Abstract
BackgroundWomen living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa.MethodsWe searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories.ResultsA total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts.ConclusionsCervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.
Highlights
Women living in Africa experience the highest burden of cervical cancer
We could not find any study that examined the prevention of human papillomavirus (HPV) and/or cervical cancer by delayed sexual debut, abstinence, and/or limiting the number of sexual partners
Considering the multiple foci of each paper, rather than just the primary focus, 17 talked about the cost-effectiveness or estimated impact of HPV vaccinations; 40 had a focus on acceptability, knowledge, and/or attitudes [12, 39,40,41, 126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152]; ten had a focus on uptake and/or retention [43, 152,153,154,155,156,157,158,159,160]; five had a focus on populations affected by human immunodeficiency virus (HIV) [47, 161,162,163]; four had a focus on males [132, 138, 150, 158]; four had a focus on safety and immunogenicity [161, 162, 164, 165]; one on adverse events [166]; and three on policy [167,168,169]; ten on male circumcision [46,47,48, 170,171,172,173,174,175,176]; two on lubricants, gels, and/or microbicides [177, 178], one on diaphragms [177]; and one on condoms [179]
Summary
Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. The purpose of this systematic review is to assess and characterize recent research within a broader public health framework, utilizing well-known public health terminology to organize and assess the range of efforts to respond to cervical cancer. In this context, these include: Primary Prevention (preventing the initial onset of cervical cancer), Secondary Prevention (early detection by screening and treatment of precancerous cervical lesions), Tertiary Prevention (treatment of cervical cancer to reduce morbidity and mortality), and Quality of Life (post-treatment care or palliative care for those without treatment options) among women in African countries. Literature highlighting feasibility considerations (accessibility, affordability, health care infrastructure, and provider training) and findings specific to HIV-infected women are integrated as appropriate in each public health category
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