Upscaling cervical cancer screening and treatment for women living with HIV at a rural referral hospital in Tanzania: protocol of a before-and-after study exploring HPV testing and novel diagnostics.
Cervical cancer
Cervical dysplasia
Human papillomavirus
LEEP
Mobile colposcopy
Screening coverage
Sub-Saharan Africa
Tanzania
Thermal ablation
Women living with HIV
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
10 Mar 2023
10 Mar 2023
Historique:
received:
28
08
2022
accepted:
26
01
2023
entrez:
9
3
2023
pubmed:
10
3
2023
medline:
14
3
2023
Statut:
epublish
Résumé
Cervical cancer (CC) is nearly always caused by persistent human papillomavirus (HPV) infection. It is the most common cancer among women living with HIV (WLWH) and is the leading cause of cancer-related death in women in East Africa, with 10,241 new cases reported in Tanzania in 2020. In 2019, the World Health Organization (WHO) presented a global strategy for the elimination of CC as a public health problem, proposing targets to meet by 2030 for HPV vaccine coverage (90% of all 15-year-old girls), CC screening (70% of all women once at 35 and again at 45 years of age) and treatment delivery, to be scaled at national and subnational levels with a context-sensitive approach. This study aims to evaluate the upscaling of screening and treatment services at a rural referral hospital in Tanzania in order to address the second and third WHO targets. This is an implementation study with a before-and-after design performed at St. Francis Referral Hospital (SFRH) in Ifakara (south-central Tanzania). CC screening and treatment services are integrated within the local HIV Care and Treatment Center (CTC). The standard of care, consisting of visualization of the cervix with acetic acid (VIA) and cryotherapy has been up-scaled with self-sampled HPV testing and also involved the introduction of mobile colposcopy, thermal ablation and loop electrosurgical excision procedure (LEEP). Participants are WLWH aged 18 to 65 years. Outcome measures included the percentage of women screened, HPV prevalence and genotype, and adherence to screening, treatment and follow-up plan. Additionally, we will explore the performance of novel diagnostic tests (QG-MPH®, Prevo-Check® and PT Monitor®), which share the features of being manageable and inexpensive, and thus a potential tool for effective triage in HPV high-prevalence cohorts. The study will provide relevant information about HPV prevalence and persistence, as well as reproductive and lifestyle indicators in a CC high-risk cohort of WLWH and about upscaling screening and treatment services at the level of a rural referral hospital in Tanzania. Furthermore, it will provide exploratory data on novel assays. ClinicalTrials.gov Identifier: NCT05256862, date of registration 25/02/2022. Retrospectively registered.
Sections du résumé
BACKGROUND
BACKGROUND
Cervical cancer (CC) is nearly always caused by persistent human papillomavirus (HPV) infection. It is the most common cancer among women living with HIV (WLWH) and is the leading cause of cancer-related death in women in East Africa, with 10,241 new cases reported in Tanzania in 2020. In 2019, the World Health Organization (WHO) presented a global strategy for the elimination of CC as a public health problem, proposing targets to meet by 2030 for HPV vaccine coverage (90% of all 15-year-old girls), CC screening (70% of all women once at 35 and again at 45 years of age) and treatment delivery, to be scaled at national and subnational levels with a context-sensitive approach. This study aims to evaluate the upscaling of screening and treatment services at a rural referral hospital in Tanzania in order to address the second and third WHO targets.
METHODS
METHODS
This is an implementation study with a before-and-after design performed at St. Francis Referral Hospital (SFRH) in Ifakara (south-central Tanzania). CC screening and treatment services are integrated within the local HIV Care and Treatment Center (CTC). The standard of care, consisting of visualization of the cervix with acetic acid (VIA) and cryotherapy has been up-scaled with self-sampled HPV testing and also involved the introduction of mobile colposcopy, thermal ablation and loop electrosurgical excision procedure (LEEP). Participants are WLWH aged 18 to 65 years. Outcome measures included the percentage of women screened, HPV prevalence and genotype, and adherence to screening, treatment and follow-up plan. Additionally, we will explore the performance of novel diagnostic tests (QG-MPH®, Prevo-Check® and PT Monitor®), which share the features of being manageable and inexpensive, and thus a potential tool for effective triage in HPV high-prevalence cohorts.
DISCUSSION
CONCLUSIONS
The study will provide relevant information about HPV prevalence and persistence, as well as reproductive and lifestyle indicators in a CC high-risk cohort of WLWH and about upscaling screening and treatment services at the level of a rural referral hospital in Tanzania. Furthermore, it will provide exploratory data on novel assays.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov Identifier: NCT05256862, date of registration 25/02/2022. Retrospectively registered.
Identifiants
pubmed: 36894985
doi: 10.1186/s12913-023-09113-3
pii: 10.1186/s12913-023-09113-3
pmc: PMC9998252
doi:
Banques de données
ClinicalTrials.gov
['NCT05256862']
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
234Subventions
Organisme : Swiss Cancer Research Foundation
ID : BIL KFS-4986-02-2020
Informations de copyright
© 2023. The Author(s).
Références
Swiss Med Wkly. 2017 Jul 11;147:w14485
pubmed: 28695551
J Acquir Immune Defic Syndr. 2013 Apr 1;62(4):405-13
pubmed: 23254153
Lancet. 2017 Feb 25;389(10071):847-860
pubmed: 27814965
Cancer Prev Res (Phila). 2020 Jul;13(7):593-600
pubmed: 32371553
Int J Womens Health. 2018 Feb 16;10:83-87
pubmed: 29497336
BMJ Open. 2020 Mar 30;10(3):e035153
pubmed: 32234744
Gynecol Oncol Rep. 2019 May 21;29:40-47
pubmed: 31309135
Prev Med. 2022 Jan;154:106900
pubmed: 34861338
BMJ Open. 2020 Sep 18;10(9):e038531
pubmed: 32948569
J Glob Oncol. 2016 Jun 1;3(1):72-78
pubmed: 28717744
Prev Med. 2020 Mar;132:105953
pubmed: 31911163
Med Dosw Mikrobiol. 2016;68(1):73-84
pubmed: 28146625
BMJ. 1999 Apr 3;318(7188):904-8
pubmed: 10102852
J Int AIDS Soc. 2018 Jun;21(6):e25110
pubmed: 29873885
Cochrane Database Syst Rev. 2010 Jun 16;(6):CD001318
pubmed: 20556751
EBioMedicine. 2020 Jun;56:102804
pubmed: 32535546
Cancer Prev Res (Phila). 2019 Oct;12(10):701-710
pubmed: 31427275
AIDS. 2018 Mar 27;32(6):795-808
pubmed: 29369827
PLoS One. 2020 May 6;15(5):e0231388
pubmed: 32374729
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
BMJ Glob Health. 2020 Mar 29;5(3):e001886
pubmed: 32337077
Int J Womens Health. 2017 Feb 02;9:69-79
pubmed: 28203108
BMJ Open. 2019 Feb 27;9(2):e024011
pubmed: 30819704
Vaccine. 2022 Mar 31;40 Suppl 1:A2-A9
pubmed: 33962839
Lancet Oncol. 2019 Feb;20(2):229-238
pubmed: 30658933
BMC Womens Health. 2020 Mar 31;20(1):65
pubmed: 32234028
Syst Rev. 2018 Nov 17;7(1):198
pubmed: 30447695