Low Screening Rates Research Articles

Analyzing Geospatial and Socioeconomic Disparities in Breast Cancer Screening Among Populations in the United States: Machine Learning Approach.

Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates. This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates. Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large-scale dataset of social determinants of health, comprising 13 variables for 72,337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence. Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06, compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor's degree were the most influential variables, all positively associated with mammography screening rates. These findings underscore the significance of social determinants and the accessibility of mammography services in explaining the variability of breast cancer screening rates in the United States, emphasizing the need for targeted policy interventions in areas with relatively lower screening rates.

Are we ready for self-sampling for cervical cancer screening? Insights from service providers and policy makers in Nepal.

Cervical cancer is the leading cancer among women in Nepal, but the country has very low screening rate, with only 8.2% of women being screened. In recent years, a self-sampling kit for testing for the human papillomavirus (HPV) has been developed to allow self-sampling and enable early detection of cervical abnormalities. This kit enables women to collect cervical samples without the need for trained healthcare providers or healthcare facilities. Nevertheless, there has been a notable absence of scientific studies to analyse the feasibility and acceptability of self-sampling for cervical cancer screening in Nepal, particularly from the perspective of various service providers. The qualitative research method used semi-structured in-depth interviews and key informant interviews with healthcare providers, online service providers, and policymakers. These interviews were conducted in person with 20 participants until data saturation was achieved. Thematic analysis was performed where the translated data was coded inductively using NVivo 12. The majority of the participants identified the self-sampling method as an alternative sampling option for detection of cervical abnormalities/cancer in Nepal. Barriers to self-sampling included a low level of knowledge and information, the cost of the self-sampling kit, unclear information regarding self-sampling process and concerns about inaccurate results among women and girls, who are the end users. Similarly, factors such as knowledge and information regarding the self-sampling technique, accessibility of available services and information, and national self-care guidelines and policies for cervical cancer screening were identified as facilitators for self-sampling. It is crucial to have evidence-based discussions, especially regarding the effectiveness of a self-care approach in cervical cancer screening and help create a supportive policy environment for implementing self-care strategies in Nepal. Furthermore, disseminating education and information nationwide through campaigns to raise awareness about self-sampling is essential among beneficiaries for the scaling up of self-sampling for cervical cancer in Nepal.

Rates of screening for sexually transmitted infections in adolescents with and without disabilities.

Individuals with disabilities experience a higher prevalence of sexually transmitted infections (STIs) compared to their counterparts without disabilities; however, there is limited data on whether they are screened for STIs at the same rate. The aim of this study was to determine whether adolescents and young adults with disabilities undergo routine screening for STIs at lower rates than individuals without disabilities. We performed a retrospective cohort study of female patients aged 16-21 years who were seen between July 2021 and August 2023 by pediatrics, internal medicine/pediatrics, or family medicine at a single institution. Disability status was determined via ICD-10 codes. STI testing information was obtained by chart review. Data were analyzed using multiple logistic regression, and adjusted odds ratios were reported for race, ethnicity, age, and disability. Among 6906 eligible patients, 90 (1.3%) had a disability. Individuals with disabilities underwent STI screening at lower rates (60% vs 77.2%, p<.001). There were lower odds of STI screening for individuals with any disability (aOR 0.38, 95% CI 0.24-0.61, p<.001), a physical disability (aOR 0.26, 95% CI 0.09-0.72, p=.008), or an intellectual disability (aOR 0.37, 95% CI 0.21-0.64, p<.001) when adjusting for race, ethnicity, and age. The rate of STI screening among adolescents and young adults with disabilities was lower compared to those without disabilities. Universal testing may help normalize STI screening so that individuals with a higher risk of STIs are not missed. Further research is indicated to identify and mitigate factors that lead to lower rates of screening.

Low Uptake of Lipid Screening—Concerning Nonadherence or Appropriate Skepticism?

This Viewpoint discusses factors that play a role in the low rate of lipid screening in children, including a lack of compelling evidence, disagreement with recommendations, and concerns for overdiagnosis and overtreatment.

Important factors influencing prostate cancer screening among indigenous men

ABSTRACT Indigenous men diagnosed with prostate cancer have the lowest five-year survival rates across all racial/ethnic groups; at least partially due to lower rates of screening and limited access to treatment. This study examined factors correlating with receipt of prostate cancer screenings among 191 Indigenous men residing in the Northern Plains using a convenience sampling method. Results of the hierarchical logistic regression revealed that participants who reported being married, who had personal cancer history, who reported having access to medical care, and/or who had knowledge related to prostate cancer exams were more likely to have the receipt of a prostate cancer screening. Findings indicate the necessity of developing appropriate prostate cancer prevention programs, family-based intervention programs, a support system for selecting an appropriate place for medical care, and prostate cancer screening education and assistance programs for this population.

Self-Collection for HPV-Based Cervical Screening: Knowledge and Attitudes of Australian Health Care Workers in an Area With Low Screening Rates, July-November 2023.

Cervical screening is crucial for early detection of and ultimately eliminating cervical cancer. Conventional methods for cervical screening that rely on clinician collection of specimens encounter barriers, including embarrassment, discomfort, accessibility, and cultural concerns. Self-collection offers a promising solution to promote cervical screening among underscreened populations. Both methods are available to screen eligible patients since changes to the Australian screening program in 2022. We surveyed Australian health care workers at medical practices in an area with low screening rates on their views about self-collection from July through November 2023. Findings revealed gaps in knowledge about appropriate test use and test accuracy. In addition, findings showed a preference for clinician collection and perceptions that their patients lack confidence in self-collection and lack the willingness to learn about self-collection for cervical screening. Lack of up-to-date information on self-collection logistics and accuracy and pessimistic views on the ability of patients to perform self-collection can hinder the use of self-collection for cervical screening. Addressing these concerns through comprehensive education, easy-to-access guidelines, and interventions designed to support self-collection as part of routine practice is essential, especially for improved participation among under- or never-screened patients.

Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis.

Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF). The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into "high risk" and "low risk" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the "low-risk" and "high-risk" groups using Kaplan-Meier analysis. In total, 66,140 (65.5%) who underwent TSA were considered "high risk" for osteoporosis. Of the "high-risk" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, "high-risk" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at "low risk". There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as "high risk" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture. III.

Neighborhood Factors related to Cancer Screening in Texas: a spatioecological study.

To examine the associations of neighborhood socioeconomic status (nSES), ethnic enclaves, residential Black segregation with screening for breast, cervical and colorectal (CRC) cancers across the state of Texas (TX). Using an ecologic study design, spatial clustering of low breast, cervical and CRC screening rates were identified across TX census tracts using local Moran's I statistics. Binomial spatial probit regression was used to estimate the associations between nSES, Hispanic/Latino and Asian American (AA) ethnic enclave neighborhoods and residential Black segregation with geospatial clusters of low screening, adjusting for behavioral characteristics. Analysis was conducted in 2024. Of 5186 tracts, 5.4%, 4.6%, and 8.7% tracts were in low screening clusters for CRC, cervical and breast cancer, respectively. Medium and high nSES tracts had reduced odds of being part of low cervical cancer screening clusters. Medium nSES tracts and Hispanic enclave tracts had increased odds of being within a low breast cancer screening cluster. AA enclave tracts displayed an increased odds of being in low CRC and low cervical cancer screening clusters. Tracts with high residential Black segregation demonstrated reduced odds of being in low CRC and low breast cancer screening clusters. Geospatial clusters of screening uptake are associated with nSES and racial and ethnic neighborhood characteristics. This indicates a need for place-based culturally sensitive interventions to address the specific assets and needs of communities with low screening uptake.

Data-driven insights into neighborhood adherence to cancer prevention guidelines in Philadelphia.

Forty percent of new cancer cases in the United States are attributed to modifiable risks, which can be influenced by the built environment. Recent cancer prevention guidelines include recommendations for making communities conducive to healthy living. Focused on the city of Philadelphia, the present study aims to 1) evaluate neighborhood-level adherence to cancer prevention guidelines by developing two novel indices and 2) identify factors driving low compliance in neighborhoods with high cancer mortality. Philadelphia neighborhoods were compared to the city overall on ten cancer prevention recommendations. Comparison scores informed two indices: one focused on the American Cancer Society's guidelines for Physical Activity, Nutrition, and Smoking, and the other focused on Healthy People 2030's guidelines for Prevention Services. Indices were mapped by neighborhood and compared to cancer mortality. Where low adherence overlapped with high cancer mortality, the recommendations driving low compliance were identified. Distinct geospatial patterns were observed in adherence to guidelines, and while drivers of low adherence varied by neighborhood, general trends emerged in different areas of the city. Concerning Physical Activity, Nutrition, and Smoking Guideline adherence, some areas appeared to be more influenced by the built environment, while others were impacted by specific behavioral risk factors such as excessive alcohol consumption. Preventive Service recommendation adherence was driven in some parts by self-reported poor health and, in others, low cancer screening rates and a high physician-to-resident ratio. In neighborhoods where poor guideline adherence overlapped with high cancer mortality, the built environment emerged as a potentially important factor. This study considers the importance of the built environment in influencing adherence to cancer prevention guidelines. Policymakers and public health officials can use this information to prioritize interventions for neighborhoods with low guideline adherence and high cancer burden and tailor interventions to focus on indicators of low guideline adherence.

Assessing the Relationship Between Self-Rated General Health and Colorectal Cancer Screening Uptake.

Colorectal cancer screening has been shown to be effective in reducing the burden of colorectal cancer.However, the screening rate has been suboptimal, and mortality due to colorectal cancer remains high. With the presence of proactiveprevention strategies, low screening rates could still be due to individual factors. Following the health-belief model, this study examined the relationship between self-rated general health perception and colorectal cancer screening. The study utilized the 2022 Behavioral Risk Factor Surveillance System (BRFSS) Annual Survey dataset. The sample size was 177,889 and included individuals aged 45-75 years. The outcome variable was a categorical variable with binary responses of screened or not screened. The main predictor variable was an ordinal variable with five responses of poor, fair, good, very good, and excellent in the assessment of self-rated general health. Other covariates were age, sex, marital status, race, insurance status, level of education, annual income, and poor physical and mental health durations. The weighting variable of the dataset was used to adjust the sample to a weighted sample size. After obtaining descriptive statistics, simple and multivariate logistic regressions were fitted to analyze the relationship between the main predictor and the outcome variables. Statistical significance was set at a 95% confidence level. The weighted sample size was 83,303,438. Of these, 70.09% were screened and 29.91% were not screened for colorectal cancer. Excellent general health was reported by 14.80%, 34.32% very good, 32.1% good, 13.91% fair, and 4.87% had poor general health. Individuals with excellent general health perception were 25% less likely (adjusted odds ratio (AOR)=0.75; 95% CI=0.65, 0.88; p<0.0001) to be screened for colorectal cancer compared to those with poor general health perception. This study identifies the individual's excellent health perception as a possible contributing factor to the deficiency towards the realization of the goal in the rate of screening uptake and the need for revised and improved awareness programs.

“It’s a Low-key Thing of Eugenics”: Barriers to Cervical Cancer Screening and Disability Reproductive Justice for People with Disabilities During the COVID-19 Pandemic

Breast and cervical cancer screening is essential to the sexual and reproductive health of women and transgender people, resulting in reduced cancer incidence, improved outcomes, and lower mortality risk. However, previous studies have found lower rates of cancer screening among people with disabilities compared to those without disabilities, and increased rates of adverse associated outcomes, including later-stage cancer diagnosis and lower survival rates (Cuypers et al., 2022; Hughes et al., 2022). As such, this paper aims to mobilize the disability reproductive justice framework as a relevant lens for examining disparities in breast and cervical cancer screening that have a detrimental impact on people with disabilities. A mixed deductive and inductive approach was used to analyze 32 interviews with people who self-identified as having a physical, sensory, psychiatric, intellectual and/or developmental disability. This study was grounded in community- based research and was guided by peer researchers with lived experiences of disability and community partners. Our findings revealed that disparities in breast and cervical cancer screening for disabled women are present and ongoing. Themes that emerged included intersectional injustices, inaccessible spaces and systems, barriers to the right to reproductive health care, lack of autonomy and self-determination, and recommendations from people with disabilities. We conclude that this inaccessibility to cancer screening is a form of modern-day eugenics. The lack of accommodation for people with disabilities and recognition of them as sexual beings has contributed to these evident health inequities. While cancer screening services were delayed and disrupted for the entire population during COVID-19, there needs to be a consideration for the heightened vulnerability of this group, as well as the existing marginalization that creates barriers to access in the first place.

An umbrella review of socioeconomic status and cancer

Extensive evidence underscores the pivotal role of socioeconomic status (SES) in shaping cancer-related outcomes. However, synthesizing definitive and actionable insights from the expansive body of literature remains a significant challenge. To elucidate the associations between SES, cancer outcomes, and the overall cancer burden, we conducted a comprehensive burden estimation coupled with an umbrella review of relevant meta-analyses. Our findings reveal that robust or highly suggestive meta-analytic evidence supports only a limited number of these associations. Individuals with lower SES, compared to those with higher SES, are disproportionately disadvantaged by reduced access to immunotherapy, KRAS testing for colorectal cancer, targeted cancer therapies, and precision treatments for melanoma. Additionally, they exhibit lower rates of breast cancer screening and higher incidence rates of lung cancer. Furthermore, countries with a higher Human Development Index demonstrate a substantially greater burden related cancer incidence, with this disparity being more pronounced among men than women.

Vision screening for preschoolers with commercial insurance: impact of geography

The American Academy of Pediatrics recommends pediatric vision screening to detect and refer vision disorders during the critical early years when intervention yields the greatest benefits. We determined the rate of vision screening for US children 3-5 years of age with commercial insurance and compared rates among those living in rural versus urban areas. Children in rural compared with urban areas were expected to have lower rates of vision screening. A cross-sectional study using commercial claims for 3- to 5-year-olds derived from the Merative MarketScan Database (IBM, Armonk, NY), 2011-2020, was conducted. Primary outcome was the proportion of children with a claim for vision screening. Adjusted incident rate ratios (aIRR) of vision screening with 95% confidence intervals were computed for children living in rural compared with urban areas of the United States. Claims for 2,299,631 children were included. Most children (1,724,923 [75.0%]) were enrolled in preferred provider organization plans and lived in urban areas (2,031,473 [88.3%]). A total of 662,619 (28.8%) had a claim for a vision screening. Children living in rural versus urban areas had a lower adjusted incident rate of vision screening (15.1 vs 30.6%, aIRR 0.57; 95% CI, 0.53- 0.61) after adjusting for sex, age, region, and insurance type. For preschool age children with commercial insurance, vision screening is low, especially in rural compared with urban areas.

Cervical cancer screening rates in females living with HIV at three healthcare settings in the United States, 2010-2019.

Females living with human immunodeficiency virus (FLWHIV) are at increased risk of cervical cancer and U.S. guidelines, first published in 2009 and updated since then, recommend more frequent screening in this population. We examined screening rates among FLWHIV in the U.S. during 2010-2019. This cohort study included 18-89-year-old FLWHIV during 2010-2019 at three U.S. healthcare settings. Sociodemographics, comorbidities, and cervical cancer screening tests were ascertained from administrative and clinical databases. We reported cervical cancer screening rates overall and by modality. Generalized estimating equations with Poisson distribution were used to estimate screening rate ratios (SRRs) and 95% confidence intervals (CIs) for the associations between screening rates and calendar year, age, race and ethnicity, and comorbidity. Among 3,556 FLWHIV, a total of 7,704 cervical cancer screening tests were received over 18,605 person-years during 2010-2019 (screening rate = 41.4 per 100 person-years). Relatively lower screening rates were associated with later calendar years (SRR = 0.71 [95% CI 0.68-0.75] for 2017-2019 versus 2010-2013), older age (SRR = 0.82 [95% CI 0.74-0.89] for 50-65-year-olds versus 18-29-year-olds), non-Hispanic white race versus non-Hispanic Black race (SRR = 0.89 [95% CI 0.81-0.98]) and greater comorbidity burden (SRR = 0.89 [95% CI 0.82-0.98] for ≥ 9 versus 0-6 comorbidity score). The decrease in cervical cancer screening rates during 2010-2019 in this large cohort of FLWHIV may be explained at least partly by guideline changes during the study period recommending longer screening intervals. Our findings of relatively lower screening rates in FLWHIV who were non-Hispanic white, older, and with greater comorbidity burden should be confirmed in other U.S.

Cross sectional survey of maternal and newborn quality of care in Niger: Selected findings, lessons learned and recommendations.

Comprehensive assessments of quality of care (QoC) are essential for monitoring progress towards meeting global and national maternal and newborn health (MNH) targets. Liverpool School of Tropical Medicine (LSTM) and the Niger Ministry of Public Health adapted a 2014 WHO QoC tool to cover antenatal care (ANC) and postnatal care (PNC) and include client voices through exit interviews. The objectives of the study were to assess quality of MNH care in Niger and to document lessons learnt from implementing the LSTM QoC tool. Quality of Care (QoC) was assessed using five tools: health facility survey (using register and official record data), partograph reviews, healthcare provider knowledge assessment, exit interviews with clients, and observation of antenatal and postnatal care. A nationally representative sample of 110 public healthcare facilities at three levels (integrated health centres, district hospitals and mother-child hospitals) and 2153 women were included. Descriptive analysis with 95% confidence intervals was presented. The health facility survey showed variable access to electricity (63% [53-72]), water (72% [62-81]), and transportation (40% [31-50]). Tests and treatment for HIV, TB, and malaria were found in more than 90% of relevant facilities. During observation of first ANC visit, 62% [48-74] women were tested for HIV; 13% [5-30] for pre-eclampsia and 22% [12-36] for anaemia. Observation of PNC showed much lower rates of screening (15% [7-27] tested for HIV and 4% [0;11] for malaria). Partographs were used in 86% of deliveries with inconsistent completion. At client interviews, respectful care indicators were variable, with providers not always explaining results to clients (59% [50-67]). Targeted allocation of resources and training could impact on QoC and reduce missed opportunities for prevention, screening and management of diseases among pregnant women and babies. The QoC assessment tool proved capable of offering a comprehensive overview of priorities in MNH, while maintaining feasibility in the Nigerien context.

Overcoming barriers of cervical cancer elimination in India: A practice to policy level advocacy

India’s ambitious goal of eliminating cervical cancer by 2030 faces significant challenges due to the high burden of disease, low screening rates, and sociocultural barriers. Despite the Government’s focus on vaccination, addressing cervical cancer requires a more comprehensive approach that is multisectoral and consider practice to policy engagement. Addressing not only vaccination but also social barriers, healthcare infrastructure, and research is key to preventing and controlling this preventable disease. Fragmented health policies with limited coverage for cervical cancer, coupled with societal issues like stigma and limited access to healthcare, particularly in rural areas, pose significant challenges. Moreover, limited awareness of HPV and vaccines hinders progress. To effectively combat cervical cancer, India must prioritize a readiness assessment to evaluate past interventions, economic feasibility, and social issues before launching new programs. Improving healthcare infrastructure, training healthcare workers, and utilizing innovative models like mobile clinics can expand access to care. Public-private partnerships with incentives can also play a crucial role in mobilizing resources. Investing in culturally appropriate public awareness campaigns is essential to educate the population about HPV, cervical cancer, and prevention strategies. A robust pharmacovigilance program is necessary to ensure vaccine safety. Additionally, India should invest in science and technology to support long-term research efforts, while increasing understanding of population-specific predisposing factors for broader-spectrum vaccines and personalized approaches. A dedicated national policy with clear objectives, strategies, and accountability mechanisms is crucial for successful cervical cancer control. Learning from the experiences of other countries can inform policy development.

Primary Care Practice Telehealth Use and Low-Value Care Services

The rapid expansion of telehealth transformed how primary care practices deliver care; however, uncertainties about the quality of telehealth-delivered care compared with in-person care remain. While there are concerns that increased telehealth may introduce wasteful care, how telehealth affects the delivery of low-value care is unknown. To examine whether a primary care practice's level of telehealth use is associated with changes in the rates of low-value care. This retrospective cohort study using a difference-in-differences study design was conducted from January 1, 2019, to December 31, 2022, using Medicare fee-for-service claims data. Participants were Medicare beneficiaries attributed to primary care practices in Michigan. Low, medium, or high tertile of practice-level telehealth use. Low-value care was assessed using 8 claims-based measures relevant to primary care, grouped into 4 main categories: office-based, laboratory-based, imaging-based, and mixed-modality services. Poisson regression models were used to estimate the association between practice-level telehealth use and rates of low-value care services, controlling for practice-level characteristics. A total of 577 928 beneficiaries (332 100 [57%] women; mean [SD] age, 76 [8] years) attributed to 2552 primary care practices were included in the study. After adjusting for practice-level characteristics and baseline differences in low-value care rates between telehealth use groups, high practice-level telehealth use was associated with lower rates of low-value cervical cancer screening (-2.9 [95% CI, -5.3 to -0.4] services per 1000 beneficiaries) and lower rates of low-value thyroid testing (-40 [95% CI, -70 to -9] tests per 1000 beneficiaries) compared with low practice-level telehealth use. Of the other 6 outcomes examined, there was no association between practice-level telehealth use and rates of low-value care services. In this cohort study of Medicare fee-for-service beneficiaries who received care from primary care practices in Michigan, some low-value care services (ie, cervical cancer screening among women older than 65 years and low-value thyroid testing) were lower among practices with high telehealth use, and there was no association between practice-level telehealth use in rates of most other low-value care services not delivered in the office. As telehealth continues to be an important part of care delivery, evaluating how it may encourage or discourage low-value care services is critical to understanding its impact on quality of care.

Human Papillomavirus Self-Sampling for Unscreened Women Aged 24 Years During the COVID-19 Pandemic.

The increasing trend of cervical cancer in women in their 20s in Japan is largely attributable to the low rate of cervical cancer screening. This study aimed to assess the usefulness of human papillomavirus (HPV) self-sampling among 24-year-old Japanese women who had never previously been screened for cervical cancer during the coronavirus disease (COVID-19) pandemic. In August 2021, consenting eligible women received HPV self-sampling kits. An Evalyn brush was used for self-sampling, and a Cobas 4800 PCR-based HPV DNA test was used to detect high-risk HPV genotypes. We analyzed the return rates of self-sampling kits and conducted a survey on the acceptability of the self-sampling method. Of the total 1997 eligible women, 13.4% (268/1997) agreed to participate. The return rate of the kits was 72.4% (194/268), corresponding to 9.7% of the eligible population. Among the participants who returned the kits, 14.9% (29/194) tested positive for HPV, and 41.4% (12/29) of these underwent subsequent cytological testing. The questionnaire results indicated that 57.8% of participants reported no pain during self-sampling, and 72.9% expressed a willingness to continue using the self-sampling method in the future. This study demonstrated that opt-in HPV self-sampling among 24-year-old women who had never been screened for cervical cancer had a favorable kit return rate and was well accepted by the participants, especially during the COVID-19 pandemic. However, the follow-up cytology test rates were low, highlighting the need for improved post-screening management.

Prevalence and correlates of common mental disorders in people living with HIV in primary health care facilities in Ekurhuleni district.

There is paucity of data regarding the prevalence of common mental disorders (CMDs) in people living with HIV (PLHIV) in Ekurhuleni Health District (EHD), South Africa. Also, there is an association between CMDs and poor HIV treatment outcomes. Guidelines therefore recommend that healthcare practitioners screen for CMDs in PLHIV. To determine the prevalence and correlates of CMDs in PLHIV in primary health care facilities in Ekurhuleni district. Seven primary health facilities in Ekurhuleni district. A cross-sectional study was conducted in which data were collected from 403 randomly selected participants, using a questionnaire that incorporated the scores of the Patient Health Questionnaire (PHQ)-9, generalised anxiety disorder (GAD)-7 and substance use disorder (SUD) criteria of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). The proportion screening positive for CMDs was calculated. 'R' statistical software was used for univariate and multivariate analysis, with a confidence interval (CI) of 95%. Most participants (63%) were female and the mean age was 43 ± 11 years. Forty per cent of participants screened positive for CMDs, 16.6%, 15.1% and 24.1% screened positive for depression, GAD and SUD, respectively. Common mental disorders were associated with poor adherence and HIV non-suppression, while increasing age and being female were associated with reduced risk of CMDs. The risk of severe SUDs in males was 11 times compared to females. During assessment, clinicians screened only 16%, 14% and 40% of the cohort for depression, GAD and SUDs, respectively. The prevalence of CMDs remains high. Adherence to recommendations to screen for CMDs in PLHIV is low.Contribution:This study reveals a low CMD screening rate, estimates the prevalence of CMDs in PLHIV in Ekurhuleni district, and its impact.

Differences in Utilization of Preventive Services for Primary Care Clinicians Participating in MIPS and ACOs.

Value-based payment programs link payments to the performance of providers on cost and quality of care to incentivize high-value care. To improve quality and lower costs, the Centers for Medicare and Medicaid Services (CMS) implemented the Quality Payment Program (QPP) for clinicians in 2017. Under the Medicare QPP, most eligible clinicians participate in one of the payment models: (a) Advanced Alternative Payment Models (A-APMs) through eligible APMs like Accountable Care Organizations (ACOs) or (b) the Merit-based Incentive Payment System (MIPS). ACO and MIPS clinicians participating in QPP differ in quality reporting requirements, and these differences are likely to affect the utilization of different quality measures, including preventive services. This study evaluated the differences in the utilization of preventive services by primary care clinicians participating in MIPS and ACOs. We use difference-in-difference regressions to compare preventive services in MIPS versus ACOs. Since preventive services like immunization and certain cancer screening are mandatory reporting measures for ACOs and voluntary measures for MIPS, the treatment group for this study is ACO clinicians and the comparison group is non-ACO MIPS clinicians. We obtained the rates of influenza immunization, pneumonia vaccination, tobacco use cessation intervention, depression screening, colorectal cancer screening, breast cancer screening, and wellness visits per 10000 Medicare beneficiaries from Medicare Provider Utilization and Payment Public Use File (2012-2018). We had 508144 total observations (ACO=25.78% and MIPS=74.22%) from 72592 unique primary care clinicians. Compared to MIPS clinicians, ACO clinicians had significantly higher rates of pneumonia vaccination (incidence rate ratio [IRR] 1.25; 95% confidence interval [CI], 1.10-1.43) but lower rates of colorectal cancer screening (IRR 0.69; 95% CI, 0.50-0.96). Similarly, clinicians in ACO shared savings-only models had significantly higher rates of pneumonia vaccination (IRR 1.28; 95% CI, 1.11-1.48), depression screening (IRR 1.72; 95% CI, 1.09-2.71), and wellness visits (IRR 1.27; 95% CI, 1.09-1.47) compared to MIPS clinicians. There were no differences between ACO and MIPS clinicians on the utilization of breast cancer screening procedures and tobacco use cessation interventions. ACO clinicians may have prioritized relatively low-cost services such as pneumonia vaccination, depression screening, and wellness visits to improve their performance under QPP. Policymakers may need to alter incentives in performance-based payment programs to ensure that clinicians are improving all types of quality measures, including cancer screening.