RESUMEN
OBJECTIVE: This study utilized a combination of HPV self-sampling, iFTA elute specimen cards, and long distance transport for centralized processing of specimens to determine the feasibility of large-scale screening in remote and transient populations. METHODS: This study was performed in two locations in Peru (Manchay and Iquitos). The "Just For Me" cervico-vaginal brush and iFTA elute cards were used for the collection and transport of specimens. Samples were shipped via FedEx to China and tested for 14 types of high-risk HPV using PCR based MALDI-TOF. HPV positive women were treated with cryotherapy after VIA triage, and followed-up with colposcopy, biopsy, ECC, and repeat HPV testing at 6 months. RESULTS: Six hundred and forty three women registered, and 632 returned a sample over a 10 day period. Within 2 weeks, specimens were shipped, samples tested, and results received by study staff. Sixty-eight women (10.8%) tested positive, and these results were delivered over 4 days. Fifty-nine HPV positive women (87%) returned for evaluation and treatment, and 2 had large lesions not suitable for cryotherapy. At 6 months, 42 women (74%) returned for follow-up, and 3 had CIN 2 (all positive samples from the endocervical canal). Ninety eight percent of participants reported that they would participate in this type of program again. CONCLUSIONS: Utilizing HPV self-sampling, solid media specimen cards for long distance transport, and centralized high throughput processing, we achieved rapid delivery of results, high satisfaction levels, and low loss to follow-up for cervical cancer screening in remote and transient populations.
Asunto(s)
Detección Precoz del Cáncer/métodos , Accesibilidad a los Servicios de Salud/organización & administración , Tamizaje Masivo/métodos , Infecciones por Papillomavirus/diagnóstico , Manejo de Especímenes/métodos , Neoplasias del Cuello Uterino/prevención & control , Frotis Vaginal/métodos , Adulto , Crioterapia , Detección Precoz del Cáncer/instrumentación , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Pruebas de ADN del Papillomavirus Humano , Humanos , Perdida de Seguimiento , Tamizaje Masivo/instrumentación , Tamizaje Masivo/organización & administración , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/terapia , Satisfacción del Paciente/estadística & datos numéricos , Perú , Servicios de Salud Rural/organización & administración , Manejo de Especímenes/instrumentación , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Neoplasias del Cuello Uterino/virología , Frotis Vaginal/instrumentaciónRESUMEN
OBJECTIVE: Cervical cancer is a preventable disease which causes significant morbidity and mortality, particularly in developing countries. Although technology for early detection continues to improve, prevention programs suffer from significant barriers. Community-based participatory research is an approach to research which focuses on collaboration with the community to surmount these barriers. The objective of this study was to evaluate the utility of community-based participatory research techniques in a mother-child screen/treat and vaccinate program for cervical cancer prevention in Manchay, Peru. MATERIALS AND METHODS: Human papillomavirus (HPV) self-sampling and cryotherapy were used for the screen/treat intervention, and the Gardasil vaccine was used for the vaccine intervention. Community health workers from Manchay participated in a 3-day educational course, designed by the research team. The community health workers then decided how to implement the interventions in their community. The success of the program was measured by (1) the ability of the community health workers to determine an implementation plan, (2) the successful use of research forms provided, (3) participation and retention rates, and (4) satisfaction of the participants. RESULTS: (1) The community health workers used a door-to-door approach through which participants were successfully registered and both interventions were successfully carried out; (2) registration forms, consent forms, and result forms were used correctly with minimal error; (3) screen/treat intervention: 97% of registered participants gave an HPV sample, 94% of HPV-positive women were treated, and 90% returned for 6-month follow-up; vaccine intervention: 95% of registered girls received the first vaccine, 97% of those received the second vaccine, and 93% the third; (4) 96% of participants in the screen/treat intervention reported high satisfaction. CONCLUSIONS: Community-based participatory research techniques successfully helped to implement a screen/treat and vaccinate cervical cancer prevention program in Manchay, Peru. These techniques may help overcome barriers to large-scale preventive health-care interventions.