Background: Cervical cancer is the most common type of cancer in sub-Saharan Africa, and it is also the cancer disease that most women die from. The high mortality rate is partly due to low attendance rates to screening services and low sensitivity of visual inspection with acetic acid, which is the standard screening method used in screening programs in sub-Saharan Africa. In order to overcome of the burden of disease new screening strategies and methods are warranted. This study aims to explore the acceptability and feasibility of HPV self-sampling compared to provider-based sampling among cervical cancer screening clients living in Dar es Salaam. Methods: Women attending cervical cancer screening at Ocean Road Cancer Institute in Dar es Salaam, Tanzania between February-April 2017 were invited into the study. The participants had (1) a provider-collected sample, and (2) a self-sample for HPV on top of the regular cervical cancer screening. 50% of the participants conducted the self-sample after receiving a written instruction guide of how to collect the sample (written). The other 50% received both the written and an oral introduction to self-sampling (written+). All participants could ask for nurse assistance during self-sample collection if needed. Individual semi-structured interviews were conducted with the participants post sample collection. Data collection stopped when saturation was reached. Data were analysed using a thematic content analysis.
Background Intimate partner violence (IPV) is a major public health concern. eHealth interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear. Objective The goal of the review is to examine the effect of eHealth interventions compared with standard care on reducing IPV, depression, and posttraumatic stress disorder (PTSD) among women exposed to IPV. Methods We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, Scopus, Global Health Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform for published and unpublished trials from inception until April 2019. Trials with an eHealth intervention targeting women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall IPV; physical, sexual, and psychological violence; depression; or posttraumatic stress disorder were included in meta-analyses. Results A total of 14 trials were included in the review; 8 published trials, 3 unpublished trials and 3 ongoing trials. Of the 8 published trials, 2 were judged as overall low risk of bias trials. The trials reported 23 types of outcomes, and 7 of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our prespecified outcomes: overall IPV (SMD –0.01; 95% CI –0.11 to 0.08; I2=0%; 5 trials, 1668 women); physical violence (SMD 0.01; 95% CI –0.22 to 0.24; I2=58%; 4 trials, 1128 women); psychological violence (SMD 0.07; 95% CI –0.12 to 0.25; I2=40%; 4 trials, 1129 women); sexual violence (MD 0.36; 95% CI –0.18 to 0.91; I2=0%; 2 trials, 1029 women); depression (SMD –0.13; 95% CI –0.37 to 0.11; I2=78%; 5 trials, 1600 women); and PTSD (MD –0.11; 95% CI –1.04 to 0.82; I2=0%; 5 trials, 1267 women). Conclusions There is no evidence from randomized trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed, and we recommend harmonizing outcome reporting in IPV trials by establishing core outcome sets. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019130124; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130124
BACKGROUND Intimate partner violence (IPV) is a major public health concern. Electronic health (eHealth) interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear. OBJECTIVE To examine the effect of eHealth interventions compared to standard care on reducing intimate partner violence, depression and post-traumatic stress disorder (PTSD) among women exposed to intimate partner violence. METHODS We searched EMBASE, MEDLINE, CENTRAL, PsycInfo, Scopus, the Global Health Library, ClinicalTrials.gov, the International Clinical Trial Registry Platform for published and unpublished trials from inception up to April 2019. Trials with an eHealth intervention targeted women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall intimate partner violence, physical violence, sexual violence, psychological violence, depression and/or post-traumatic stress disorder were included in meta-analyses. RESULTS A total of fourteen trials were included in the review; eight published trials, three unpublished trials and three ongoing trials. Two out of the eight published trials were judged as overall low risk of bias trials. The trials reported a total of 23 different types of outcomes and seven of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our pre-specified outcomes: overall IPV (SMD: -0.01; 95% CI: -0.11 to 0.08; I2=0%; five trials, 1668 women); physical violence (SMD: 0.01; 95% CI: -0.22 to 0.24; I2=58%; four trials, 1128 women); psychological violence (SMD: 0.07; 95% CI: -0.12 to 0.25; I2=40%; four trials, 1129 women); sexual violence (MD: 0.36; 95% CI: -0.18 to 0.91; I2=0%; two trials, 1029 women); depression (SMD: -0.13; 95% CI: -0.37 to 0.11; I2=78%; five trials, 1600 women); and PTSD (MD: -0.11; 95% CI: -1.04-0.82; I2=0%; five trials, 1267 women). CONCLUSIONS There is no evidence from randomised trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed and we recommend harmonising outcome reporting in IPV trials by establishing core outcome sets. CLINICALTRIAL PROSPERO: CRD42019130124.
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