Cervical Cancer Screening Coverage Research Articles

Impact of HPV vaccination on HPV infection and cervical related disease burden in real-world settings (HPV-RWS): protocol of a prospective cohort

BackgroundCervical cancer is one of the most common cancers in women and could be prevented by human papilloma virus (HPV) vaccination. Cervarix, the first available HPV vaccine, has been widely administrated to Chinese women, while little was known about its effect on the prevention and control for HPV related diseases in China. The study aims to assess the impact of Cervarix on HPV infection and cervical related diseases in real world.MethodsThis is a prospective, multi-age birth cohort study to investigate the incidence and continuous status of HPV infection, and relevant cervical diseases by exposure status (with Cervarix vaccination history or without any HPV vaccination history). It is planned to recruit 12,118 eligible women at age of 9 to 45 years from vaccination clinics or hospital outpatient clinics, and then follow up them for three years. The standard questionnaire will be used to collect information such as demographic characteristics, menstruation and obstetrical histories, history of sexual behavior, personal behavior history, history of disease and pathogen infection, medication history, and family history at baseline. After three years, the changes of these behaviors will be investigated again, and other related health status information will be retrieved from the electronic health records during the follow-up period. If available physically and legally, the cervical cancer screening will be performed, including type-specific HPV deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) testing and contingent thinprep cytologic test (TCT) and colposcopy. The free cervical cancer screening will be captured and uploaded timely to the Yinzhou Regional Health Information Platform (YRHIP); therefore, the long-term outcomes of participants will be monitored.DiscussionThis prospective cohort study will assess the impact of HPV vaccine on HPV infection and related cervical diseases in women aged 9–45 years, which makes up for the lack of evidence in Chinese women. The results of this study will provide support for understanding the impact of HPV vaccination in China, and make a contribution to increasing HPV vaccination and cervical cancer screening coverage in China.Trial registrationThis study has been retrospectively registered on clinicaltrials.gov (NCT05341284) on April 22, 2022.

Human Papilloma Virus Vaccination and Cervical Cancer Screening Coverage in Managed Care Plans—United States, 2018

(Abstracted from Prev Med 2022;159:107019) To prevent cervical cancer, vaccination against human papillomavirus (HPV) is recommended for adolescents aged 21 to 65 years and cervical cancer screening for women aged 21 to 65 years. The National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) evaluates managed care plan effectiveness of care for HPV vaccination and cervical cancer screening, allowing individual health plans to assess their preventive services performance rates compared with other plans.

Comparison of self-collected versus clinician collected cervicovaginal specimens for detection of high risk human papillomavirus among HIV infected women in Ethiopia

BackgroundIn order to meet the WHO 2030 cervical cancer elimination program, evaluation and utilization of sensitive testing method, and feasible sampling technique is a paradigm for enhancing cervical cancer screening coverage. Self-sampling for screening of HPV DNA testing is one of the easiest and sensitive techniques, though the evidence was limited in the Ethiopian context. This study aimed to compare the performance of self-collected vaginal specimen versus clinician collected cervical specimen for detection of HPV among HIV positive women in Ethiopia.MethodsWe conducted a comparative cross-sectional study design to collect cervicovaginal specimens among HIV positive women of age older than 24 years. Data were collected from six government hospitals from January to October 2021. A total of 994 cervicovaginal specimens was collected by clinicians and HIV positive women themselves in the cervical cancer screening unit using Abbott Cervi-Collect Specimen Collection Kit, and molecular HPV testing was conducted. Data were entered into an Excel spreadsheet and analyzed using SPSS version 25. Sensitivity, specificity and kappa were reported with p < 0.05 considered as statistically significant.ResultsThe prevalence of high-risk HPV was 29.4% among self-sampled specimen and 23.9% among clinician collected specimens. The overall concordance of the test result was 87.3%. Oncogenic HPV types, other than HPV16&18 were predominant in both sampling techniques, 19.9% from vaginal self-collected specimen and 16.7% of clinician collected cervical specimens. The sensitivity and specificity of self-sampled HPV test was 84.0% and 88.4%, respectively. The level of agreement was good (k = 0.68) and statistically significant (p < 0.001). The discriminatory power of the test as true positive and negative was excellent with an area under the curve of 0.86.ConclusionThe magnitude of oncogenic HPV was higher in self-collected samples than the clinician collected specimen with good agreement between the two sampling methods. Thus, we recommend the Ministry of Health in Ethiopia to expand utilization of the self-sampled technique and enhance the coverage of screening in the country.

Willingness to utilize cervical cancer screening among Ethiopian women aged 30-65 years.

BackgroundCervical cancer screening is a means of detecting cervical cancer early, before it develops, in order to reduce disease mortality and morbidity. When women are screened for cervical cancer between the ages of 30 and 40 years at least one time in their life, their risk of cancer could be decreased by 25–36%. Despite this advantage, cervical cancer screening coverage in Ethiopia is still <2%. As a result, we wanted to see how ready women in the Girar Jarso district, Ethiopia, were to get a cervical cancer test.MethodologyCommunity-based cross-sectional study was done using a stratified cluster sampling technique among 855 women aged 30–65 years in the Girar Jarso district, Ethiopia, from 1 June 2021 to 1 September 2021. A pretested and semi-structured interviewer-administered questionnaire was used to collect the data. EpiData management version 4.6 was used to enter data, which was then exported to SPSS version 23 for analysis. Logistic regression analysis was performed, and variables with a p-value of <0.05 were taken as statistically significant predictors of the willingness to utilize cervical cancer screening.ResultsOf the 855 women, only 315 (46.7%, CI = 43–50.3) women were willing to be checked for cervical cancer, with 181 (21.2%) women having been screened at least one time in their life. Age of 30–39 years [AOR = 2.80 (95% CI: 1.05, 7.48)], urban resident [AOR = 2.12 (95% CI: 1.06, 4.48)], positive attitude [AOR = 1.68 (95% CI: 1.11, 2.53)], wealth status, awareness of cervical cancer, and low perceived barriers were independent predictors of the willingness to utilize cervical cancer screening.Conclusion and recommendationThe willingness to utilize cervical cancer screening services is low in the Girar Jarso district. To improve community awareness and attitude, continued and sustainable advocacy on the value of cervical cancer screening should be offered through mass media and health extension workers.

Access to Cervical Cancer Screening for Women Living With HIV: A Record Linkage Study.

BackgroundAccording to the Global Strategy to Accelerate the Elimination of Cervical Cancer launched by the World Health Organizations (WHO), 70% of all women should undergo cervical cancer (CC) screening by 2030. While integrated HIV care and CC screening services exist, lack of unified data and patient management systems hinder reaching the set WHO goals. We used record linkage methods to assess the number of women receiving HIV care and visual inspection with acetic acid (VIA) based CC screening at Kanyama First Level Hospital (FLH) in Lusaka, Zambia.&#x0D; MethodsWe retrieved HIV patient records from SmartCare, Zambia’s National Electronic Health Records system, and the CC screening database for the years 2004 to 2018, and 2010 to 2018, respectively. We restricted this pilot study to women attending Kanyama FLH for HIV services, and its surrounding clinics for CC screening. We used the following linkage variables: first name, last name, facility, and year of birth. We used a machine learning based approach with Random Forest classifiers to identify records from the HIV and CC screening services belonging to the same person. We created synthetic patient record datasets to train and test the linkages. After the linkage, we anonymized the data and retrieved screening status from the CC screening database. We assessed the percentage of women in HIV care undergoing CC screening and the respective screening results. We calculated the time to CC screening with reference to the start of the HIV Antiretroviral Therapy treatment (ART).&#x0D; ResultsWe retrieved a total of 32,970 records from SmartCare and 176,736 records from CC screening databases. With the linkage we determined that of all women that ever accessed HIV treatment services at Kanyama FLH between 2004 and 2018, 2,999 (9%) received CC screening. Of those that were screened, 30% received the CC service at Kanyama FLH, while the rest from 13 surrounding facilities. 61% of women accessed CC services before starting ART. Of the women screened for CC, 371 had a positive VIA result (12%), 2,395 (80%) a negative and 233 (8%) had a missing or indeterminate result. When we restricted the analysis to women, who were eligible for screening (aged 25 to 59 years), the screening coverage was 9.6%.&#x0D; ConclusionOur study demonstrates the significance of record linkage efforts in determining CC screening coverage among women living with HIV. According to these findings, CC screening coverage among patients receiving ART services between 2004 and 2018 was at 9%, showing the depth of effort required to meet WHO targets at the time. The linkage output was primarily influenced by the scarcity of available linkage variables and data missingness, resulting in potentially overestimating or underestimating the CC coverage. This is typical of data systems in low- and middle-income countries; however, this study demonstrates that record linkage is useful in bridging these widespread data gaps.

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador.

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.

Breast and cervical cancer screening adherence in Jiangsu, China: An ecological perspective.

BackgroundHigh screening coverage can effectively reduce the mortality in breast and cervical cancer. Further research on extending the coverage of breast and cervical cancer screening in China is required. This study explored factors influencing women's “two-cancer” screening service utilization using an ecological approach.MethodsData were obtained from the National Health Services Survey (NHSS) conducted in 2018 in Jiangsu, China. A total of 3,500 women aged 18–64 years were included in the analysis. Chi-squared test, hierarchical multiple logistic regression analysis, and binary logistic regression analysis were performed.ResultsIn total, 44.1% of the women had been screened for breast cancer (BC) and 40.9% for cervical cancer (CC). Breast cancer screening (BCS) and cervical cancer screening (CCS) differed significantly in the following common categories: age, gestational experiences, chronic disease status, body mass index (BMI), exercise, health checkup, marital status, number of children, employment, education, family doctors, and health records. In the results of hierarchical multiple logistic regression analysis, the explanatory power of the final model was 37.5% and the area under the receiver operating characteristic curve was 0.812. The results showed that being in the age group of 35–64 years, having gestational experiences, having chronic diseases, exercising, having a health checkup, being married, having children, and being employed were statistically significant positive predictors of “two-cancer” screening adherence. The household size was a barrier. For BCS, obesity was also a negative factor, and a higher overall self-related health status was a positive factor. Being married and living in households of three or more families were not predictors. For CCS, having health records was also positively significant, while having chronic disease did not influence adherence.ConclusionThe findings provide an ecological explanation for women's BCS and CCS service utilization. Both proximal and distal factors should be considered to achieve a high coverage rate.

Willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Meru District, Arusha Region, Northern Tanzania.

The ability for women to self-collect human papillomavirus (HPV) samples can potentially reduce the risk of cervical cancer and increase screening coverage. To assess the willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Arusha region, northern Tanzania. A hospital-based cross-sectional study was conducted among 706 women aged 18-55 years in Meru District Hospital and Usa River Health Centre from March to April 2019. Face-to-face intervies were conducted using a questionnaire. Data analysis was performed using Stata version 14.0. The log-binomial regression was used to determine factors associated with willingness to self-collection of HPV samples. Majority (70%) of the women were willing to self-collection of HPV samples for cervical cancer screening and was associated with attending Meru District hospital (PR=2.02, 95%CI 1.77-2.31); good knowledge about cervical cancer warning signs (PR=1.11, 95%CI 1.01-1.22), prevention (PR=1.13, 95%CI 1.04-1.20), and symptoms (PR=1.61, 95%CI 1.33-1.93); and having formal employment (PR=1.22, 95%CI 1.07-1.37). The majority of women were willing to self-collect HPV samples for cervical cancer screening. Self-collection is, therefore, an acceptable and viable means of screening for cervical cancer, which has great implications for Tanzania from a health policy perspective.

Health care provider's experience and perspective of cervical cancer screening in Singapore: A qualitative study

BackgroundIn Singapore, the current cervical cancer screening (CCS) coverage rate of 48% falls below the national target of 70%. Health care providers (HCPs) play a critical role in promoting CCS uptake. However, there is limited understanding of the perspectives of HCPs regarding CCS. Hence, we aimed to understand the challenges encountered by HCPs delivering CCS in different care settings in the Singapore health system. We also aimed to explore perspectives on newer features of CCS such as self-sampling and HPV genotyping.MethodsPhysicians, nurses, program administrators and laboratory technicians involved with CCS were invited for a one-on-one semi-structured interview conducted over Zoom between May to August 2021. The interviews were transcribed and analyzed using thematic analysis.ResultsEighteen HCPs from 12 institutions were interviewed. Most participants were women (61.1%) and worked in public health institutions (72.2%). For factors influencing CCS, nine key themes were identified and organized into four categories: (1) patient factors, (2) HCP factors, (3) health system factors and (4) health promotion factors. Key themes commonly highlighted by study participants were related to patients' preferences and acceptance for screening, the processes of delivering CCS, the national priority for cervical cancer and the effectiveness of existing health promotion efforts. Five key themes were identified for CCS innovations. Self-sampling was viewed favorably to increase CCS uptake, while primary HPV screening with HPV partial genotyping had higher sensitivities to detect pre-cancers and cancers compared to cytology. Extended HPV genotyping beyond HPV16/18 could play an important role in CCS with increasing HPV vaccination coverage, as well as in the management of persistent HPV infection.ConclusionIn Singapore, HCPs face multiple challenges for CCS in practice. Insights from this study are directly relevant to, and useful for developing policies around national CCS programs and treatment guidelines.

Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organised Screening Programme (Paris Region, France).

Objectives: We aimed to examine social inequalities in participation in cervical cancer screening (CCS) in a metropolitan area by implementing a pilot organised screening programme. The pilot programme consisted of sending invitations to women who did not perform a pap smear within the past 3 years, managing interventions to reach vulnerable women, training healthcare professionals, and organising follow-ups of abnormal pap smears. Methods: We studied participation in CCS between January 2014 and December 2016 among 241,257 women aged 25–63 years old. To assess relative inequalities, Odds Ratios were computed using multilevel logistic regression. To assess absolute inequalities, the CCS coverage and the rate difference were calculated. Inequalities were computed by age and neighbourhood characteristics (social deprivation and proportion of single women). Results: Disparities in participation in CCS were observed by age and social deprivation. For overall screening compared to opportunistic screening, disparities by age were larger (OR25-35_vs._55–64 = 2.13 [2.08–2.19] compared to 2.02 [1.96–2.07]), but disparities by social deprivation were decreased (OR10%_most_vs._10%_least_deprived = 2.09 [1.90–2.30] compared to 2.22 [2.02–2.44]). Conclusion: Disparities in CCS participation remain despite the organised programme. To reduce these inequalities, free screening should be proposed and evaluated.

Cervical cancer screening utilization and associated factors among women of 30–65 years in Girar Jarsoo district North shoa, Ethiopia, 2021

BackgroundCervical cancer screening is the method of early detection of cervical cancer before occurrence to decrease mortality and morbidity of the women. When women screened at least once in their lifetime for cervical cancer, their risk of cancer could be decreased by 25–36%. Despite this advantage the coverage of cervical cancer screening remains below 2% across country level. Therefore, this study aimed to assess cervical cancer screening utilization and associated factors among women 30–65 years in north shoa Ethiopia. MethodCommunity-based cross-sectional study was conducted using stratified cluster sampling technique among 855 women in March 2021. Data were collected using pretested and semi-structured interviewer administered questionnaire. Adjusted odds ratio with a 95% confidence interval was used to report the association between predictors and the outcome variable. ResultCervical cancer screening utilization was found to be 21.2% (95% CI = 18.5–23.9).Being HIV positive [AOR = 16.49 (95% CI: 9.20–29.54)], knowing someone who had ever been screened for cervical cancer [AOR = 5.46 (95% CI: 2.53–11.79)], having good knowledge about cervical cancer screening [AOR = 3.8 (95% CI: 2.21–6.56)], women found in fourth quintile wealth index [AOR = 3.31 (95% CI: 1.13–9.70)] and having low perceived barriers for cervical cancer screening [AOR = 2.58 (95% CI: 1.43–4.64] were found to be significantly associated with cervical cancer screening utilization. ConclusionThe study revealed the utilization of cervical cancer screening among women 30–65 years is low. Health education program and other multi-disciplinary approaches should be done to increase cervical cancer screening utilization.

Human papilloma virus vaccination and cervical cancer screening coverage in managed care plans — United States, 2018

Human papilloma virus (HPV) vaccination for adolescents aged 11–12 years and cervical cancer screening for women aged 21–65 years are recommended to help prevent cervical cancer. The purpose of this study was to describe 2018 National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) data for the United States on HPV vaccination and cervical cancer screening from 275 commercial preferred provider organizations (PPOs), 219 commercial health maintenance organizations (HMOs), and 204 Medicaid HMOs. The Centers for Disease Control and Prevention and NCQA analyzed the data in 2021. The HEDIS® measure for HPV vaccination was the percentage of male and female adolescents aged 13 years who completed HPV immunization (2– or 3–dose series) on or before their 13th birthday. The measure for cervical cancer screening was the percentage of women screened either with cervical cytology within the last 3 years for women aged 21–64 years or with cervical cytology/HPV co-testing within the last 5 years for women aged 30–64 years. Nationally, the mean rate for HPV vaccination in 2018 was 37.8% in Medicaid HMOs, 30.3% in commercial HMOs, and 24.9% in commercial PPOs. The mean rate for cervical cancer screening was 75.9% in commercial HMOs, 72.6% in commercial PPOs, and 60.3% among Medicaid HMOs. Medicaid HMOs reported higher HPV vaccination rates but lower cervical cancer screening rates than commercial plans. These differences raise questions about explanatory factors and how to improve prevention performance by plan category.

GAMBARAN DUKUNGAN SUAMI TERHADAP DETEKSI DINI KANKER SERVIKS DI DESA TUMBAK BAYUH WILAYAH KERJA PUSKESMAS MENGWI II BADUNG

Cervical cancer is the second killer cancer of women after breast cancer. The high mortality rate due to cervical cancer is caused by the low coverage of cervical cancer screening. One of the factors that influence cervical cancer screening is the husband’s support. This research aims to describe the husband’s support for cervical cancer screening. It was descriptive quantitative research. It applied the purposive sampling technique with a sample of 100 respondents. The data were collected using an online questionnaire and analyzed using univariate analysis. The results obtained that respondents who had done cervical cancer screening were 72%, but only 30% did it routinely. Husband’s support for cervical cancer screening was in a good category, namely 72%. It consists of four sub-sections. It was the informational support in the poor category (77%) and the rest were assessment support (65%), emotional support (81%), and instrumental support (83%) in the good category. The conclusion is most of the respondents had done their cervical cancer screening, but most of them did it not routinely. Husband’s support for cervical cancer screening was mostly in the good category. Education regarding cervical cancer screening's importance to prevent morbidity and mortality of cervical cancer, should not only targets women but also their husbands. Thus, husbands can provide support to their wives to do cervical cancer screening regularly.

Cervical cancer screening coverage and its related knowledge in southern Malawi

BackgroundCervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world’s highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened.MethodsA population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status.ResultsThe percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC.ConclusionMost of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.

Cervical Cancer Screening Coverage - China, 2018-2019.

The World Health Organization set a 2030 target of 70% cervical cancer screening coverage for women aged 35-45 years. Coverage stood at 37% in China in 2015. In 2018-2019, China's cervical cancer screening coverage reached 43.4% in women aged 35-44 years and 36.8% in women aged 35-64 years. Screening coverage was still lower in rural areas as well as central and western regions; large variations existed across provincial-level administrative divisions. National and local policy and financial support should be maintained for cervical cancer screening, along with more targeted health education and outreach efforts and strengthened accessibility of health services in the rural areas and central and western regions.

Effectiveness and feasibility of HPV self-sampling for coverage of cervical cancer screening on internet-based

Objectives: To assess self-sampling HPV testing combining with the internet may serve as a primary cervical cancer screening method in low-resource settings, and to establish an internet self-sampling cervical cancer screening-management model. Methods: 20,136 women aged 30~59 years with vaginal self-sampling HPV testing as primary screening on internet-based was performed in 13 provinces, municipalities of China. The women who participated in the screening registered on the screening website. A questionnaire was investigated the acceptance of self-sampling after self-sampling. Results: Among 20103 women with qualified samples, 35.81% of them was remote areas, 37.69% of them was never-screened, 59.96% of them under-screened, 18.54% with a primary school education or below and overall high-risk HPV prevalence was 13.86%. In 8136 respondents, 95.97% of women felt self-collection was easy to operate, 84.61% had no discomfort when using a self-sampling brush, 62. 37% women were more likely to choose self-sampling for cervical cancer screening in the future, 92. 53% were willing to introduce to others around them. Multivariate analysis showed that the reliability of self-sampling and the easy degree of sampling were the independent influencing factors of selecting self-sampling (p&lt;0.05), while no statistical significance was found in different age, education, occupation, gravidity, medical insurance, age of sexual initiation (p&gt;0.05). Conclusions: The Internet-facilitated self-HPV-testing screening and management model for cervical cancer prevention with large sample study is feasible and effective and can be used as a supplement to the traditional screening, especially in marginal areas with few medical resources, finally the coverage of cervical cancer screening will be significantly improved.

Referral mechanism and beneficiary adherence in cervical cancer screening program in Tiruchirappalli district, Tamil Nadu state, India, 2012-2015.

A screening program for cervical cancer was established in 2011 in Tamil Nadu. Since the inception of the program, coverage, and dropout of screening has not been analyzed. We conducted a study to describe the referral mechanism in the cervical cancer screening program implemented in Tamil Nadu, to estimate the level of adherence to the referral process by the beneficiaries, and to identify strengths and weaknesses related to the referral mechanism in the program. ">This descriptive study was conducted during 2015-2016 in the Tiruchirappalli administrative district of Tamil Nadu. All women aged 30 years and above, who were screened in public health facilities, were the participants. Using a structured form, we collected the data maintained in the registers at the district health administration. We estimated the screening coverage, follow-up evaluation, and dropout rates at different stages of the referral mechanism. We used SPSS and Epi Info software for analysis. Coverage of cervical cancer screening was 4,838(41.6%). We estimated 4,838(41.6%) of screened positives were lost to follow-up for a colposcopy examination. Biopsy samples were obtained from 3425(84%) of those who required a biopsy. Cervical cancer was diagnosed in 159(4.6%) and precancerous lesions in 528(15.4%) women. More than half of the target population was screened in public health facilities. The dropout rate was less than half of those screened at the colposcopy evaluation level. Major pitfalls of the program were human resource issues at referral centers and poor maintenance of meaningful data.

Trends and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020

This study aimed to verify the temporal trend and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020. This is a trend study with Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interview (Vigitel) data from 2011 to 2020. The outcome was the prevalence of cytopathological examination in the last three years. Slope index of inequality (SII) and concentration index (CIX) were used to estimate inequalities. An increasing trend in the outcome was observed in Brazil in the period surveyed, as well as a decrease in most regions, capitals, and in all groups according to education. There was a decrease in coverage in most regions of Brazil. We highlight that SII presented its worst results in 2011 and 2012, reaching 15.8p.p. (95%CI: 14.1; 17.6) and 15.0p.p. (95%CI: 13.1; 16.9), respectively, among women with 12 years or more of education. There was a decrease in coverage of cervical cancer screening in most Brazilian regions and capitals from 2011 to 2020. In the period before and during the pandemic, a reduction in the outcome was observed in the South and Southeast regions, suggesting that the COVID-19 pandemic caused geographical inequalities in the coverage for this exam in Brazil.

Regional and Country-Level Trends in Cervical Cancer Screening Coverage in High HIV Prevalence Settings: A Systematic Analysis of Population-Based Surveys in Sub-Saharan Africa (2000-2020)

Regional and Country-Level Trends in Cervical Cancer Screening Coverage in High HIV Prevalence Settings: A Systematic Analysis of Population-Based Surveys in Sub-Saharan Africa (2000-2020)

Implementing community-based human papillomavirus self-sampling with SMS text follow-up for cervical cancer screening in rural, southwestern Uganda.

BackgroundSelf-collected HPV screening may improve cervical cancer screening coverage in low resource countries, yet data guiding implementation and follow-up of abnormal results are sparse.MethodsThis is a prospective cohort implementation study of HPV self-testing program in Mbarara, Uganda with mobile phones to facilitate result notification and referral for treatment at a regional hospital. The effectiveness of the interventions was analyzed using Proctor’s model of implementation. Women were interviewed following screening and at 6 months to assess acceptability and barriers to follow-up. Data were analyzed using descriptive statistics.Results159 of 194 (82%) of eligible women underwent HPV self-sampling; of these, 27 (17%) returned positive for high-risk HPV subtypes. We sent SMS messages providing test results and follow-up instructions to all participants. Seventeen (63%) hrHPV-positive participants reported receiving SMS text instructions for follow-up, of whom 6 (35%) presented for follow-up. The most common reasons for not returning were: lack of transportation (n = 11), disbelief of results (n = 5), lack of childcare (n = 4), and lack of symptoms (n = 3). Confidence in test results was higher for self-screening compared to VIA (Likert score 4.8 vs 4.4, P = 0.001).ConclusionsDespite the use of SMS text-based referrals, only one-third of women presented for clinical follow-up after abnormal HPV testing.