Screening Coverage Rates Research Articles

Community-based screening by Anti-HCV reflex HCV Ag test and accessible post-screening care toward elimination of hepatitis C in two hyperendemic townships

Hyperendemic townships of hepatitis C virus (HCV) infection should devote extra efforts to eliminate HCV. We aimed to evaluate efficacy of the screening and linkage to care in two HCV hyperendemic townships. Village-to-village HCV screening using anti-HCV reflex HCV Ag test was conducted in two HCV hyperendemic rural townships (Lioujiao and Yijhu). All residents aged 30 years or older were invited. Those patients detected as infected were referred to nearby hospitals or clinics in Lioujiao and to an accessible outreach hepatology clinic in Yijhu. The populations of Lioujiao and Yijhu townships at time of survey were 18,389 and 14,787 with 6086 (33.1%) and 4604 (31.1%) having ever been previously screened, and 1517 and 1071 responded to this screening respectively. Their crude screening coverage rates were 41.5% and 38.5%, and adjusted screening coverage rates were 54.3% and 94.6% respectively. The prevalence rates of anti-HCV and HCV Ag were 17.9% and 11.9% in Lioujiao, and 9.2% and 5.6% in Yijhu respectively, with their rates of antigenemia (HCV Ag/anti-HCV) being 62.1% and 60.6% respectively. Numbers needed to test (NNT) to find a candidate for anti-viral treatment were 9 and 18. For linkage to care, treatment rate by referral (Lioujiao) was slightly lower than by accessible outreach hepatology clinic (Yijhu) (84.9% vs. 93.3%, p=0.093). Overall successful sustained virological response rate at week 12 was 98.2% (161/164) in outreach hepatology clinic. Since NNT was low, it was worthwhile conducting intensive screening in these hyperendemic townships. For high treatment rate, accessible outreach hepatology clinic is feasible especially in areas without adequate medical resources.

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.

Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study.

Screening, brief intervention and referral to treatment (SBIRT) is a programme to reduce alcohol consumption for drinkers with high alcohol consumption levels. Only 2.9% of patients in primary health care (PHC) are screened for their alcohol use in Germany, despite high levels of alcohol consumption and attributable harm. We developed an open-access simulation model to estimate the impact of higher SBIRT delivery rates in German PHC settings on population-level alcohol consumption. A hypothetical population of drinkers and non-drinkers was simulated by sex, age, and educational status for the year 2009 based on survey and sales data. Risky drinking persons receiving BI or RT were sampled from this population based on screening coverage and other parameters. Running the simulation model for a ten-year period, drinking levels and heavy episodic drinking (HED) status were changed based on effect sizes from meta-analyses. In the baseline scenario of 2.9% screening coverage, 2.4% of the adult German population received a subsequent intervention between 2009 and 2018. If every second PHC patient would have been screened for alcohol use, 21% of adult residents in Germany would have received BI or RT by the end of the ten-year simulation period. In this scenario, population-level alcohol consumption would be 11% lower than it was in 2018, without any impact on HED prevalence. Screening coverage rates below 10% were not found to have a measurable effect on drinking levels. Large-scale implementation of SBIRT in PHC settings can yield substantial reductions of alcohol consumption in Germany. As high screening coverage rates may only be achievable in the long run, other effective alcohol policies are required to achieve short-term reduction of alcohol use and attributable harm in Germany. There is large potential to apply this open-access simulation model to other settings and for other alcohol interventions.

A population-based combination strategy to improve the cervical cancer screening coverage rate in Bamako, Mali.

Cervical cancer screening coverage rate is <5% in Sub-Saharan Africa and <2% in French- speaking African countries. In 2016, we implemented strategies to improve cervical cancer screening in Bamako, the "Weekend70 program". The present study objectives are to determine the effect of this program on women's participation in cervical cancer screening in Bamako, and to estimate the cervical cancer screening coverage rate in Bamako. From 1 January 2016 to 31 July 2020, we conducted an operational research by developing several strategies to improve the cervical cancer screening coverage rate among adolescents and women ≥15years old in Bamako, Mali. The strategies consisted of awareness-raising activities, strengthening of screening practices in healthcare facilities and cost-free cervical cancer screening during the weekend. Descriptive statistics were presented. The cervical cancer coverage rate was calculated by dividing the number of women screened by the total number of women ≥20years old, based on Mali demographic data. The total number of women screened was 289924. Residents from Bamako represented 91.9% (266436/289924) vs 8.1% (23488/289924) who lived outside Bamako. The mean age was 33.2 (± 11.5)years old. Around 46.1% of participants attending the cervical cancer screening were between 30 and 49years old (World Health Organization prioritized target age for cervical cancer screening). Women ≥60years old represented <5%. Cervical cancer screening participation increased significantly, from <800 women screened per week before the implementation of the program to a peak of 4100 women screened per week during the "Weekend70 program". Overall, the cervical cancer screening coverage rates at the end of the study among women ≥20years old was 47.3%, and 56.9% in the WHO target population. In an impoverished context, a multi-component strategy significantly increases cervical cancer screening participation.

Feasibility and acceptability of human papillomavirus self-sampling in a semi-urban area in northern Tanzania.

To assess the feasibility and acceptability of HPV self-sampling in Arusha region, northern Tanzania, because the ability for women to self-collect HPV samples can help reduce the number of health facility visits and improve cervical cancer screening coverage rates. We conducted a facility- and community-based cross-sectional study among 350 women aged 25-55years in Arumeru district, Arusha region, northern Tanzania. Women were trained to self-collect an HPV sample, and follow-up visits were used to provide results after laboratory testing. Data were analyzed using Stata version 15.1 and summarized using mean and standard deviation for numeric variables and frequencies and percentages for categorical variables. Among 350 women, 65 (18.6%) ever screened for cervical cancer, all provided self-collected samples, and 349 (99.4%) would advise their female friends to undergo the same procedure. The prevalence of positive HPV results was 31 (8.9%), of which 26 (83.9%) were further examined. Two women found with lesions were treated following the national guidelines. This study has demonstrated that the HPV self-sampling intervention for cervical cancer screening is a feasible and acceptable intervention, especially in resource-limited countries like Tanzania. Scaling-up policies should consider addressing the potential barriers to the uptake of this intervention.

Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade

BackgroundBreast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown.ObjectiveTo assess the determinants of BC screening coverage in Flanders.MethodsReimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type.ResultsOver all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972).ConclusionCoverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.

A shared battle against cancer: overcoming screening uptake differences within European countries

Abstract Cancer is the second leading cause of dead in Europe and it is responsible of more than 30% of all deaths. For this reason, European Union (EU) identified the battle against cancer as a priority for the European Research Program 2021-2027.About 40% of total deaths for cancers could be prevented with screening.Validated screening test are available for breast (BC), cervical (CC) and colorectal cancers (CRC). In 2003 the Recommendation of the European Council indicated the right timing and the population target but, nowadays, the percentage of screening within EU is low and consistent differences persist among States.In 2020 there are still countries that don't have population-based screening programs. Last data available for all 28 EU countries are referred to 2014. Data were retrieved from “Osservasalute” reports and Global Burden of Disease database.Pearson test and a paired t test were used to describe correlation between mortality and screening coverage rates. In 2014 the mean percentage of screening was 70.7% for CC, 68.7% for BC and 31.3% for CRC and the mean of mortality rate was of 2.1, 10.4 and 17.2 for 100,000, respectively.The rate of mortality did not change significantly in 2017 (2, 10 and 16 for 100,000 respectively).The median coverage is 67 for BC [IR: 43-91], 21.4 for CRC [IR: -3-46] and 70.6 for CC [IR: 54-87]. Pearson test resulted in a negative correlation for all three cancers equal to -0.045, -0.060 and -0.561, respectively.A higher adherence to screening programs is significantly associated to lower mortality rates in all the three types of cancer (p &amp;lt; 0.01). Even if many factors determine the rate of cancer mortality, screening represents the best method to early diagnosis and treatment.Up-to-date data are needed to correctly monitor progress towards the common goal of reaching the entire target population with screenings.A strong leadership at international level is necessary to improve screening programs all over EU and support screening campaigns. Key messages Screening is one of the most efficient and life-saving way to prevent cancer. It is needed to improve screening adherence through population-based programmes both at international and national level. Last data available for all EU countries are referred to 2014. It is necessary to update the data in order to enhance the understanding of screening efficiency.

Implementation of a nationwide universal ultrasound screening programme for developmental dysplasia of the neonatal hip in Mongolia.

PurposeMongolia is the first Asian country to launch universal ultrasound screening for newborns with developmental dysplasia of the hip (DDH). The aims of this study were to determine the coverage and treatment rate of this programme.MethodsData from birth statistics and ultrasound hip screening from 29 hospitals were retrospectively reviewed (2010 to 2016, pre-nationwide phase; and 2017 to 2019, nationwide programme). DDH was diagnosed using the Graf-technique and treated according to ‘ABCD’, a modified Graf classification (Group A: Graf Type 1, mature; B: 2a, physiologically immature; C: 2c to 3, early DDH; D: 4, dislocated). Group B children were followed with monthly ultrasound. Group C and D children were treated with a flexion and abduction orthosis (Tübingen). Screeners used a web-based platform to upload images for quality surveillance.ResultsBetween 2017 and 2019, 230 079 live births were registered and 176 388 newborns screened. The nationwide screening coverage rate in newborns increased from 73.6% in 2017 to 82.1% in 2019. Group A (148 510 children, 84.2%) was discharged, while Group B (25 820, 14.6%) was followed. Among children in Group B, 284 cases worsened to Group C and were, therefore, treated with a Tübingen orthosis. The remaining 2058 (1.2%) of newborns with DDH were treated with a Tübingen orthosis, including 1999 newborns in Group C and 59 in Group D. Since 2017, a total of 142 860 (81.0%) hip sonograms were uploaded to the platform.ConclusionA simplified diagnostic and therapeutic framework for ultrasound DDH screening for newborns was successfully deployed in Mongolia, a developing country, providing high surveillance coverage and appropriate treatment.Level of evidence: IV

Newborn hearing screening coverage and detection rates of hearing impairment across China from 2008-2016

BackgroundNewborn hearing screening (NHS) can reduce the economic and social burden of hearing impairment. To track the progress of the goal set by the National Program of Action for Child Development (NPACD) and to estimate the detection rates of hearing impairment, the present study examined NHS coverage in 2008–2010 and 2016 and the detection of hearing impairment across China in 2016.MethodsLicensed medical institutions across China were surveyed in 2012 and 2018 by the National Center for Birth Defects Monitoring of China to collect data for the 2008–2010 period and for 2016 on live births, initial screening rates (total and referral), secondary screening rates (total and referral), and rates of hearing impairment diagnosis among infants who were referred in the secondary screening. To calculate universal newborn hearing screening (UNHS) coverage, the number of newborns who received NHS within 4 weeks after birth was divided by the number of live births. The detection rate of hearing impairment was calculated by combining referral rates on primary and secondary screening with the rate of diagnosis.ResultsNational UNHS coverage increased from 29.9% in 2008 to 86.5% in 2016, with different regions showing different increases. During this period, the number of provinces with UNHS coverage over 90.0% increased from 2 to 17, with UNHS coverage in 2016 being substantially higher in eastern provinces (93.1%) than in western provinces (79.4%). In 2016, the detection rate of hearing impairment across the country was 0.23% (95% CI 0.15–0.25%), and it varied from 0.17% in western provinces to 0.22% in central provinces and 0.28% in eastern provinces. The lowest rate was 0.02% in Heilongjiang Province and the highest rate was 0.63% in Hainan Province.ConclusionsNational UNHS coverage increased substantially from 2008 to 2016, although provinces and regions still showed differences. The detection rate of infant hearing impairment in China is comparable to that in other countries. A national individual-level information system is urgently needed in China to facilitate the integration of screening, diagnosis and treatment of infant hearing impairment, which may also lead to a more accurate estimate of the detection rate.

Routine Screening in a California Jail : Effect of Local Policy on Identification of Syphilis in a High-Incidence Area, 2016-2017.

California is experiencing a syphilis and congenital syphilis epidemic, and many persons diagnosed with syphilis report a history of recent incarceration or sexual contact with a person who has recently been incarcerated. Fresno County's local health department and jail collaborated to implement a routine syphilis screening policy for male adults aged 18-30 and female adults aged 18-35 booked into the facility. We evaluated syphilis screening, case finding, and treatment rates after implementation of the new policy. We linked jail census and laboratory data to syphilis surveillance data to assess screening coverage, positivity, and treatment rates for age-eligible persons who were booked into Fresno County Jail from April 1, 2016, through December 31, 2017. Of 24 045 age-eligible persons who were booked into the jail during the study period, 5897 (24.5%) were female and 18 148 (75.5%) were male. Of 7144 (29.7%) persons who were screened for syphilis, 611 (8.6%) had a reactive rapid plasma reagin blood test result (16.4% [253 of 1546] of female adults; 6.4% [358 of 5598] of male adults) and 238 (3.3%) were newly diagnosed with syphilis, as confirmed by matching to the surveillance system (6.9% [106 of 1546] of female adults; 2.4% [132 of 5598] of male adults). Of persons identified with syphilis, 51.7% (n = 123 of 238) received adequate recommended treatment (59.4% [63 of 106] of female adults; 45.5% [60 of 132] of male adults). The age-based syphilis screening policy adopted in this jail yielded high positivity, including newly identified syphilis infections among female adults of childbearing age. The targeted screening policy was formalized in the county-negotiated contract with the jail's private correctional health care company in 2018-a strategy that can be replicated.

Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France.

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d’information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

Cervical cancer screening in the Canadian armed forces: An estimation of screening participation rates using the CF-HERO surveillance system

BackgroundMilitary women are faced with unique circumstances, including frequent relocation and occupational factors that may influence their participation in routine cervical cancer screening. No data on programmatic participation in cervical cancer screening in Canadian Armed Forces women has been synthesized to date. ObjectiveTo estimate cervical cancer screening rates in Canadian military women using clinical and administrative data sources. MethodsActively serving Regular Force females who were >25 years of age between January 1st 2015 and December 31st 2017 were included in the study. Scanned documents containing Papanicolaou (Pap) test results were extracted from electronic health records and further linked to demographic data sources. Screening coverage rates were calculated over the three-year study period, and results were stratified by both military command and rank. ResultsThe study period yielded over 23,000 person-years of data. The average screening rate over this period was 77.7 %, and was highest in the 45−60 year age group. Variations in rates were observed by rank and command, with higher screening rates observed in Officers and Royal Canadian Navy staff. Overall, screening rates showed a declining trend for all groups across the study period. ConclusionsCervical cancer screening rates amongst CAF members are currently below recommended guidelines and appear to be declining. These trends mirror those observed more widely in the general Canadian population, and may be a consequence of recent changes to guidelines for both cervical cancer and human papillomavirus (HPV) screening.

Outcomes of regional-based newborn hearing screening for 35,461 newborns for 5 years in Akita, Japan

ObjectivesNewborn hearing screening (NHS) has been actively performed since 2001 in Akita, Japan. The NHS coverage rate has increased yearly, and performance has been consistently >90% since 2012. The purpose of this study was to summarize NHS outcomes in the Akita prefecture of Japan and to obtain new insights for from our summarized data for the future. MethodsA total of 35,461 newborns in hospitals and clinics where hearing screening was performed in Akita from 2012 to 2016 were included. The outcome data of NHS were collected for analysis. ResultsThe overall screening coverage rate for hearing loss was 94.7%. Of the screened infants, 0.53% received a referral on the 2-stage automated auditory brainstem response (ABR), and 80.4% of referred infants had a check-up at the hospital to receive a diagnostic hearing examination. Finally, the prevalence of bilateral congenital hearing loss was 0.14%, that of bilateral moderate to profound hearing loss was 0.12%, and that of unilateral congenital hearing loss was 0.10%. Furthermore, the average consultation period in infants with risk factors was significantly later than that in infants without risk factors (p = 0.0015). Follow-up for infants diagnosed with normal hearing after diagnostic hearing examination revealed that 4.7% suffered bilateral moderate to profound hearing loss later. This percentage is significantly higher than that of the general group (p < 0.001). ConclusionThe prevalence of bilateral congenital hearing loss was 0.14% in Akita and 0.12% of infants were diagnosed with bilateral moderate to severe hearing loss. Medical personnel should be enlightened regarding the importance of performing hearing diagnostic examinations until 3 months of age. Even if infants were diagnosed with normal hearing after a diagnostic examination, we strongly suggest continuing follow-up until they are able to perform pure tone audiometry with accuracy.

Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa From 1998 to 2012: A Population-Based Cancer Registry Study.

PURPOSEIn this study, we aimed to investigate trends in the age-standardized and age-specific incidence rates in two distinct regions (the northern and southern areas) of South Africa covered by a population-based cancer registry. In addition, trends in coverage of the cervical cancer screening program were assessed using routine health service data.METHODSOccurrences (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analyzed for all variables using CanReg4. Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women age ≥ 30 years by sub–health district were extracted from the District Health Information System.RESULTSIn the northern area, annual age-standardized incidence rates per 100,000 women increased from 24.0 (95% CI, 21.1 to 27.0) in 1998-2002 to 39.0 (95% CI, 35.6 to 42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI, 18.5 to 21.4) in 1998-2002 and 18.8 (95% CI, 16.2 to 21.4) in 2008-2012, and the southern area had a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of occurrences were diagnosed at disease stages I and II and 35%, at III and IV; 36% had with missing stage information (2003-2012). In 77% of occurrences, a histologically verified diagnosis was made, compared with only 12.3% by cytology.CONCLUSIONThis study has demonstrated an almost two-fold increase in the incidence rate in the northern area but little change in the southern area of the cancer registry.

Neonatal deafness: screening coverage assessment throughout national PMSI database in the region of Paris

To estimate the screening coverage of neonatal bilateral permanent deafness (NBPD) among neonates in the region of Paris (Île-de-France), between 2012 and 2017, using data from the Program for Medicalization of Information System (PMSI). The study population covers hospital stays of newborns (0 to 28 days of life) in the region of Paris between 2012 and 2017. The data were extracted from PMSI database using DIAMANT system. The annual screening coverage rate is estimated by the ratio between the number of newborn stays with the code Z13.51 and one of the two specific medical procedures for NBPD screening and the number of live births recorded in health facilities. In 2017, 133 152 newborn stays with a Z13.51 code were counted in the Ile-de-France region, out of 178 011 live births; less than 75% of newborns. Hospital stays including a medical procedure CDQP009 or CDQP017 represent a proportion of 16.3% in 2017. The annual estimated rate of screening coverage of NBPD using the PMSI (89,8%, taking into account the different coding practices) is lower than the one calculated from data of the FPDPHE (95,5%) and national/regional target rate set by the National screening Program. Our methodology and the observed results revealed that an annual NBPD screening coverage rate could be estimated, if the National plan and coding practices requirements follow the guidelines. Harmonization of coding practices and data quality assurance are essential to be able to build an indicator of NBPD screening coverage based on routinely collected data (PMSI, SNDS), which can contribute to the monitoring of the implementation of the screening program for the neonates.

Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015.

BackgroundChagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease.AimThe objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010–2015) after its introduction in Catalonia.MethodsIn a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months.ResultsFrom 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9–12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi. Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p < 0.05).ConclusionThe increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries.

Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa, 1998-2012 - A Population-Based Cancer Registry Study

Background: South Africa introduced free cytology-based screening for cervical cancer in 1999. A high cervical cancer incidence has been observed in rural Eastern Cape Province, an area with a high prevalence of Human Immunodeficiency Virus and extensive provision of highly active anti-retroviral therapy. Cervical cancer incidence trends from the population-based Eastern Cape Cancer Registry are further examined by distinct geographic areas; northern and southern. Methods: Cases (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analysed for all variables using CanReg4.Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women 30 years and older by sub-health district were extracted from the District Health Information System. Findings: In the northern area, annual age-standardized incidence rates per 100 000 women increased from 24.0 (95% CI: 21.1-27.0) in 1998-2002 to 39.0 (95% CI: 35.6-42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI: 18.5-21.4) in 1998-2002 and 18.8 (95% CI: 16.2-21.4) in 2008-2012, and a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of cases were diagnosed at disease stages I and II, 35% III and IV, and 36% with missing stage information (2003-2012). In 77% of cases, a histologically verified diagnosis was made, compared with only 12.3% by cytology. Interpretation: The significant increase in the incidence in the northern area does not appear to be directly related to the screening programme but may portend increases associated with the widespread provision of highly active ante-retroviral therapy. Funding Statement: South African Medical Research Council. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the South African Medical Research Council.

Quantitative Assessment on Waiting Time in Quality Assurance of Screening Program With Application to Taiwanese Population-Based Organized Service Colorectal Cancer Screening

Background: In a population-based organized service colorectal cancer (CRC) screening program, waiting time for confirmatory diagnosis for those who screened as positive test would be affected by coverage rate, positive rate, and compliance rate given clinical capacity of different settings. Long waiting time might cause the anxiety of patient and affect the quality of life. It is an essential index in the quality assurance of screening program. Aim: We aim to project the waiting time in different scenarios by changing the joint effect of these 3 factors (coverage rate, positive rate, and compliance rate). Methods: We proposed a stochastic process for modeling a complicated structure of screening data containing arrival rate for attending screening (coverage rate), positive rate, compliance rate, and waiting time for confirmatory diagnosis. It was applied to Taiwanese nationwide CRC screening program during the period of 2004 to 2009. The estimated parameters were used to project the waiting time by changing different scenarios. Results: Given positive rate and compliance rate, the waiting time was lengthened with increasing coverage rate. Under the similar scenario with Taiwanese nationwide population-based screening (7% of positive rate and 60% of compliance), the waiting time expanded from 10 days to 101 days as the coverage rate increased by 10-fold (from 5% to 50%). If the referral policy allows 2 months of waiting time for follow-up confirmatory, a 3-year CRC screening program can reach to 90% of coverage rate. If positive rate increases as a result of the cutoff value or compliance rate is enhanced, the waiting time can be prolonged in a quantitative manner. Conclusion: Waiting time for confirmatory examination usually plays an important role in the assessment of the quality assurance of screening program. After considering the change of 3 joint effects on coverage rate, positive rate, and compliance rate, we can project the waiting time and provide a quantitative assessment on referral policy to improve the quality of service for decision-maker.

National cervical cancer prevention program in the Arab States: Strategies and cost-minimization study of the Tunisian case

BackgroundThe Arab states geographic region is marked by a low to moderate cervical cancer screening coverage rates and the absence of national human papillomavirus (HPV) vaccination programs, except for the United Arab Emirates. Knowing that the HPV prevalence among Tunisian woman is estimated to 4.9/100 000 according to the “HPV Center” data, this study aims to estimate the cost of a national cervical cancer prevention program in Tunisia using either the primary prevention method (the two-dose schedule anti-HPV vaccine according to the WHO recommendation for young adolescents) or the secondary prevention method (the Pap smear test according to three time-lapse periodicity). MethodsThe mean incremental cost of one avoided cervical cancer case was calculated for each prevention scenario. ResultsThe ascending incremental costs by avoided cervical cancer case are: 1- the national vaccination program through the GAVI support ($ 1803), 2- the cervical cancer screening according to 10-year periodicity ($ 8219), 3- the cervical cancer screening according to 5-year periodicity ($ 14,567), 4- the cervical cancer screening according to 3-year periodicity ($ 20,479), 5- and finally the national vaccination program according to the manufacturer marketed price ($ 36,854). ConclusionCurrently, the anti-HPV national vaccination program combined with cervical cancer screening according to 5-year periodicity present the best cost-effective strategy for cervical cancer prevention in Tunisia. This study gives Tunisian decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the cervical cancer prevention strategies.

Assessing the validity of self-reported breast cancer screening coverage in the Belgian Health Interview survey

Introduction Worldwide, breast cancer is the leading cause of cancer-related deaths among females. In Belgium, it is the first female cancer in terms of incidence (more than a third of cancers) and the leading cause of premature death in women. Hence, reducing deaths through early diagnosis is an important objective for the health authorities. Screening for breast cancer is generally recognized as being effective in reducing mortality from this cancer. Studies have demonstrated the effectiveness of mammography screening for breast cancer, especially for women aged 50 to 69 years. According to the international guidelines, it is advisable to measure the proportion of the target population covered by screening. Due to the time and the costs related to medical records abstraction, information on breast cancer screening is often based on self-reports in population-sample surveys. Self-reported data may however be inaccurate due to recall errors and biases, impeding valid inference. The validity of self-report can be verified by comparing this information with a trusted measure or “gold standard” such as health insurance data. This study investigates first the validity of self-report information on breast cancer screening in the Belgian Health interview survey (BHIS), using the Belgian compulsory Health Insurance (HI) data as gold standard and second, the selection bias due to non-participation. Methods Individual data of the Belgian Health Interview Survey 2008 (BHIS2008) were linked to HI data covering more than 99% of the population. Only women aged 50–69 years who responded to the question related to the breast cancer screening in the BHIS2008 “having had a mammogram in the last two years” were considered (n = 1009). This indicator measures the rate of eligible women undergoing mammography. In the HI data related to the same women, the fact that women had a reimbursement for a mammography within the last two years was used as golden standard. The breast cancer screening coverage rates from both data sources were compared. The sensitivity, specificity and predictive values of the self-reported indicator were estimated for which HI data served as were golden standard. We also assessed the selection bias by comparing the screening coverage in the BHIS2008 sample with that of a completely random sample of HI data (representing 1/40 of the Belgian population). Results Mammographic coverage rate in the BHIS2008 sample was estimated to be 73% through the self-reported information and 63% through the HI information. From the random sample, the coverage rate was 61.9%. The sensitivity of reporting a mammography was high (93.9%) while the specificity was moderate (62%) for whole Belgium. However, within the 37.9% of women reporting to have had a mammography in the past 2 years, but for which no confirmation could be found in the HI dataset, the almost the half (17%) had indeed undergone a mammography in the last 3 years. This is a typical “telescoping bias”, when people perceive events as being more recent than they actually were. The positive and negative predictive values were respectively 81% and 85%. The difference between HI and random sample coverage rates was small (1.5%), and there was not significant evidence of selection bias. Conclusions The mammographic coverage rate in women aged 50–69 years is overestimated in the BHIS2008. This is in line with expectations since such information can be subject to social desirability and/or telescopic bias. There was almost no selection bias. Although the validity of breast cancer screening in the BHIS2008 is moderate, BHIS remains an added value for the breast cancer screening in the general population since it offers the opportunity to link with plenty of other parameters, like the health and the socioeconomic status as well as other health (preventive) behaviours.