Showing posts with label Cervical cancer screening. Show all posts
Showing posts with label Cervical cancer screening. Show all posts

Tuesday, April 5, 2016

A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening among Women with HIV

OBJECTIVE:
Women living with HIV experience higher risk of cervical cancer, but screening rates in the United States are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervicovaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV.

MATERIALS AND METHODS:
This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women older than 18 years, with HIV infection, attending an HIV clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer.

RESULTS:
A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences in comparing HPV-positive with HPV-negative women nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer.

CONCLUSIONS:
The intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible.

Purchase full article at:   http://goo.gl/wwMV0l

  • 1Department of Gynecology and Obstetrics, Johns Hopkins University School of Nursing and 
  • 2Johns Hopkins School of Medicine, Baltimore, MD.
  •  2016 Apr;20(2):139-44. doi: 10.1097/LGT.0000000000000195. 



Monday, March 14, 2016

Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care

Cervical cancer prevention/control efforts among women living with HIV/AIDS (WLH) are socially and structurally challenging. Healthcare access and perceived HIV stigma and discrimination are factors that may challenge risk reduction efforts. This study examined socio-structural determinants of cervical cancer screening among women engaged in HIV care. 

One hundred forty-five WLH seeking health/social services from AIDS Service Organizations in the southeastern US completed a questionnaire assessing factors related to cervical cancer prevention/control. 
  • 90% were African American, mean age 46.15 ± 10.65 years. 
  • 81% had a Pap test <1 year ago. 
  • Low healthcare access was positively associated with having a Pap test <1 year ago. 
  • About 36 % reported ≥2 Pap tests during the first year after HIV diagnosis. 
  • Lower educational attainment was positively associated with having ≥2 Pap tests. 
  • 35% reported more frequent Pap tests after diagnosis. 
  • Lower income was moderately associated with more frequent Pap tests post-diagnosis. 
Findings highlight the successes of HIV initiatives targeting socio-economically disadvantaged women and provide evidence that health policy aimed at providing and expanding healthcare access for vulnerable WLH has beneficial health implications.

Purchase full article at:   http://goo.gl/7G4ei9

By:  Bynum SA1Wigfall LT2,3,4Brandt HM4,5Julious CH6Glover SH2,3Hébert JR4,7.
  • 1Division of AIDS, Behavioral, and Population Sciences, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA. shalanda.bynum@nih.gov.
  • 2Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
  • 3Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
  • 4South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
  • 5Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
  • 6Palmetto AIDS Life Support Services, Inc., Columbia, SC, USA.
  • 7Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. 
  •  2016 Mar 8.



Wednesday, March 2, 2016

Social Network Characteristics & Cervical Cancer Screening among Quechua Women in Andean Peru

BACKGROUND:
Peru has high cervical cancer incidence and mortality rates compared to other Andean countries. Therefore, partnerships between governmental and international organizations have targeted rural areas of Peru to receive cervical cancer screening via outreach campaigns. Previous studies have found a relationship between a person's social networks and cancer screening behaviors. Screening outreach campaigns conducted by the nonprofit organization CerviCusco created an opportunity for a social network study to examine cervical cancer screening history and social network characteristics in a rural indigenous community that participated in these campaigns in 2012 and 2013. The aim of this study was to explore social network characteristics in this community related to receipt of cervical cancer screening following the campaigns.

METHODS:
An egocentric social network questionnaire was used to collect cross-sectional network data on community participants. Each survey participant (ego) was asked to name six other women they knew (alters) and identify the nature of their relationship or tie (family, friend, neighbor, other), residential closeness (within 5 km), length of time known, frequency of communication, topics of conversation, and whether they lent money to the person, provided childcare or helped with transportation. In addition, each participant was asked to report the nature of the relationship between all alters identified (e.g., friend, family, or neighbor). Bivariate and multivariate analyses were used to explore the relationship between Pap test receipt at the CerviCusco outreach screening campaigns and social network characteristics.

RESULTS:
Bivariate results found significant differences in percentage of alter composition for neighbors and family, and for mean number of years known, mean density, and mean degree centrality between women who had received a Pap test (n = 19) compared to those who had not (n = 50) (p's < 0.05). The final logistic regression model was statistically significant (χ2 (2) = 20.911, p < .001). The model included the variables for percentage of family alter composition and mean density, and it explained 37.8 % (Nagelkerke R (2)) of the variance in Pap test receipt, correctly classifying 78.3 % of cases. Those women with higher percentages of family alter composition and higher mean density in their ego networks were less likely to have received a Pap test at the CerviCusco campaigns.

CONCLUSIONS:
According to this exploratory study, female neighbors more than family members may have provided an important source of social support for healthcare related decisions related to receipt of a Pap test. Future studies should collect longitudinal social network data on participants to measure the network effects of screening interventions in rural indigenous communities in Latin American countries experiencing the highest burden of cervical cancer.

Full article at:  http://goo.gl/WreW3H

  • 1Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 135 Cannon Street, Ste. 303, MSC 835, Charleston, SC, 29425, USA. luquej@musc.edu.
  • 2Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA, USA. sopoku@georgiasouthern.edu.
  • 3Augusta University, GRU Cancer Center, Augusta, GA, USA. dferris@gru.edu.
  • 4CerviCusco, Cusco, Peru. dferris@gru.edu.
  • 5CerviCusco, Cusco, Peru. wendy_s14@hotmail.com. 
  •  2016 Feb 24;16(1):181. doi: 10.1186/s12889-016-2878-3.



Tuesday, March 1, 2016

Integrating Cervical Cancer Screening with HIV Care in Cameroon: Comparative Risk Analysis of Cervical Disease in HIV-Infected Women Receiving Antiretroviral Therapy to Women in the General Population

BACKGROUND:
While the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon.

METHODS:
A retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status.

RESULTS:
Included were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15-0.73, p = 0.006).

CONCLUSION:
HIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

Below:  Prevalence of abnormal Pap smear cytology in the study groups



Purchase full article at:   http://goo.gl/WwcCDi

  • 1Centre Médical d'Arrondissement de Baré, Nkongsamba, Cameroon.
  • 2International Training & Education Center for Health (I-TECH), Seattle, United States of America.
  • 3Regional Hospital of Nkongsamba, Nkongsamba, Cameroon.
  • 4University Teaching Hospital, Yaounde, Cameroon.
  • 5Department of Public Health, University of Douala, Douala, Cameroon. 
  •  2016 Feb 11;11(2):e0149152. doi: 10.1371/journal.pone.0149152. eCollection 2016.



Monday, February 22, 2016

Cervical Cancer Screening among Homeless Women in the Greater Paris Area (France): Results of the ENFAMS Survey

Little is known about the prevalence of cervical cancer screening (CCS) and its correlates among homeless women in France. The objectives of this study were to determine the prevalence of women who had never been screened for cervical cancer and to identify the associated factors. 

This cross-sectional study was based on data collected in the ENFAMS survey, which was conducted in 2013 among 764 sheltered homeless mothers in the Greater Paris Area. Robust Poisson regression models were used to estimate the association between no lifetime CCS and certain sociodemographic and health-related factors (selected from the behavioral model of vulnerable populations). 

Analyses were carried out separately for women with and without a regular gynaecological follow-up (RGF). The proportion of never-screeners was 33% among the women with an RGF versus 64% among those without an RGF (P<0.001). Among the latter, never having been screened for CCS was associated mainly with socioeconomic conditions, the length of time lived in France, a history of delivery in France and the duration of homelessness. 

In those with an RGF, the factors were mainly poor health service utilization and language difficulties. This first quantitative study of CCS among homeless women in the Greater Paris Area points to the need for it to be proposed and performed more systematically in primary care. 

Every contact between this hard-to-reach population and health services should be an opportunity to check their screening status and to ensure that those in need actually undergo a Pap test.

Purchase full article at:   http://goo.gl/pb8VmU

  • Department of Social Epidemiology, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136) 
  • b Department of the Inter-Regional Epidemiological Autorithy, French Institute for Public Health Surveillance, Saint-Maurice 
  • c Department of General Practice, School of Medicine, Sorbonne Universities, UPMC Univ Paris 06, Paris, France.
  •  2016 Feb 18. 



Saturday, February 20, 2016

Uptake of Cervical Cancer Screening and Associated Factors among Women in Rural Uganda: A Cross Sectional Study

Background
In developing countries, inadequate access to effective screening for cervical cancer often contributes to the high morbidity and mortality caused by the disease. The largest burden of this falls mostly on underserved populations in rural areas, where health care access is characterized by transport challenges, ill equipped health facilities, and lack of information access. This study assessed uptake of cervical cancer screening and associated factors among women in rural Uganda.

Methods
This descriptive cross sectional study was carried out in Bugiri and Mayuge districts in eastern Uganda and utilised quantitative data collection methods. Data were collected using a semi-structured questionnaire on cervical cancer screening among females aged between 25 and 49 years who had spent six or more months in the area. Data were entered in Epidata 3.02 and analysed in STATA 12.0 statistical software. Univariate, bivariate and multivariate analyses were performed.

Results
Of the 900 women, only 43 (4.8%) had ever been screened for cervical cancer. Among respondents who were screened, 21 (48.8%) did so because they had been requested by a health worker, 17 (39.5%) had certain signs and symptoms they associated with cervical cancer while 16 (37.2%) did it voluntarily to know their status. Barriers to cervical cancer screening were negative individual perceptions 553 (64.5%) and health facility related challenges 142 (16.6%). Other respondents said they were not aware of the screening service 416 (48.5%). The independent predictors of cervical cancer screening were: being recommended by a health worker [AOR = 87.85, p<0.001], knowing where screening services were offered [AOR = 6.24, p = 0.004], and knowing someone who had ever been screened [AOR = 9.48, p = 0.001].

Conclusion
The prevalence of cervical cancer screening is very low in rural Uganda. Interventions to increase uptake of cervical cancer screening should be implemented so as to improve access to the service in rural areas.

Below:  Suggested measures for increasing uptake of cervical cancer screening services



Full article at:   http://goo.gl/rQQ6D8

By:  
Rawlance Ndejjo, Trasias Mukama, David Musoke
Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Angele Musabyimana
Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda




Saturday, February 13, 2016

Qualitative Study of Cervical Cancer Screening among Lesbian and Bisexual Women and Transgender Men

BACKGROUND:
Lesbian, bisexual, and queer (LBQ) women, as well as transgender men, are less likely than their heterosexual and female-identifying counterparts to access cervical cancer screening services. Although numerous factors that influence receipt of cervical screening have been identified, several gaps in research and knowledge merit additional research.

OBJECTIVE:
The aims of this study were to examine cervical cancer screening behaviors of LBQ women and transgender men using American Cancer Society guidelines as the standards for comparison and to determine factors that influence participation in cervical cancer screening.

METHODS:
A convenience sample of 21- to 65-year-old LBQ women and transgender men was recruited from the Internet and community events. Qualitative data were collected through in-depth telephone interviews and open-ended questions on an online questionnaire. A deductive-inductive content analysis approach was used.

RESULTS:
The sample was mostly non-Hispanic white women who identified as lesbian. Most were routine cervical cancer screeners. Eighteen factors/themes were identified in the data and were contextualized within a health services theoretical framework.

CONCLUSIONS:
This study showed that although some factors overlap with the general female population, there are other areas that are specific to LBQ women and transgender men. Creating welcoming and inclusive healthcare environments is particularly important to facilitating cervical screening among LBQ women.

IMPLICATIONS FOR PRACTICE:
Nurse leaders can modify clinical environments, and clinical nurses can be educated to provide safe care for LBQ women and transgender men.

Purchase full article at:   http://goo.gl/ZwQayf

  • 1Author Affiliations: College of Nursing, University of Wisconsin-Milwaukee (Dr Johnson); College of Nursing, Medical University of South Carolina, Charleston (Drs Nemeth, Mueller, and Stuart); and Department of Health Education, San Francisco State University, California (Dr Eliason).
  •  2016 Feb 8.  



Sunday, February 7, 2016

High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZulu-Natal, South Africa

Objectives
HPV infection causes cervical cancer, yet information on prevalence and risk factors for HPV in Africa remain sparse. This study describes the prevalence of HPV genotypes and risk factors associated with HPV among young women ≤ 30 years of age in KwaZulu-Natal (KZN), South Africa.

Methods
Cervicovaginal lavage samples were tested for HPV genotypes in 224 women enrolled in a prospective cohort study. Clinical, behavioural and demographic data were collected. We measured prevalence of HPV genotypes and using logistic regression, examined for factors associated with HPV.

Results
Median age of participants was 21 years [interquartile range (IQR):18–23]. The overall prevalence of HPV was 76.3% (171/224) with multiple and single genotypes prevalent in 56.3% and 20.1% of women respectively. Proportion of women with high-risk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58) was 54.5%. Women not living with their partner [adjusted odds ratio (aOR)] = 3.42 95% CI1.22–9.60; p = 0.019), was significantly associated with HPV infection and high-risk HPV genotype infection.

Conclusion
The high burden of HPV and associated risk behaviours highlight the need to intensify behavioural interventions to prevent HPV acquisition in young women. The large scale delivery of HPV vaccine should be prioritised to prevent HPV acquisition and reduce HPV-related morbidity.

Full article at:   http://goo.gl/6UTV10

Craig Meyers, Editor
1Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
2Division of Medical Virology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
3Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
4Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa
5Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
6Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America
7National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa
Penn State University School of Medicine, UNITED STATES
#Contributed equally.
PLoS One. 2016; 11(1): e0146603. Published online 2016 Jan 19. doi:  10.1371/journal.pone.0146603





Knowledge, Attitude & Practice Regarding Cervical Cancer among Rural Community Women in Northeast Thailand

BACKGROUND:
Cervical cancer is the second most common malignancy among women worldwide, and women of reproductive age in Thailand. However, information on the behavior regarding cervical cancer in rural community Thailand is sparse.

OBJECTIVE:
To assess the knowledge, attitude, and practice regarding cervical cancer (CC) among rural community women in Nakhon Ratchasima, Thailand, using predesigned structured questionnaires.

MATERIALS AND METHODS:
A cross-sectional survey was conducted in 8 villages of Non Sung district, Nakhon Ratchasima province, Thailand, during January to April 2015. Bloom's taxonomy was used as a framework for the study. 265 women aged between 30-60 years old were selected by simple random sampling. All participants completed predesigned questionnaires with 4 parts: demographic data, knowledge, attitude, and practice regarding cervical cancer. Descriptive statistics were used for analysis in this study.

RESULTS:
The majority of participants were in the age group of 41-50 years old (42.6%) with senior secondary school level of education (32.1%), marriage status (85.0%), agricultural employment (59.6%), and family income between 6,000- 10,000 baht per month (54.3%). Some 63.4% and 68.7% participants had high knowledge and moderate level of attitudes regarding CC, while 41.1%, 48.7%, and 10.2% had neem regularly, irregularly or never screened for CC, respectively. The main reasons for not screening were were shyness (44.4%) and no time (55.6%). Vaginal discharge and itching were the common signs and symptoms of participants who were screened at a health promotion hospital of sub-district.

CONCLUSIONS:
CC is still a health problem in the rural community. Therefore, health education is required, particularly for those who have never undergone screening.

Full PDF article at:  http://goo.gl/vOGZlA

  • 1Department of Public Health, Faculty of Public Health, Vongchavalitkul University, Nakhon Ratchasima, Thailand E-mail : natthawut.k@hotmail. com, natthawut_kae@vu.ac.th.




Wednesday, January 20, 2016

Human Papillomavirus Infection and Vaccination: Awareness and Knowledge of HPV and Acceptability of HPV Vaccine among Mothers of Teenage Daughters in Weihai, Shandong, China

In preparation for the introduction of human papillomavirus (HPV) vaccine, we investigated awareness and knowledge of HPV/HPV vaccine and potential acceptability to HPV vaccine among mothers with a teenage daughter in Weihai, Shandong, China. 

A cross-sectional survey was conducted in 2013 with a sample of 1850 mothers who had a daughter (aged 9-17 years) attending primary, junior and senior high schools. In the final sample (N = 1578, response rate 85.30%), awareness of HPV was reported by 305 (19.32%) mothers. Awareness varied significantly by daughter's age (P<0.01), mother's education level (P<0.01), mother's occupation (P<0.01), household income (P<0.01) and residence type (P<0.01). 

Knowledge about HPV/HPV vaccine was poor with a mean total score of 3.56 (SD = 2.40) out of a possible score of 13. Mothers with a higher education level reported higher levels of knowledge (P = 0.02). Slightly more than one-fourth (26.49%) of mothers expressed their potential acceptability of HPV vaccine for their daughters. 

Acceptability increased along with increased daughters' age (P<0.01), household income (P<0.01) and knowledge level (P<0.01). House wives and unemployed mothers had the highest acceptability (P<0.01). The most common reasons for not accepting HPV vaccination were "My daughter is too young to have risk of cervical cancer (30.95%)", "The vaccine has not been widely used, and the decision will be made after it is widely used (24.91%)", "Worry about the safety of the vaccine (22.85%)". 

Awareness and knowledge of HPV/HPV vaccines are poor and HPV vaccine acceptability is low among these Chinese mothers. 

These results may help inform appropriate health education programs in this population.

Full article at: http://goo.gl/S9wBIx

By:  Yu Y1Xu M2Sun J3Li R1Li M1Wang J1Zhang D2Xu A4,5.
  • 1Weihai Center for Disease Control and Prevention, Weihai, Shandong, PR China.
  • 2Medical College, Qingdao University, Qingdao, Shandong, PR China.
  • 3Queensland University of Technology, Brisbane, Queensland, Australia.
  • 4Academy of Preventive Medicine, Shandong University, Jinan, Shandong, PR China.
  • 5Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, Shandong, PR China.
  •  2016 Jan 14;11(1):e0146741. doi: 10.1371/journal.pone.0146741. eCollection 2016.