Metaprop: a Stata command to perform meta-analysis of binomial data

Women in low- and middle-income countries (LMICs) bear a disproportionate burden of cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies such as 5-fluorouracil and imiquimod, for which efficacy evidence is available from high-income settings. We investigated African women's perceptions and perceived acceptability of these therapies for cervical precancer treatment. Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25-65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored women's experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded and analysed using qualitative description using NVIVO software. Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to women's perceptions of topical therapies. Participants were highly receptive to topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost and lack of privacy with pelvic examinations. Participants had a preference for topical therapies that are used less frequently compared to those used daily. Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs. Not applicable.

Background:Women in low- and middle-income countries (LMICs) bear a disproportionate burden of cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies such as 5-fluorouracil and imiquimod, for which efficacy evidence is available from high-income settings. We investigated African women’s perceptions and perceived acceptability of these therapies for cervical precancer treatment.Methods:Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25–65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored women’s experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment, and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded, and analyzed using qualitative description using NVIVO software.Results:Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening, and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to women’s perceptions of topical therapies. Participants were highly receptive of topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost, and lack of privacy with pelvic exams. Participants had a preference for topical therapies that are used less frequently compared to those used daily.Conclusions:Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy, and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs.

Prevalence of cervical HPV infection in women with systemic lupus erythematosus: A systematic review and meta-analysis.

BackgroundGlobally, cervical cancer is an increasing public health issue, and vaccination against HPV has proven to be an effective strategy to reduce this neoplasia. The purpose of this study was to assess the effectiveness of the quadrivalent vaccine in reducing the prevalence and incidence of HPV infection in women, aged 18 to 24 years old, in the cities of Ouro Preto and Mariana, Minas Gerais, Brazil.MethodsA concurrent cohort study was performed, with an initial follow-up of 12 to 18 months. The selected young women were interviewed and divided into two groups: vaccinated and unvaccinated. Participants underwent a Pap smear and cervical sample collection for HPV detection, genotyping performed by PCR-RFLP, type-specific PCR, and using the PapilloCheck®. The prevalence of HPV infection was analyzed using the compare proportions test. Poisson and Cox multivariate regression models were used to estimate vaccine effectiveness.ResultsThere was no significant difference in the overall prevalence of HPV infection between vaccinated and unvaccinated groups (23.6% vs. 18.7%; p = 0.364). However, the prevalence of infection by HPV 6/11, 16 and 18 types in vaccinated young women (1.1%) was lower than in unvaccinated ones (7.5%; p = 0.030). Regarding non-vaccine types, a higher prevalence was identified among vaccinated women (22.5% vs. 11.2%; p = 0.018). The overall incidence of HPV infection was 15.75/100 young women/year in non-immunized women compared to 9.12/100 young women/year among those immunized. The effectiveness of the vaccine was 64.0%, regardless of the viral type, and no vaccinated woman was detected with the specific vaccine HPV-type in follow-up. HPV33/45, related to cross-protection, were detected in 12.3% of vaccinated women and 1.2% of unvaccinated ones (p < 0.001) at baseline. These viral types were identified at follow-up in 2.03/100 young women/year of vaccinated participants and 4.24/100 young women/year of unvaccinated ones.ConclusionsThe results showed that the quadrivalent HPV vaccine was effective in reducing the prevalence of vaccine-type HPV and the incidence of infection by any HPV type. Public health policies must encourage vaccination to prevent HPV infection. However, surveillance of HPV infection should be continued to assess the prevalence of different genotypes and the impact of the vaccination program.

HTLV-1 infection increases susceptibility to other infections. Few studies have addressed the co-infection between HPV and HTLV-1 and the immune response involved in this interaction. The aim of this study was to determine the prevalence of cervical HPV infection in HTLV-1-infected women and to establish the risk factors involved in this co-infection. A cross-sectional study was carried out in Salvador, Brazil, between September 2005 and December 2008, involving 50 HTLV-1-infected women from the HTLV Reference Center and 40 uninfected patients from gynecological clinic, both at the Bahiana School of Medicine. HPV infection was assessed using hybrid capture. HTLV-1 proviral load was quantified using real-time polymerase chain reaction (PCR). The mean age of HTLV-1-infected women (38 ± 10 years) was similar to that of the control group (36 ± 13 years). The prevalence of HPV infection was 44% in the HTLV-1-infected group and 22.5% in uninfected women (p = 0.03). HTLV-1-infected women had lower mean age at onset of sexual life (17 ± 3 years versus 19 ± 3 years; p = 0.03) and greater number of lifetime partners compared with the control group (4 ± 3 versus 2 ± 1; p < 0.01). In the group of HTLV-1-infected patients, there was neither difference in HTLV-1 proviral load between HPV-infected women and the uninfected. The prevalence of HPV infection was higher in HTLV-1-infected women. Further studies should be performed to evaluate the progression of this co-infection.

200 years of diagnosis and treatment of cervical precancer

Oral human papillomavirus infection in women with cervical HPV infection: New data from an Italian cohort and a metanalysis of the literature

HPV type-specific distribution was evaluated in genital samples collected from 151 women from West Africa and Horn of Africa, living in the Asylum Seeker Center in Bari Palese (Italy), undergoing voluntary screening correlated with cytological abnormalities. HPV-DNA was assayed by Linear Array HPV genotyping test. HPV DNA was detected in 39.1 % of the women, 42.5 % of which had multiple infection and 69.5 % had high-risk HPV infection. Age-prevalence rates evidenced a peak of HPV infection in women ≤ 20 years of age (53.1 %). HPV 53 and 16 were the most common viral types (13.5 and 12.0 % respectively). Abnormal Pap test results were found in 4.4 % of women with known cytological result. Although a prevalence of HPV positive women higher in African than in European women was expected, the differing rate between residents and migrants African women must be investigated in future studies.

Background and context: Cervical cancer is a largely preventable disease, yet kills about 260,000 women each year, mostly in low- and middle-income countries (LMIC). Cervical screening is a proven technique for reducing the incidence of cervical cancer, but only if screen-positive women receive timely, effective precancer treatment. As planning efforts to scale up cervical precancer treatment programs to reach more women are occurring in many high-burden countries, tools to determine what and how much equipment to procure and how to deploy it could help decision-makers make better use of scarce resources. Aim: To assist decision-makers, PATH developed the Cervical Precancer Treatment Planning Tool, with the aim of increasing access to lifesaving treatment while optimizing the use of scarce resources. This tool contains a scenario-based Excel model and Tableau data visualization mapping tool, which enable users to examine various strategies for deployment of ablative cervical precancer treatment equipment. The tool evaluates the number of women treated, the number of treatment devices needed, associated start-up costs, and cost of gas across five different scenarios. Strategy/Tactics: The model contains baseline data, gathered from a literature review and PATH fieldwork, for nine countries in sub-Saharan Africa, but it can be adapted to generate data for any LMIC. Users can also adjust baseline values to reflect the most current local data. The Tableau data visualization, which uses Uganda as an illustrative example, provides results at a district level. The tool's parameters, baseline inputs, and outputs were vetted with cervical precancer experts from eight African countries in 2017. Program/Policy process: The tool is available to country decision-makers who want to weigh the tradeoffs when trying to balance patient convenience and access with efficient utilization of equipment, skilled personnel, and financial resources. Results from the tool can inform national precancer treatment program strategies and decisions about device procurement and deployment. Outcomes: The country-level tool is publicly available ( https://sites.path.org/marketdynamics/ ) for decision-makers to make informed strategic decisions about their country's cervical precancer treatment programs. What was learned: The single-visit approach (SVA) for screening and treatment leads to treatment of the most women, but the financial costs for this scenario are on average more than 7 times greater than the next most costly scenario. In addition, treatment devices are underutilized in the SVA. While reducing the number of devices in each country reduces costs and improves equipment utilization, many women would require a second visit for treatment. Depending on the equipment deployment scenario (e.g., one treatment device per hospital), some women may need to travel long distances for this follow-up visit, potentially reducing treatment completion rates for those in need.

Innovative strategies are urgently needed to meet the World Health Organization’s 2030 target of treating 90% of women with precancerous cervical lesions, especially in countries most affected by cervical cancer. We assessed the acceptability of self-administered intravaginal therapies for treating cervical precancer in women undergoing cervical cancer screening and precancer treatment in Kenya. We conducted a cross-sectional study among women aged 18 to 65 years undergoing cervical cancer screening or precancer treatment between January and October 2023 in Kisumu County, Kenya. Participants completed a questionnaire about their perceptions and perceived acceptability of self- or provider-administered topical therapies for cervical precancer treatment. Quantitative data were summarized using descriptive statistics. A total of 376 questionnaires were completed. The median age of participants was 35 years (interquartile range: 25–62), 62% had a primary education or less, and 71% earned $5 or less daily. All participants had been screened for cervical cancer, and 191 (51%) had received precancer treatment, primarily thermal ablation. Ninety-eight percent of participants were willing to use a self-administered intravaginal therapy for cervical precancer, if available. The majority, 91%, believed their male partner would support their use. Given a choice, 63% preferred self-administration at home compared to provider-administration of a topical therapy in the clinic, citing time and cost savings. In multivariate analysis, married women were more likely to expect partner support for self-administration than single women. Participants preferred a therapy used less frequently but for a longer duration, compared to daily use therapy with a shorter duration of use. Self-administered intravaginal therapies for cervical precancer treatment are highly acceptable among women undergoing screening and precancer treatment in Kenya.

Human papillomavirus is a common pathogen that infects the skin and mucosal epithelium, is transmitted sexually; causes condylomas or squamous cell carcinomas. Two (16 and 18) of the 150 HPV serotypes are oncogenic types. Studies have been done on the infection by oncogenic human papillomavirus 16/18 and associated factors are found to be very limited in Ethiopia. This study aimed to assess the prevalence of oncogenic human papillomavirus infection (HPV 16/18) and associated factors among women. An institutional-based cross-sectional study was conducted among 337 women screened for cervical cancer in two hospitals in East Gojjam Zone from February to April 2021 G.C. Four BSc-qualified nurses who worked in the chosen hospitals collected the data using pretested questionnaire and an HPV test (OncoE6TM Cervical Test) specific to HPV16/18 in cervical swabs. Descriptive analysis was performed to determine the prevalence and a multivariate logistic regression model was used to identify the associated factors of HPV16/18 infection. Finally, statistical significance was declared at P < 0.05. The prevalence of HPV infection was 14.2% (95% CI: 10.7% -18.1%). The mean age of the respondents was 36.7±9.1 years. Women with the age group of 55-65 years (AOR = 7.91, 95% CI: 1.95-32.09), early initiation of sexual intercourse (AOR = 5.36, 95% CI: 1.58-18.13), history of sexually transmitted infection (STI) (AOR = 3.52, 95% CI: 1.27-9.72), human immunodeficiency virus (HIV) positive status (AOR = 6.8, 95% CI: 1.99-23.54), and number of lifetime sexual partners (AOR = 4.37, 95% CI: 1.15-17.3) were important independent factors associated with the presence of oncogenic HPV infection. We found a relatively low prevalence of high-risk HPV infection. Age, early initiation of sexual intercourse at less than 18 years, STI of women, being HIV seropositive, and a number of sexual partners were important factors for high-risk HPV infection. Women aged > 46 years, women with early initiation of sex, a history of STI, being HIV positive, and a history of multiple sexual partners should be encouraged to be screened and vaccinated for HPV infection. Wider-ranging studies are also needed in HPV-infected women in association with the cervical lesion.

Quality improvement initiatives on colposcopy and treatment of cervical pre-cancer services in Bhutan: Experiences, challenges, and way forward.

Human papillomavirus (HPV) accounts for over 80% of anal cancer cases. In the effort to prevent HPV-related cancers, the 9-valent HPV vaccine emerged as a crucial intervention, targeting HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58; the previous 4-valent (types 6,11,16,18) and 2-valent (types 16, 18). This study involved 213 women aged 21-50 attending gynecology and colonoscopy clinics in San Juan, Puerto Rico. The study assessed anal HPV prevalence and analyzed vaccination status-related differences. Anal swabs were collected for HPV testing using the ATILA AmpFire, targeting 17 HPV types. This method identified 15 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, and 68) and two low-risk HPV types (6 and 11). Prevalence of any HPV, HR-HPV, and LR-HPV, and of specific HPV types were calculated by overall and vaccination status. Differences were assessed for statistical significance (p&amp;lt;0.05) using Fisher's exact or Pearson χ2 test. The mean age of women was 36.0 ± 5.9 years. Overall, 19.7% (n=44) had received the HPV vaccine; among them, 52.2% (n=23) had received the 4-valent vaccine, 2.3% had received the 2-valent vaccine, 2.3% had received the 9-valent vaccine, and 43.2% were uncertain about their specific HPV vaccine type. The prevalence of anal HPV infection was 68.5% for any HPV, 61.5% for HR-HPV, and 15.0% for LR-HPV. The most prevalent HR-HPV types were HPV 56 (13.2%), HPV 68 (11.7%), and HPV 66 (11.2%). There were no statistically significant differences in the prevalence of any HPV, HR-HPV, and LR-HPV between vaccinated and unvaccinated women. The most common HR-HPV type among vaccinated were HPV 66 (20.5%), HPV 31 (18.2%), HPV 56 (15.9%), while the most common among unvaccinated women were HPV 56 (12.4%), HPV 68 (12.4%), and HPV 16 (12.4%). Additionally, when evaluating as a grouped variable, the HPV genotypes covered by the 4-valent, unvaccinated women had a significantly higher prevalence of these types as compared to those vaccinated (28.9% vs. 13.6%, respectively, p-value =.03). The unvaccinated women showed a lower prevalence for HPV types covered by the 9-valent vaccine compared to the vaccinated cohort (43.2% vs. 45.5%). However, this difference was not statistically significant. We found a high prevalence of anal HPV among these women, with lower prevalence of 4-valent and 2-valent HPV types among vaccinated women, evidencing the pivotal role of HPV vaccination. Future research should assess the 9-valent vaccine's long-term effectiveness against more HPV types. Funding: Research Centers in Minority Institutions (RCMI), University of Puerto Rico (NIMHD # 2U54MD007600-36), and CAPAC Research Training Program (NCI #R25CA240120). Citation Format: Anelisse Dominicci-Maura, Ana Patricia Ortiz, Josefina Romaguera, Filipa Godoy-Vitorino. Prevalence of anal HPV infection in women attending a gynecology and colposcopy clinic: Assessing the potential impact of HPV vaccination [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4804.

Cervical human papilloma virus infection of women attending social hygiene clinics in Hong Kong

The aim of our study was to determine the risk factors associated with anal HPV infection in HIV-negative women with high-grade cervical lesion. The study group included 172 "high-risk" women who underwent conization for high-grade cervical intraepithelial lesion or microinvasive cervical cancer (CIN 2+). The control group consisted of 100 "low-risk" women with non-neoplastic gynecologic diseases. All participants completed aquestionnaire detailing medical history and sexual risk factors and were subjected to anal and cervical HPV genotyping. Concurrent cervical and anal HPV infections were detected in 42.4% (73/172) women of the study group, and in 8.0% (8/100) of women in the control group, respectively. The subgroup with concurrent HPV infections (n=73) dominated women with CIN 3 and microinvasive cancer and anal HPV 16 infections (n=53). Women with concurrent infections more frequently reported any type of sexual contact with the anus including non-penetrative anal sex (OR 2.62, p=0.008). Reporting >5 lifetime sexual partners (OR 2.43, p=0.041), smoking > 60 cigarettes per week (OR 2.33, p=0.048), and ahistory of penetrative anal intercourse (OR 3.87, p=0.002) were observed as the significant risk factors in women with multiple concurrent HPV infections. Our data support anal HPV testing and anal Pap smear screening in all women with severe cervical lesions caused by HPV 16 and ahistory of any sexual contact with the anus, heavy smoking and/or more than 5 lifetime sexual partners. anal cancer, cervical intraepithelial neoplasia, HPV, risk factor.