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Objetivo: identificar, na literatura científica, as estratégias utilizadas por enfermeiros da Atenção Primária para a prevenção do câncer de colo do útero. Métodos: revisão integrativa nas bases de dados EMBASE, LILACS (BVS), SCOPUS e Web of Science, entre março e abril de 2023. Após a busca, seguiu-se com leitura na íntegra dos artigos selecionados e extração dos dados para análise. A amostra final foi constituída por 5 estudos. Resultados: as principais estratégias utilizadas foram intervenções educativas, com predominância de palestras e posterior convite ou coleta de material para a realização do exame preventivo. Também foram utilizadas rodas de conversa (círculo de cultura), orientações por contato telefônico e oferta de ficha clínica auto preenchível na consulta de enfermagem. Conclusões: os estudos possibilitaram identificar estratégias positivas na prevenção do câncer de colo do útero, podendo direcionar enfermeiros a investir cada vez mais em metodologias voltadas a uma maior autonomia das mulheres
Objective: to identify, in the scientific literature, the strategies used by primary care nurses to prevent cervical cancer. Methods: An integrative review of the EMBASE, LILACS (BVS), SCOPUS, and Web of Science databases between March and April 2023. After the search, the selected articles were read in full, and the data were extracted for analysis. The final sample consisted of 5 studies. Results: the main strategies used were educational interventions, with a predominance of lectures and subsequent invitations or collection of material to carry out the preventive exam. Conversation circles (culture circles), telephone guidance, and the provision of a self-completed clinical form during the nursing consultation were also used. Conclusions: the studies made it possible to identify positive strategies for preventing cervical cancer, which could direct nurses to increasingly invest in methodologies aimed at increasing women's autonomy
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Humanos , Educação em SaúdeRESUMO
In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.
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BACKGROUND: Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. METHODS: We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage. RESULTS: We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages. CONCLUSION: The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.
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Infecções por Papillomavirus , Telemedicina , Feminino , Humanos , Infecções por Papillomavirus/diagnóstico , Triagem , Instalações de SaúdeRESUMO
BACKGROUND: In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity-in relation to the core components proposed by the National Program on Cervical Cancer Prevention-with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. METHODS: This descriptive study used a multi-method approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data from the National Screening Information System. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. RESULTS: Our results showed that the core components with highest fidelity were training, sample handling, and transportation. Regarding the offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the follow-up and treatment core component, we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers. CONCLUSIONS: Our study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle-income settings.
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PROBLEM IDENTIFICATION: Haitian women in Haiti and in the United States experience a disproportionate burden of cervical cancer, however their uptake of cervical cancer prevention services remains concerningly low. LITERATURE SEARCH: A comprehensive search on bibliographic databases coupled with a grey literature search was conducted. A total of 401 studies were identified, with 28 studies retained after following Arksey and O'Malley's Scoping Review Guidelines. DATA EVALUATION/SYNTHESIS: Knowledge levels of HPV and cervical cancer, along with preventative measures was alarmingly low. Traditional health practices, cultural worldviews, and social networks had an influence on the uptake of cervical cancer prevention. Health systems barriers were found to be a prevalent barrier among Haitian women in the U.S. CONCLUSIONS: Future health promotion interventions developed for Haitian women must address personal, cultural, social, and structural factors with an emphasis on modifying knowledge and beliefs to improve engagement in cervical cancer prevention behaviors.
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Neoplasias do Colo do Útero , Estados Unidos , Feminino , Humanos , Haiti , Neoplasias do Colo do Útero/prevenção & controle , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
Background: Cost data of human papillomavirus (HPV) self-sampling programs from low-and-middle-income countries is limited. We estimated the total and unit costs associated with the Hope Project, a community-based HPV self-sampling social entrepreneurship in Peru. Methods: We conducted a micro-costing analysis from the program perspective to determine the unit costs of (1) recruitment/training of community women (Hope Ladies); (2) Hope Ladies distributing HPV self-sampling kits in their communities and the laboratory testing; and (3) Hope Ladies linking screened women with follow-up care. A procedural manual was used to identify the program's activities. A structured questionnaire and in-depth interviews were conducted with administrators to estimate the resource/time associated with activities. We obtained unit costs for each input previously identified from budgets and expenditure reports. Findings: From November 2018 to March 2020, the program recruited and trained 62 Hope Ladies who distributed 4,882 HPV self-sampling kits in their communities. Of the screened women, 586 (12%) tested HPV positive. The annual cost per Hope Lady recruited/trained was $147·51 (2018 USD). The cost per HPV self-sampling kit distributed/tested was $45·39, the cost per woman followed up with results was $55·64, and the cost per HPV-positive woman identified was $378·14. Personnel and laboratory costs represented 56·1% and 24·7% of the total programmatic cost, respectively. Interpretation: Our findings indicate that implementation of a community-based HPV self-sampling has competitive prices, which increases its likelihood to be feasible in Peru. Further economic evaluation is needed to quantify the incremental benefits of HPV self-sampling compared to more established options such as Pap tests. Funding: Thomas Francis Jr. Fellowship provided funding for data collection. The Hope Project was funded by grants from Grand Challenges Canada (TTS-1812-21131), Uniting for Health Innovation, Global Initiative Against HPV and Cervical Cancer, University of Manitoba, and the John E. Fogarty International Center (5D43TW009375-05).
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HPV vaccination of adolescent girls is the most effective measure to prevent cervical cancer. The World Health Organization recommends that adolescent girls receive two doses of vaccine but only a small proportion of girls from regions with the highest disease burden are vaccinated because of cost and logistical considerations. Our Costa Rica HPV Vaccine trial suggested that one dose of the bivalent HPV vaccine provides robust and lasting protection against persistent HPV infections for over a decade. Data from a post-licensure trial of the quadrivalent vaccine in India also suggested that a single dose may be effective in reducing cervical cancer risk. To formally compare one versus two doses of the bivalent and nonavalent HPV vaccines, we implemented a large, randomized, double-blind trial to investigate the non-inferiority of one compared to two vaccine doses in the prevention of new HPV16/18 infections that persist 6 or more months. Bivalent and nonavalent vaccines will be evaluated separately. The trial enrolled and randomized (1:1:1:1 to 1- and 2-dose arms of the bivalent and nonavalent vaccines) 20,330 girls 12 to 16 years old residing in Costa Rica. Trial participants are followed every 6 months for up to 5 years. We also aim to estimate vaccine efficacy by comparing the rates of 6 month persistent infection in unvaccinated women with the rates in the follow-up visits of trial participants. We included one survey of unvaccinated women at the start of the study (N = 4452) and will include another survey concomitant with follow up visits of trial participants at year 4.5 (planned N = 3000). Survey participants attend two visits 6 months appart. Herein, we present the rationale, design, and enrolled study population of the ESCUDDO trial. ClinicalTrials.gov Identifier: NCT03180034.
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Alphapapillomavirus , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Adolescente , Criança , Costa Rica/epidemiologia , Feminino , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Infecção Persistente , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Eficácia de VacinasRESUMO
BACKGROUND: Approximately 70% of cervical carcinoma cases show the presence of high-risk Human Papilloma Virus (HPV), especially HPV-16 and HPV-18, and can be used to stratify high risk patients from low risk and healthy. Currently, molecular biology techniques such as polymerase chain reaction (PCR) are used to identify the presence of virus in patient samples. While the methodology is highly sensitive, it is labor intensive and time-consuming. Alternative techniques, such as vibrational spectroscopy, has been suggested as a possible rapid alternative. Therefore, in this study, we evaluate the efficiency of cervical fluid Fourier Transform Infrared spectroscopy (FTIR) in patient risk stratification informed by PCR. METHODS: Cervical fluid samples (n = 91) were obtained from patients who have undergone routine Papanicolaou (Pap) test. Viral genome was identified and classified as high/low-risk by PCR-Restriction Fragment Length Polymorphism (PCR-RFLP). FTIR spectra were acquired from samples identified by PCR-RFLP as No-HPV (n = 10), high-risk HPV (n = 7), and low-risk HPV (n = 7). RESULTS: Of the 91 samples, was detected the viral genome by PCR in 36 samples. Of these 36 samples, nine samples were identified to contain high-risk HPV (HR-HPV) and nine samples were found to have low-risk HPV (LR-HPV). The FTIR spectra acquired from No-HPV, LR-HPV, and HR-HPV showed differences in 1069, 1437, 1555, 1647, 2840, 2919, and 3287 cm-1 bands. Principal Component Analysis (PCA) showed distinct clusters for No-HPV and HR-HPV and No-HPV and LR-HPV, but there was significant overlap in the clusters of HR-HPV and LR-HPV. PCA-Linear Discriminant Analysis (PC-LDA) after Leave One Out Cross Validation (LOOCV) classified No-HPV from HR-HPV and No-HPV from LR-HPV with 100% efficiency in the 1400-1800 cm-1 spectral range. LOOCV classifications for LR-HPV and HR-HPV from each other were 71 and 75%, respectively, in the 2800-3400 cm-1 spectral range. CONCLUSIONS: The results highlight the high sensitivity of PCR-RFLP in HPV identification and show that FTIR can classify samples identified as healthy, low, and high-risk samples by PCR-RFLP. GENERAL SIGNIFICANCE: We show the possibility of using FTIR for initial cervical cancer risk stratification followed by detailed PCR-RFLP investigations for suspect cases.
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We conducted a prospective evaluation of the diagnostic performance of high-resolution microendoscopy (HRME) to detect cervical intraepithelial neoplasia (CIN) in women with abnormal screening tests. Study participants underwent colposcopy, HRME and cervical biopsy. The prospective diagnostic performance of HRME using an automated morphologic image analysis algorithm was compared to that of colposcopy using histopathologic detection of CIN as the gold standard. To assess the potential to further improve performance of HRME image analysis, we also conducted a retrospective analysis assessing performance of a multi-task convolutional neural network to segment and classify HRME images. One thousand four hundred eighty-six subjects completed the study; 435 (29%) subjects had CIN Grade 2 or more severe (CIN2+) diagnosis. HRME with morphologic image analysis for detection of CIN Grade 3 or more severe diagnoses (CIN3+) was similarly sensitive (95.6% vs 96.2%, P = .81) and specific (56.6% vs 58.7%, P = .18) as colposcopy. HRME with morphologic image analysis for detection of CIN2+ was slightly less sensitive (91.7% vs 95.6%, P < .01) and specific (59.7% vs 63.4%, P = .02) than colposcopy. Images from 870 subjects were used to train a multi-task convolutional neural network-based algorithm and images from the remaining 616 were used to validate its performance. There were no significant differences in the sensitivity and specificity of HRME with neural network analysis vs colposcopy for detection of CIN2+ or CIN3+. Using a neural network-based algorithm, HRME has comparable sensitivity and specificity to colposcopy for detection of CIN2+. HRME could provide a low-cost, point-of-care alternative to colposcopy and biopsy in the prevention of cervical cancer.
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Histeroscopia/instrumentação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Displasia do Colo do Útero/diagnóstico por imagem , Adulto , Idoso , Brasil , Colposcopia , Sistemas Computacionais , Feminino , Humanos , Microtecnologia , Pessoa de Meia-Idade , Redes Neurais de Computação , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)-driven mixed methods study, we conducted in-depth interviews (N = 21) and surveys (N = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.
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Infecções por Papillomavirus , Neoplasias do Colo do Útero , República Dominicana , Detecção Precoce de Câncer , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço VaginalRESUMO
The Human Papillomavirus (HPV) Prevention and Control Board is an independent multidisciplinary board of international experts that disseminates relevant information on HPV to a broad array of stakeholders and provides guidance on strategic, technical and policy issues in the implementation of HPV control programs. In response to drastic drop of vaccine coverage following the adverse event crisis in Carmen del Bolivar, Colombia, the HPV Prevention and Control Board in collaboration with the Colombian National Cancer Institute and Colombian League Against Cancer convened a meeting in Bogota, Columbia (November 2018). The goal of the meeting was to bring together national and international group of experts to report the disease burden, epidemiology and surveillance of HPV and HPV-related cancers, to discuss the successes and especially the challenges of HPV vaccination and screening in Colombia, as well as the lessons learnt from neighbouring countries. The meeting provided a platform to confer various stakeholder's perspectives, including the role of the Colombian healthcare system and to catalyse various parts of the public health community in Colombia into effective action. The conclusion of the meeting included following suggestions to strengthen HPV prevention and control: 1) Re-introducing school-based vaccine programs, 2) Integrating primary and secondary prevention programs, 3) Developing an innovative crisis communication plan targeting healthcare workers, teachers and general population, 4) Building trust through efficient and timely communication, 5) Building strong relationship with media to ensure a stable vaccination campaign support, and 6) Promoting empathy among healthcare professionals towards patients to build trust and communicate effectively.
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Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Vaccination against human papillomavirus (HPV) could reduce mortality from cervical cancer globally by as much as 90%. The purpose of our study was to explore multi-level barriers and facilitators to implementation of a national HPV vaccine program in the Dominican Republic; this article focuses on parent-level barriers and facilitators. In this qualitative study, we conducted six focus groups (N = 64) with parents of school-age children in the Santo Domingo area of the Dominican Republic, representing diverse socioeconomic groups and geographic settings. Thematic content analysis, using inductive and deductive approaches, was done following transcription and translation of audio-recordings from focus group discussions. Among this group of parents in the Santo Domingo area, facilitators to vaccine uptake were favorable attitudes towards vaccines in general and concern about cervical cancer as a health issue. Barriers found were low to moderate knowledge of HPV and cervical cancer, especially in the rural and suburban groups, and cost and lack of public awareness of the vaccine. This study identified key barriers and facilitators to HPV vaccine implementation in the Dominican Republic. Health messaging, incorporating specialist providers as opinion leaders, will need to be tailored to broad audiences with varying levels of information and awareness, anticipating misinformation and concerns, and will need to emphasize HPV vaccine as a method to prevent cancer.
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Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Papillomavirus , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Criança , República Dominicana , Humanos , Infecções por Papillomavirus/prevenção & controle , Pesquisa Qualitativa , VacinaçãoRESUMO
Introduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women's knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups (N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.
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Programas de Rastreamento/normas , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias do Colo do Útero/diagnóstico , República Dominicana , Detecção Precoce de Câncer/métodos , Feminino , Grupos Focais/métodos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Neoplasias do Colo do Útero/epidemiologiaRESUMO
OBJECTIVE: To assess the impact of HPV testing on longstanding problems faced by screening programs in Latin America, using the case of the Jujuy Demonstration Project (JDP) in Argentina. MATERIALS AND METHODS: . The study measured the level of impact produced by the introduction of HPV-testing on problems faced by cytology programs by analyzing modifications on specific problems produced during the JDP. Impact was classified as direct/indirect, and positive/negative. RESULTS: Direct/positive impact was found in issues concerning age and screening frequency,cytology laboratories and screening sensitivity, and low coverage. Direct/negative impact was mainly related to the adherence to triage cytology by HPV+ women with self-collected-tests, and the delivery and labelling of samples. Indirect impact of HPV-Test was mostly positive, and related to the programmatic reorganization which was facilitated by the introduction of HPV testing. CONCLUSIONS: HPV testing provides an opportunity window for improving primary screening, but does not solve programmatic problems.
OBJETIVO: Evaluar el impacto de la prueba deVPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba deVPH en Jujuy (PDJ),Argentina. MATERIAL Y MÉTODOS: Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. RESULTADOS: El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de ta- mizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. CONCLUSIONES: La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.
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Testes de DNA para Papilomavírus Humano , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal , Argentina/epidemiologia , Coleta de Dados , Países em Desenvolvimento , Feminino , Fidelidade a Diretrizes , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Infecções por Papillomavirus/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Avaliação de Programas e Projetos de Saúde , Determinantes Sociais da Saúde , Problemas SociaisRESUMO
Resumen: Objetivo: Evaluar el impacto de la prueba de VPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba de VPH en Jujuy (PDJ), Argentina. Material y métodos: Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. Resultados: El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de tamizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. Conclusiones: La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.
Abstract: Objective: To assess the impact of HPV testing on longstanding problems faced by screening programs in Latin America, using the case of the Jujuy Demonstration Project (JDP) in Argentina. Materials and methods: The study measured the level of impact produced by the introduction of HPV-testing on problems faced by cytology programs by analyzing modifications on specific problems produced during the JDP. Impact was classified as direct/indirect, and positive/ negative. Results: Direct/positive impact was found in issues concerning age and screening frequency, cytology laboratories and screening sensitivity, and low coverage. Direct/negative impact was mainly related to the adherence to triage cytology by HPV+ women with self-collected-tests, and the delivery and labelling of samples. Indirect impact of HPV-Test was mostly positive, and related to the programmatic reorganization which was facilitated by the introduction of HPV testing. Conclusions: HPV testing provides an opportunity window for improving primary screening, but does not solve programmatic problems.
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Humanos , Feminino , Esfregaço Vaginal , Neoplasias do Colo do Útero/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Testes de DNA para Papilomavírus Humano , Argentina/epidemiologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Problemas Sociais , Avaliação de Programas e Projetos de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Coleta de Dados , Fidelidade a Diretrizes , Infecções por Papillomavirus/epidemiologia , Países em Desenvolvimento , Determinantes Sociais da SaúdeRESUMO
OBJECTIVE: To compare the knowledge, beliefs, and practices regarding HPV vaccination among mothers of vaccine-eligible girls in Mexico and the USA. METHODS: Similar samples of Mexican mothers with vaccine-eligible daughters were surveyed at two clinics in Cuernavaca, Morelos, from July to October 2012 (n = 200) and at two clinics in Oxnard, California, from August to November 2013 (n = 200). RESULTS: Although mothers in the USA had less knowledge and more negative attitudes toward the vaccine than their counterparts in Mexico, vaccine uptake rates were higher in the USA (49% vs. 40%). US mothers were more likely to have discussed and been offered the HPV vaccine by a clinician than mothers in Mexico. In multivariate analyses, having been offered the HPV vaccine was the most important predictor of vaccine uptake. CONCLUSIONS: Our results suggest that healthcare access or other system, clinic, or provider factors are the main drivers of vaccine receipt in this binational sample of Mexican mothers. Interventions and programs that encourage clinicians to offer the HPV vaccine should be developed to increase vaccine uptake in both countries.
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Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos/psicologia , Mães/psicologia , Núcleo Familiar/psicologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/psicologia , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Mães/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/etnologia , Vacinação/estatística & dados numéricosRESUMO
Resumen: Objetivo: Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH), por parte de agentes sanitarios (AS), en Jujuy, Argentina. Material y métodos: Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. Resultados: Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. Conclusiones: La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar la AT-VPH.
Abstract: Objective: To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered door-to-door by Community Health Workers (CHWs) in Jujuy, Argentina. Materials and methods: A self-administered questionnaire was applied to 478 CHWs. RE-AIM model was used to evaluate adoption and implementation dimensions. Results: Adoption: 81.8% offered SC and 86.4% were satisfied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%). Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. Conclusions: The adoption of SC strategy was high among CHWs. Program strategies should be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Manejo de Espécimes , Esfregaço Vaginal , Autoexame , Agentes Comunitários de Saúde/psicologia , Detecção Precoce de Câncer/métodos , Testes de DNA para Papilomavírus Humano , Argentina , Atitude do Pessoal de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/prevenção & controle , Inquéritos e Questionários , Carga de Trabalho , Utilização de Procedimentos e TécnicasRESUMO
Abstract: Objective: To describe HPV vaccine program implementation, monitoring and evaluation experiences in Latin America. Materials and methods: We reviewed published articles in peer-reviewed journals and reports from government websites, as well as the PAHO/WHO/UNICEF Joint Reporting form and the ICO/IARC HPV Information Centre database. Results: By December 2016, 13 countries/territories in Latin America (56%) have introduced HPV vaccines. The majority have done so in the past three years, targeting 10-12 year old girls with a two dose schedule, through school programs. Vaccine coverage ranges from 30 to 87%. Safety monitoring is well established, but monitoring vaccine impact is not, and data are not available. Conclusions: Although Latin America is the most advanced developing region with HPV vaccine introduction, systems for its monitoring are weak and there is a paucity of consistently available coverage data for this vaccine. Challenges remain to introduce HPV vaccines in several countries, to achieve high coverage, and to strengthen monitoring, evaluation and reporting.
Resumen: Objetivo: Describir las experiencias con la implementación, monitoreo y evaluación de programas de vacunación contra VPH en América Latina. Material y métodos: Revisamos datos publicados en revistas, informes gubernamentales, así como los informes de monitoreo de programas de inmunizaciones de la OPS/OMS/UNICEF y del centro de información del VPH del ICO/IARC. Resultados: Hasta diciembre de 2016, 13 países/territorios en América Latina (56%) han introducido vacunas contra VPH. La mayoría lo han hecho en los últimos tres años, apuntando a niñas de 10 a 12 años con un calendario de dos dosis, a través de programas escolares. La cobertura de vacunas varía entre 30 y 87%. La vigilancia de la seguridad está bien establecida, pero el monitoreo del impacto de la vacuna no, y los datos no están disponibles. Conclusiones: Aunque América Latina es la región en desarrollo más avanzada en la introducción de la vacuna contra VPH, los sistemas para su monitoreo son débiles y hay una escasez de datos de cobertura disponibles. Sigue habiendo desafíos para introducir vacunas contra VPH en varios países, para lograr una alta cobertura y para fortalecer el monitoreo, la evaluación y la presentación de informes.
Assuntos
Humanos , Masculino , Feminino , Criança , Vacinação/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/efeitos adversos , Avaliação de Programas e Projetos de Saúde , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Esquemas de Imunização , Detecção Precoce de Câncer , Monitoramento Epidemiológico , Utilização de Procedimentos e Técnicas , América Latina/epidemiologiaRESUMO
OBJECTIVE: To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered doorto-door by Community Health Workers CHWs) in Jujuy, Argentina. MATERIALS AND METHODS: A self-administered questionnaire was applied to 478 CHWs.RE-AIM model was used to evaluate adoption and implementation dimensions. RESULTS: Adoption:81.8% offered SC and 86.4% were satis- fied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%).Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. CONCLUSIONS: The adoption of SC strategy was high among CHWs.Program strategiesshould be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.
OBJETIVO: Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH),por parte de agentessanitarios(AS),en Jujuy,Argentina. MATERIAL Y MÉTODOS: Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. RESULTADOS: Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. CONCLUSIONES: La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar laAT-VPH.
Assuntos
Agentes Comunitários de Saúde , Detecção Precoce de Câncer/métodos , Testes de DNA para Papilomavírus Humano , Autoexame , Manejo de Espécimes , Esfregaço Vaginal , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Atitude do Pessoal de Saúde , Agentes Comunitários de Saúde/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Utilização de Procedimentos e Técnicas , Inquéritos e Questionários , Neoplasias do Colo do Útero/prevenção & controle , Carga de TrabalhoRESUMO
OBJECTIVES: The methylation profile of genes in precursor lesions in cervical cancer was characterized to improve screening techniques for high-grade intraepithelial neoplasia. METHODS: A total of 447 cervical cytology samples obtained from women who underwent colposcopy were examined. The cases were distributed as follows: (1) cervices without cervical intraepithelial neoplasia (CIN; nâ¯=â¯152); (2) cervices with a CIN grade of 1 (CIN 1; nâ¯=â¯147); and (3) cervices with a CIN grade of 2 or 3 (CIN 2/3; nâ¯=â¯148). The methylation pattern for a panel of 15 genes was analysed by quantitative methylation-specific PCR (qMSP) and compared between the groups (≤CIN 1 vs. CIN 2+). RESULTS: In the validation set, seven genes presented significantly different methylation profiles according to diagnosis, namely, DAPK1 (pâ¯=â¯0.001), EPB41L3 (pâ¯=â¯0.001), HIC1 (pâ¯=â¯0.028), hsa-miR-124-2 (pâ¯=â¯0.001), LMX1A (pâ¯=â¯0.001), SOX1 (pâ¯=â¯0.001), and TERT (pâ¯=â¯0.001). Six genes showed a significant increase in the frequency of methylation in the presence of hr-HPV, namely, DAPK1 (pâ¯=â¯0.001), EPB41L3 (pâ¯=â¯0.001), hsa-miR-124-2 (pâ¯=â¯0.001), LMX1A (pâ¯=â¯0.001), SOX1 (pâ¯=â¯0.001), and TERT (pâ¯=â¯0.001). The methylation of the hsa-miR-124 gene showed sensitivity and specificity (86.7% and 61.3%, respectively) similar to that of the HPV test (91.3% and 50.0%, respectively). The independent factors associated with the diagnosis of CIN 2+ and the methylation of the hsa-miR-124-2 (ORâ¯=â¯5.1), SOX1 (ORâ¯=â¯2.8), TERT (ORâ¯=â¯2.2), and LMX1A (ORâ¯=â¯2.0) genes were a positive test for hr-HPV (odds ratio [OR]â¯=â¯5.5). CONCLUSIONS: Hypermethylation of the hsa-miR-124-2, SOX1, TERT, and LMX1A genes may be a promising biomarker for precursor lesions in cervical cancer regardless of the hr-HPV status.