - Marette H. Lee
- British Columbia Cancer AgencyCervical Cancer Screening ProgramVancouverBCCanada
- Vancouver General HospitalGynecologic OncologyVancouverBCCanada
| | - Gavin Stuart
- Faculty of MedicineThe University of British ColumbiaVancouverBCCanada
| | - Dirk van Niekerk
- British Columbia Cancer AgencyCervical Cancer Screening ProgramVancouverBCCanada
| | - Gina Ogilvie
- British Columbia Centre for Disease ControlVancouverBCCanada
- Faculty of MedicineThe University of British ColumbiaVancouverBCCanada
- Women’s Health Research InstituteBC Women’s HospitalVancouverBCCanada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer ControlBC Cancer Research InstituteVancouverBCCanada
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBCCanada
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