Secondary Prevention Of Cervical Cancer Research Articles

The changing role for extended resections in an era of advanced radiotherapy techniques and novel therapies in gynaecological malignancy

Pelvic exenteration, first described in 1948 and subsequently refined, may be offered as a last hope of cure to patients with recurrent or locally advanced pelvic tumours, where radiotherapy is not an option. It is a complex, morbid, ultra-radical procedure involving en-bloc resection of the female reproductive organs, lower urinary tract, and a portion of the rectosigmoid.This article discusses the evolution of and current indications for pelvic exenteration in gynaecologic oncology as well as the reasons for its decline: primary and secondary prevention of cervical cancer (the recurrence of which is the most common indication for exenteration); improvements in treatment of cervical, endometrial, vaginal and vulvar cancer in the primary and recurrent setting; and the advent of novel therapies.

The possibilities of opportunistic cervical screening in the assisted reproductive technology clinic

Secondary prevention of cervical cancer in the conditions of opportunistic cervical screening by co-testing in 5618 women over 30 years of age allowed to identify a high-risk group of cervical cancer for further examination using viral load assessment, immunocytochemical determination of the level of cancer proteins p16INK4a and Ki-67, extended video colposcopy and cervical biopsy with histological examination of surgical material. The obtained data demonstrated the expediency of changing the testing strategy by integrating the methods tested in the framework of opportunistic screening into the nationwide population screening program for cervical cancer.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update.

To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally. American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus. This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Secondary prevention and treatment of cervical cancer - update from Poland

Introduction. Cervical cancer is the 4th most common cancer in terms of incidence and mortality in women worldwide. The aim of the study was to investigate and analyze the effects of Poland’s publicly funded cervical cancer screening and treatment programs. Material and methods. The study analyzed the financial and epidemiological data provided by the Polish National Health Fund and the Polish National Cancer Registry on the prevention and treatment of cervical cancer in Poland in 2011–2017. Results. Our study identified a systematic reduction in the number of patients undergoing cervical cytology. Despite high levels of financial expenditure, no correlation was found between the total cost of benefits in PLN million (W = 0.911; p = 0.404) and mortality expressed by the standardized coefficient (W = 0.884; p = 0.243). Conclusions. Despite decreasing mortality rates in cases of cervical cancer in Poland, the organization and delivery of prevention and treatment programs should be considered insufficient.

HPV test kao primarni test skrininga u prevenciji cervikalnog karcinoma u Republici Hrvatskoj

The knowledge that persistent infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer has led to changes in strategies for the prevention and early detection of this cancer, with aim to eradicate it. Primary prevention through the use of vaccines that prevent HPV infection has been implemented since 2006, while secondary prevention of cervical cancer has been significantly improved by the introduction of the HPV test, either as the only method of primary screening or in combination with the Pap test. Screening based on the Pap smear has been unquestionably successful in reducing incidence and mortality in the last century. More recently, there have been gradual changes in the use of the HPV test, from its use as a reflex test after the detection of mild cytological abnormalities, through co-testing, to the use of the HPV test as the only test in primary screening thanks to the evidence gathered from the use of large, randomized research and meta-analysis. The advantages of using the HPV test over the Pap test include a higher sensitivity in detecting premalignant lesions, a higher negative predictive value of the test, and a safe extension of the time interval between screenings. However, the introduction of the HPV test as a primary screening test is not so simple and requires strict testing quality control and elaborate guidelines to ensure an optimal strategy and prevent additional burden on the healthcare system. This review presents the national cervical cancer screening program in the Republic of Croatia, the problems that prevented the start of a pilot project in one Croatian county selected for the introduction of the HPV test as a primary screening test in the prevention of cervical carcinoma, and the tasks ahead in the next period which would ensure the smooth implementation of the pilot project and implement the HPV test as the primary screening test in Croatia. Based on the results of the pilot project, it is necessary to precisely define: the age at which primary HPV testing should start and stop in the cervical cancer screening program, the examination interval after a negative primary HPV test, further procedures with women with a positive primary HPV test, the procedures for conducting reflex cytological testing and further treatment of the patient in accordance with the findings, the possibilities and justification of introducing self-sampling as part of the cervical cancer screening program based on the HPV test as the primary screening test, and finally the type of HPV test that is most suitable for the primary screening in Croatia.

Uloga HPV testiranja u prevenciji karcinoma grlića materice

The well-established etiological association between cervical cancer development and the infection with high risk genotypes of Human papilloma viruses (hr-HPV) signify the role of HPV testing in both primary and secondary cervical cancer prevention. HPV testing methods are grouped into diagnostic and prognostic tests with the use of various techniques of molecular biology. Diagnostic tests enable detection the presence of HPV DNA (screening) and identification of HPV genotypes (genotyping). Prognostic or triage tests are used for the determination of HPV infected women who are at high risk for the development and/or progression to cervical cancer. hr-HPV testing in cervical cancer screening protocols can be implemented as primary testing or co-testing with cytology and as testing in a triage of women with high risk. The inclusion of hr-HPV testing as primary testing or co-testing is based on higher sensitivity and negative predictive value for the detection of CIN3 lesions compared to cytology alone. Several triaging tests are recommended for risk stratification such as genotyping for HPV 16 and 18, detection of E6/E7 mRNA and DNA methylation marker tests. For an efficient reduction of cervical cancer pervasiveness in Serbia, the implementation of cervical cancer organized population-based screening program that includes HPV testing is essential.

Cervical cancer prevention in Africa: A policy analysis

BackgroundCervical cancer is a major public health challenge in Africa. We analyzed the presence and content of policies for the primary, secondary and tertiary prevention of cervical cancer in Africa, to identify areas of opportunity for policy strengthening in the region most affected by cervical cancer globally. MethodsWe searched for publicly-available policy documents among countries in Africa. Using a data extraction form, we gathered data from these policies about key elements of primary, secondary and tertiary prevention approaches and activities based on World Health Organization (WHO) guidelines. We also contacted key stakeholders in each country to confirm these details. We summarized each country’s policy details (summed score for each prevention stage and overall), and compared these scores across individual countries and groups of countries based on economic, policy and public health characteristics. ResultsMost countries had at least one policy addressing some aspect of cervical cancer prevention. Primary and secondary prevention were more commonly addressed, and certain details like age of vaccination, screening age/interval and method, were frequently mentioned in these policies. ConclusionCountries with high HIV burden and relatively more donor financing for health had more comprehensive cervical cancer policies; there was no apparent association with cervical cancer mortality, female representation in government, or economic indicators (poverty prevalence or income inequality). Policy summaryThere is room to improve cervical cancer policy comprehensiveness in Africa, and to bring these policies in line with evidence and expert recommendations. This analysis is timely given upcoming monitoring of the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. These findings suggest some improvements in African cervical cancer policy, including increased inclusion of vaccination, but many topics remain under-specified. The influence of internal and external factors on policymaking should also be considered.

Primary and secondary prevention of uterine cervical cancer: Up-To-Date Information, Guidelines, and the need for their application in Greece

Background/Aim: Human papilloma virus (HPV) and uterine cervical cancer (UCC) are causatively related. In Greece, evidence-based guidelines for primary and secondary prevention of UCC have yet to be developed and applied in clinical practice. Our purpose here is to present such guidelines together with up-to-date data on HPV screening protocols. Methods: We surveyed current literature on UCC prevention, national and international data on UCC, and national guidelines on UCC preventive measures in various countries, as well as their role in UCC control. Results: It is well known that clinical practice guidelines optimize patient care. Introduction of guidelines regarding primary and secondary prevention of UCC express a favorable outcome of control and elimination of the disease. This is outlined in screening protocols of several countries worldwide. The lack of such guidelines in Greece in previous years led to misinformation of both healthcare professionals and general population. The development of clear and up-to-date guidelines in Greece during 2021 constitutes an important step that will play a pivotal role in UCC prevention in Greece. What needs to be ensured is on the one hand that all healthcare professionals are informed about these guidelines and on the other hand the application of these guidelines an everyday clinical practice. Conclusions: Systematic use of primary and secondary preventive measures and screening protocols are efficient in both control and elimination of UCC. Based on our search and our clinical experience, it is imperative for all Obstetrics and Gynecology clinicians in Greece to be familiar with all relevant screening and vaccination programs available.

The Influence of Sexual Behavior and Demographic Characteristics in the Expression of HPV-Related Biomarkers in a Colposcopy Population of Reproductive Age Greek Women.

Simple SummaryThis observational study aimed to investigate the possible influence of sexual behavior and demographic characteristics in the expression of HPV-related biomarkers in a colposcopy population. Lifestyle factors that impacted HPV DNA positivity in a statistically significant manner were younger age at first sexual intercourse, a history of more than four sexual partners as well as a partner change during the last year before HPV DNA assessment. Although ambitious, the development and validation of lifestyle scoring systems that combine molecular and epidemiological patient data to effectively predict underlying cervical pathology will represent a milestone in the quest of cervical cancer prevention.Despite the significant scientific evolution in primary and secondary cervical cancer prevention in the battle started by George Papanicolaou in the previous century, global cervical cancer mortality rates remain disappointing. The widespread implementation of HPV-related molecular markers has paved the way to tremendous developments in cervical cancer screening, with the transition from cytological approach to the more accurate and cost-effective HPV testing modalities. However, the academic audience and different health systems have not yet adopted a universal approach in screening strategies, and even artificial intelligence modalities have been utilized from the multidisciplinary scientific armamentarium. Combination algorithms, scoring systems as well as artificial intelligent models have been so far proposed for cervical screening and management. The impact of sexual lifestyle inherently possesses a key role in the prevalence of HPV-related biomarkers. This study aimed to investigate any possible influence of sexual behavior and demographic characteristics in the expression of HPV-related biomarkers in a colposcopy population from October 2016 to June 2017, and corroborated the determining role of age at fist intercourse; the older the age, the lower the probability for DNA positivity. Multivariate analysis illustrated additionally that a number of sexual partners exceeding 4.2 was crucial, with women with ≤5 partners being approximately four times less likely to harbor a positive HPV DNA test (p < 0.0001). Similarly, a reported partner change during the last year before HPV DNA assessment contributed to 2.5 times higher odds for DNA positivity (p = 0.0006). From this perspective, the further development and validation of scoring systems quantifying lifestyle factors that could reflect cervical precancer risk seems paramount.

Abstract 55: Cervical Cancer Prevention in sub-Saharan Africa: A Policy Analysis

Abstract Purpose: We analyzed the presence and comprehensiveness of cervical cancer control policies in sub-Saharan Africa, where cervical cancer is the leading cause of cancer death for women. Methods: Publicly-available policies for primary, secondary, and tertiary cervical cancer prevention were collected, and scored for comprehensiveness based on elements included (e.g. vaccination schedule and target age, screening age interval and strategy, precancerous lesion removal method, cancer treatment approach, and presence of palliative care) (summed score, possible range 0- 12). We compared the median number of policy points for countries based on policy environment (availability of other non-communicable disease policy), health financing (external and domestic health expenditures), economic status (poverty prevalence and income inequality), health outcomes (life expectancy, HIV prevalence, cervical cancer mortality), and sub-region. Results: Policies from 47 countries in sub-Saharan Africa were analyzed. Policies were generally most comprehensive for secondary and primary prevention; only 19 countries had any tertiary prevention policy. It was more common for policies to include information about target age (for primary and secondary prevention), vaccine schedule, and screening method, and less common to include information about awareness-raising or accompanying behavior change approaches. Countries with greater external financing for health had more comprehensive cervical cancer policies, as did countries with higher HIV prevalence. Conclusion: Cervical cancer control policies in Africa are highly variable in comprehensiveness. External factors, like the role of global donors, and internal factors, like local disease burden, may influence relative priority of cervical cancer prevention and therefore affect policy comprehensiveness. Future research should use mixed methods to explore reasons for this variation and identify areas for policy strengthening. Citation Format: Rifa Akanda, Corrina Moucheraud. Cervical Cancer Prevention in sub-Saharan Africa: A Policy Analysis [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 55.

A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities.

The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.

The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines

The American Cancer Society (ACS) released updated cervical cancer screening guidelines in 2020 that endorse a shift in practice to primary human papillomavirus (HPV) screening in people with a cervix, beginning at ages of 25-65 years. When access to US Food and Drug Administration-approved primary HPV testing is not available, the ACS offers cotesting or cytology as acceptable alternative strategies but suggests that these testing modalities may be excluded from future iterations of the guidelines. The ASCCP recognizes the benefits and risks of primary HPV cervical cancer screening while acknowledging the barriers to widespread adoption, including implementation issues, the impact of limited HPV vaccination in the United States, and inclusion of populations who may not be well represented on primary HPV screening trials, such as underrepresented minorities. The ASCCP endorses the 2018 US Preventive Services Task Force Recommendation Statement and supports the ACS cervical cancer screening guidelines. Most importantly, the ASCCP endorses any cervical cancer screening for secondary prevention of cervical cancer and recommends interventions that improve screening for those who are underscreened or unscreened.

Concrete case: An opportunity to improve cervical cancer prevention—Primary and secondary prevention of cervical cancer in patients with cervical cancer and their families.

e18571 Background: cervical cancer (CC) reveals regional and social inequalities and should be understood not only as an oncological indicator, but essentially as an indicator of social vulnerability and health care needs.CC is the second most incident and the most deadly among women from the Northeast’S Brazil and the third most incident in Brazil Although the HPV vaccine coverage and the Pap smear test are available through the Brazilian public health system, the coverage of the target population is low. objective: Verify the conditions of access/use of the health system by women with cervical cancer (CC) and their families. Methods: Cross-sectional study involving cancer patients admitted to IMIP between 2016 and 2019. The variable data were related to the sociodemographic profile, preventive examination, Human Papillomavirus (HPV) and the influence of the diagnosis of CC on the search for preventive and screening measures by women's family members. Results: Out of the 285 participants,between 9-21 years old and 101 between 25-69 years old. Of the patients studied,55,8% lives urban area. It has a higher performance of biopsies in the public sector (59,5%). The sociodemographic analysis highlights the non-white race (78,2%) and only 6,8% with complete high school. The knowledge about performing the Pap smear reached 88,9% and the disinformation about the HPV reached 44,4%.the school was the largest source of information about the HPV vaccine (30,6%). Related to the influence of cancer, 62,2% said that young family members underwent HPV vaccination and 82,2% related their diagnosis to search for preventive in family members over 25 years old. a much higher percentage than vaccination coverage and preventive exam in the study region report that the diagnosis of cancer influenced the decision to vaccinate (42%) and update the pap test (69%). about 30% of patients had never taken the pap test. the early start (15 - 19y) of the pap test was not significant for the periodic performance of the pap test. 46% reported the lack of information about the importance of the exam as a reason for not performing it and 34% reported fear. conclusion :Strengthening educational activities and offering vaccines against HPV and Pap smears in the diagnosis of a case of cervical cancer can be an opportunity to expand the coverage of preventive measures more effectively among people close to the patient and her community, which cannot be missed. The school was an important source of information about the HPV vaccine and should be directly involved in this fight.Reducing an inequality cycle.

The cytological component of cervical cancer screening: causes of false negative and false positive results, and ways to avoid them

Cervical cancer (CC) screening is a major component of secondary prevention of CC and involves screening all women at risk of developing this disease, most of whom are asymptomatic. Cytology remains an important component of CC screening in the era of primary screening by genotyping the human papillomavirus. Papanikolaou staining is the method of choice for CC screening. This review highlights the causes of false negative results for various methods of Pap tests and how they can be prevented. A detailed analysis of conditions accompanied by a high probability of false positive abnormal results of the Pap test, an explanation of the pathophysiological basis of this phenomenon, clinical and cytological criteria for differential diagnosis is also presented.Pap test is a screening test. The aim of the cytological examination in CC screening is to assign the patient to a group with absent neoplastic changes in the cervical epithelium, a group with neoplastic changes in the cervical epithelium present, or a group when it is impossible to make an accurate differential diagnosis between benign reactive changes and neoplasia. The Bethesda Cytology Reporting System is used to unify and standardize these categories in most countries of the world. Benign conditions are a common cause of false positive reports of cellular atypia on cervical screening, as evidenced by a large number of studies. This fact should be taken into account both in the interpretation of the results and, if possible, in the planning of cervical screening. The most common conditions that are accompanied by reactive changes in the cervical epithelium, which can be incorrectly assessed as atypia, are: reactive and reparative inflammatory changes, atrophy, metaplasia, reactive changes caused by intrauterine devices. In this regard, when working with the cytological component of cervical screening, it is important for the clinician to understand the basic principles of assessing the cervical epithelium, which will allow using the descriptive part of the report to determine tactics if a false negative or false positive screening result is suspected.Thus, understanding the impact of common benign conditions on the cervical epithelium makes it possible to rationally plan cytological cervical screening and correctly interpret its results in order to achieve the best clinical results that are not limited to the detection of precancerous conditions.

Characteristics of human papillomavirus infection among women with cervical cytological abnormalities in the Zhoupu District, Shanghai City, China, 2014\u20132019

BackgroundHuman papillomavirus (HPV) infection is currently the main cause of cervical cancer and precancerous lesions in female patients. By analyzing 6-year patient data from Shanghai Zhoupu Hospital in China, we retrospectively analyzed the epidemiological characteristics of women to determine the relationship between HPV genotype and cytological test results.MethodsFrom 2014 to 2019, 23,724 cases of cervical shedding were collected from Zhoupu Hospital in Shanghai, China. By comparing the results of HPV and ThinPrep cytology test (TCT), the HPV infection rate of patients was retrospectively analyzed. HPV genotyping using commercial kits can detect 21 HPV subtypes (15 high-risk and 6 low-risk). According to the definition of the Bethesda system, seven types of cervical cytology results were involved.Results3816 among 23,724 women, nearly 16.08%, were infected with HPV. The top three highest HPV prevalence rates were high-risk type infection, including HPV52 (3.19%), 58 (2.47%) and 16 (2.34%). The number of single-type HPV infections (3480 (91.20%)) was much larger than the number of multi-type ones (336 (8.8%)). Single-type infections were mainly in women aged 50–60 (16.63%) and women under 30 (15.37%), while multi-type infections were more common in women over 60 (2.67%). By analyzing the long-term trends, between 2014 and 2019, HPV52, 58, and 16 subtypes changed significantly, and the HPV positive rate also changed significantly during this period. Among 4502 TCT positive women, 15 (4.04%), 125 (2.64%),159 (1.54%), 4202 (17.71%) and 1 (0.004%) had atypical glandular cells (AGC), high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL), atypical squamous cells (ASC)and cervical adenocarcinoma, respectively. The HPV infection rates were 66.08%, 63.99%, 115.20%, 119.50%, and 31.72% for NILM, AGCs, HSILs LSILs and ASCs, respectively.ConclusionsHPV and TCT screening were very important steps in the secondary prevention of cervical cancer. Through the tracking and analysis of HPV and TCT results in this study, it can provide valuable information for Shanghai's HPV screening and prevention strategies, and provide references for clinical decision-making in the treatment of cervical cancer and precancerous lesions.

Cervical cancer screening in Poland in current SARS-CoV-2 pandemic: Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology - a summary January 2021.

The Polish Society of Colposcopy and Cervical Pathophysiology (PTKiPSM) together with the Polish Society of Gynecologists and Obstetricians (PTGiP) issued a final summary of interim guidelines for secondary cervical cancer prevention during the SARS-CoV-2 pandemic based on the analysis of the latest directional publications and the authors' own experiences. The aim of the summary is to facilitate the implementation of the most effective possible screening of cervical precancerous lesions and cervical cancer due to temporary significant limitation of screening as a consequence of the ongoing epidemiological threat. These final guidelines are taking into account the 2020 call of the World Health Organization (WHO) for global epidemiological elimination of cervical cancer. The guidelines supplement the interim guidelines of PTKiPSM and PTGiP announced in March 2020 on the possible deferral of diagnostic and therapeutic procedures in patients with abnormal screening tests results in secondary prevention of cervical cancer in current pandemic.

Primary and secondary prevention of cervical cancer in Indian women using a public private participation approach: results of a pilot program

Primary and secondary prevention of cervical cancer in Indian women using a public private participation approach: results of a pilot program

Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria.

Introductioncervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept.Methodsin this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically.Resultssame day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%.Conclusiontriaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.

Smartphone-Enhanced Training, QA, Monitoring, and Evaluation of a Platform for Secondary Prevention of Cervical Cancer: Opportunities and Challenges to Implementation in Tanzania.

PURPOSEUntil human papillomavirus (HPV)–based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation.METHODSWe assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data.RESULTSFrom July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who “graduated” from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable.CONCLUSIONThe SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.