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Children and adolescents in developing countries continue to be disproportionately affected by cancer and have significantly lower survival rates (30%) than their counterparts in high-income countries (80%). This disparity is driven by poor access to childhood cancer medicines. The World Health Organization and St. Jude Children's Research Hospital launched the Global Platform for Access to Childhood Cancer Medicines to provide continuous supply of quality childhood cancer medicines to developing countries. As much movement has not been seen with the platform, this research aimed to develop a stakeholder-informed guidance to support effective implementation of the platform and maximize opportunities to deliver on its intended goals. This study was guided by the Consolidated Framework for Implementation Research (CFIR). Participants were recruited based on the stakeholder categories framework and included policymakers from the Ministry of Health, organizations implementing access to medicines programs in Nigeria, medicines logistics providers, and health professionals and personnel at service delivery points such as oncologists and pharmacists. Data collection involved key informant interviews using a pilot-tested semi-structured interview guide. Data analysis was done by thematic content analysis. Ethical approval was obtained from the National Health Research Ethics Committee of Nigeria and the Ethics Review Board of University of Toronto. The findings reveal critical insights spanning five domains of the CFIR framework, each contributing uniquely to understanding the multifaceted issues of childhood cancer medicine access with a view to understanding pathways to implementation of the platform. Successfully implementing the platform could entail a partner-driven approach, integration with existing programs to avoid fragmentation, supporting capacity strengthening at the primary care level, and engaging patients and communities. This information was used to suggest a nuanced implementation framework for the platform in Nigeria and similar settings which could be beneficial for improving access for children who desperately need childhood cancer medicines to survive.
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INTRODUCTION: cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction "human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients". This study piloted this concept. METHODS: in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. RESULTS: same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. CONCLUSION: triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.
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Infecciones por VIH/complicaciones , Tamizaje Masivo/métodos , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , Ácido Acético , Adulto , Anciano , Alphapapillomavirus/aislamiento & purificación , Biopsia , Estudios de Cohortes , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Persona de Mediana Edad , Nigeria , Infecciones por Papillomavirus/complicaciones , Proyectos Piloto , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/virología , Estudios Prospectivos , Sensibilidad y Especificidad , Triaje/métodos , Neoplasias del Cuello Uterino/virología , Adulto JovenRESUMEN
PURPOSE: To provide resource-stratified (four tiers), evidence-based recommendations on the primary prevention of cervical cancer globally. METHODS: The American Society of Clinical Oncology convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (consensus ratings group) for one round of formal ratings. RESULTS: Existing sets of guidelines from five guideline developers were identified and reviewed; adapted recommendations formed the evidence base. Five systematic reviews, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75%. RECOMMENDATIONS: In all resource settings, two doses of human papillomavirus vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. Individuals with HIV positivity should receive three doses. Maximal and enhanced settings: if girls are age ≥ 15 years and received their first dose before age 15 years, they may complete the series; if no doses were received before age 15 years, three doses should be administered; in both scenarios, vaccination may be through age 26 years. Limited and basic settings: if sufficient resources remain after vaccinating girls age 9 to 14 years, girls who received one dose may receive additional doses between age 15 and 26 years. Maximal, enhanced, and limited settings: if ≥ 50% coverage in the priority female target population, sufficient resources, and cost effectiveness, boys may be vaccinated to prevent other noncervical human papillomavirus-related cancers and diseases. Basic settings: vaccinating boys is not recommended.It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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AIMS: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)-naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. METHODS: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naive HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. RESULTS: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged â¦35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was â§5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the contrary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate linear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. CONCLUSIONS: A significant burden of dyslipidemia exists among ART-naive HIV-infected persons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder.
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Dislipidemias/epidemiología , Dislipidemias/virología , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Adulto , Recuento de Linfocito CD4 , Estudios Transversales , Dislipidemias/terapia , Femenino , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Estudios Retrospectivos , Carga Viral , Adulto JovenRESUMEN
OBJECTIVE: The effects of maternal HIV infection and antiretroviral therapy on hearing of HIV-exposed newborns in sub-Saharan Africa have not been investigated. We determined the prevalence of sensorineural hearing loss among HIV-exposed newborns and the association between the hearing threshold and maternal and newborn parameters. DESIGN: A cohort audiometric study of newborns between October 2012 and April 2013. SETTINGS: A secondary and tertiary hospital-based study. PARTICIPANTS: Consecutive 126 HIV-exposed and 121 HIV-unexposed newborns. INTERVENTION: Hearing screening of the newborns was done with Auditory Brainstem Response and compared with maternal HAART, CD4 cell counts, RNA viral loads and newborn CD4 cell count percentage. MAIN OUTCOME MEASURE: Hearing threshold levels of both groups were measured and analysed. RESULTS: Around 11.1% of HIV-exposed and 6.6% of unexposed newborns had hearing impairment (Pâ=â0.2214). About 6.4% of HIV-exposed and 2.5% HIV-unexposed newborns had hearing threshold of more than 20âdBHL (Pâ=â0.1578). There was no significant association between the hearing thresholds of HIV-exposed newborns and maternal CD4 cell counts (Pâ=â0.059) but there was with maternal viral load (Pâ=â0.034). There was significant difference between the hearing thresholds of HIV-exposed newborns with CD4% of 25 or less and more than 25. This study showed significant difference in the hearing of the 119 HAART-exposed newborns and seven unexposed newborns [Pâ=â0.002; risk ratio, 0.13 (0.05-0.32)]. CONCLUSION: There was a trend towards more hearing loss in HIV-exposed newborns. However, hearing thresholds increase with increasing mothers' viral load. The background information supports the need for further studies on the role of in-utero exposure to HIV and HAART in newborn hearing loss.