RESUMO
BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. OBJECTIVES: To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. SEARCH METHODS: We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. MAIN RESULTS: Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). AUTHORS' CONCLUSIONS: Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.
Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Manejo de Espécimes/métodos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Autocuidado/métodos , Autocuidado/estatística & dados numéricos , Manejo de Espécimes/estatística & dados numéricosRESUMO
OBJECTIVE: To compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. METHODS: A Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). RESULTS: At commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be 'cost-effective' vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective. CONCLUSIONS: HPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.
Assuntos
Infecções por Papillomavirus/economia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/economia , Alphapapillomavirus/genética , Alphapapillomavirus/imunologia , Colômbia/epidemiologia , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/prevenção & controle , Análise Custo-Benefício , Feminino , Genótipo , Humanos , Incidência , Cadeias de Markov , Infecções por Papillomavirus/epidemiologia , Vacinas contra Papillomavirus/imunologia , Sistema de Registros , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/economiaRESUMO
Objective Comparing cervical cancer mortality rates in Colombian departments, as well as in urban and rural areas and examining the potential causes of any differences. Methodology This was an ecologic study. Mortality due to cervical cancer was estimated from data collected between 2005 and 2008 by the Colombian National Statistics Bureau (DANE).This included overall mortality in Colombia, mortality by department and mortality by rural and urban area. DANE provided theunder-recording indicator for mortality by departments and the unmet basic needs index. Spearman correlation coefficient was estimated for average mortality by department, unmet basic needs and under-recording variables. Results The overall annual mortality rate from 2005 to 2008 due to cervical cancer in Colombia ranged from 10 to 11.1 per 100,000 females. Mortality reported in urban areas was higher than in rural areas (10.3-11.7 cf 7.6-8.7). The lowest average mortality was reported from the Chocó department (4.7) and the highest from Meta (18.2). An inverse correlation was found between average mortality by department and unmet basic needs. The under-reporting' indicator had an inverse correlation with mortality, meaning that departments having recording issues also reported lower mortality rates. Conclusions Health systems must adopt strategies designed to improve information systems for supporting decision-making and optimise the use of health resources, particularly for vulnerable populations and populations having unmet basic needs. Comparing mortality amongst departments and areas will not lead to reliable conclusions in such under-recording conditions.
Objetivo Comparar las tasas de mortalidad por cáncer de cuello uterino en los departamentos de Colombia, tanto en las zonas urbanas como en las zonas rurales y examinar las posibles causas de las diferencias. Métodos Este fue un estudio ecológico. La mortalidad causada por cáncer de cuello uterino fue estimada a partir de los datos recolectados entre los años2005 y 2008 por el Departamento Administrativo Nacional de Estadística (DANE).La mortalidad global en Colombia, la mortalidad por departamento y la mortalidad por zonas rurales y urbanas fueron incluidas en estas cifras. El DANE proporcionó el indicador del sub registro de la mortalidad por departamentos y el índice de las necesidades básicas insatisfechas (NBI). El coeficiente de correlación de Spearman fue estimada por mortalidad promedio por departamento, NBI y las variables de sub registro. Resultados La tasa anual de mortalidad global desde el año 2005 hasta el año 2008, causado por cáncer de cuello uterino en Colombia, osciló entre 10 hasta 11,1 por 100.000 mujeres. La mortalidad registrada en las zonas urbanos tenía una tasa más alta que en los zonas rurales (10.3-11.7 cf 7.6-8.7). La tasa más baja de mortalidad promedio fue registrada en el departamento de Chocó (4.7) y la más alta del departamento de Meta (18.2). Se encontró una correlación inversa entre la mortalidad promedio por departamento y las NBI. El indicador del sub registro tenía una correlación inversa con la mortalidad, significando que los departamentos que tienen problemas relacionadas con el registro también registraron tasas más bajas de mortalidad. Conclusiones Los sistemas de salud deben adoptar estrategias encaminadas a mejorar los sistemas de información para apoyar a la toma de decisiones y optimizar el uso de los recursos sanitarios, particularmente para las poblaciones vulnerables y las poblaciones con necesidades básicas insatisfechas. Al comparar la mortalidad entre los departamentos y las zonas no conducirá a conclusiones confiables en tales condiciones de registro.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias do Colo do Útero/mortalidade , Colômbia/epidemiologia , Métodos Epidemiológicos , Disparidades nos Níveis de Saúde , População Rural , População UrbanaRESUMO
OBJECTIVE: Comparing cervical cancer mortality rates in Colombian departments, as well as in urban and rural areas and examining the potential causes of any differences. METHODOLOGY: This was an ecologic study. Mortality due to cervical cancer was estimated from data collected between 2005 and 2008 by the Colombian National Statistics Bureau (DANE).This included overall mortality in Colombia, mortality by department and mortality by rural and urban area. DANE provided the under-recording indicator for mortality by departments and the unmet basic needs index. Spearman correlation coefficient was estimated for average mortality by department, unmet basic needs and under-recording variables. RESULTS: The overall annual mortality rate from 2005 to 2008 due to cervical cancer in Colombia ranged from 10 to 11.1 per 100,000 females. Mortality reported in urban areas was higher than in rural areas (10.3-11.7 cf 7.6-8.7). The lowest average mortality was reported from the Chocó department (4.7) and the highest from Meta (18.2). An inverse correlation was found between average mortality by department and unmet basic needs. The 'under-reporting' indicator had an inverse correlation with mortality, meaning that departments having recording issues also reported lower mortality rates. CONCLUSIONS: Health systems must adopt strategies designed to improve information systems for supporting decision-making and optimise the use of health resources, particularly for vulnerable populations and populations having unmet basic needs. Comparing mortality amongst departments and areas will not lead to reliable conclusions in such under-recording conditions.
Assuntos
Neoplasias do Colo do Útero/mortalidade , Adolescente , Adulto , Idoso , Colômbia/epidemiologia , Métodos Epidemiológicos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Pessoa de Meia-Idade , População Rural , População Urbana , Adulto JovemRESUMO
Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios. Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes...
Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios. Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes...