Evaluation of a Low-Cost Liquid-Based Pap Test in Rural El Salvador

Guo, Jin Jin; Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Felix, Juan C.

doi:10.1097/lgt.0b013e31829aa052

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Also, the cost of transportation and time required for follow-up with cytology is higher than the additional cost of cytology for some women. Again, while liquid-based cytology is generally more expensive than conventional cytology, we use low-cost cytology [ 28 ] which makes the cost similar to conventional cytology. With samples taken into a collection medium (ThinPrep), it is also possible to perform concurrent testing (HPV DNA testing and a visual inspection method (VIA or mobile colposcopy)).…”

Section: Discussionmentioning

confidence: 99%

Tritesting in Battor, Ghana: an integrated cervical precancer screening strategy to mitigate the challenges of multiple screening visits and loss to follow-up

Effah,

Tekpor,

Mawusi Wormenor

et al. 2023

ecancer Journal

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Background Human papillomavirus (HPV) DNA testing is more sensitive than cytology for detecting cervical precancer; however, increasing reports of high-risk HPV (hr-HPV)-negative cases of cervical intraepithelial neoplasia (CIN) and even malignancy motivate the use of combined testing. We present our experience with ‘tritesting’, defined as the performance of HPV DNA testing, cytology and visual inspection in a single session at the Cervical Cancer Prevention and Training Centre, Ghana. We further determined the prevalence rates of hr-HPV infection, abnormal cytology and cervical lesions among women screened using tritesting. Methods This descriptive retrospective cross-sectional study assessed all women screened via tritesting between April 2019 to April 2023. HPV DNA testing was performed using the Sansure MA-6000, GeneXpert or AmpFire platforms. Visual inspection was performed using enhanced visual assessment mobile colposcopy or visual inspection with acetic acid. Liquid-based cytology was performed using cervical samples taken with a Cervex-Brush® and fixed in PreservCyt, while samples for conventional cytology were taken using an Ayre spatula and cytobrush. Results Among 236 women screened (mean age, 39.1 years (standard deviation, 10.9)), the overall prevalence rates of hr-HPV infection and cervical lesions were 17.8% (95% confidence interval (CI), 13.1–23.3) and 11.9% (95% CI, 8.0–16.7), respectively. Cytology yielded findings of atypical squamous cells of undetermined significance or worse in 2.5% (95% CI, 0.9–5.5) of women. Histopathology following loop electrosurgical excision procedure revealed CIN I (tritest positive) and CIN III (hr-HPV-positive, visual inspection ‘positive’, cytology-negative) in one woman each. Factors independently associated with hr-HPV infection among ‘tritested’ women were age ≥ 39 years, tertiary level of education and current contraceptive use. Twenty-seven out of 39 hr-HPV-positive women (69.2%; 95% CI, 52.4–83.0) showed a type 3 transformation zone and would have needed to be recalled for a cytologic sample to be taken in a ‘see and triage’ approach with HPV DNA testing and a visual inspection method. Conclusion This study brings tritesting into the spotlight, as an alternative to other methods, particularly for women who prefer this due to the advantage of a single visit to a health facility and being more cost-effective, if they have to travel long distances to access cervical screening services.

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Section: Discussionmentioning

confidence: 99%

Tritesting in Battor, Ghana: an integrated cervical precancer screening strategy to mitigate the challenges of multiple screening visits and loss to follow-up

Effah,

Tekpor,

Mawusi Wormenor

et al. 2023

ecancer Journal

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“…Existen estudios que proponen que la CBL es una alternativa costo efectiva teniendo en cuenta el costo de una máquina para CBL en $50 000 y la comparación entre costos de insumo per cápita entre la CC y la CBL, de $2.5 y $6 respectivamente 26 . Esto se fundamenta en la reducción del número de falsos negativos, la cantidad de muestras insatisfactorias, disminución del tiempo para obtener y evaluar la muestra, la conservación de esta para estudios especializados posteriores 27,28 y además, la reducción del tiempo para derivar a la paciente para la colposcopía y el tiempo de…”

Section: Discussionunclassified

Características Del Tamizaje Para Cáncer Cérvico-Uterino en 08 Establecimientos De Salud, Lima Metropolitana 2017

2019

RFMH

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Introduccion: El uso de Citología Convencional de Papanicoloau (CC) frente a Base Líquida (CBL), el profesional que realiza la extracción, primera lectura y diagnóstico de la muestra; el uso de la clasificación Bethesda, la detección de ADN del VPH y el seguimiento de hallazgos ASCUS son eslabones en el tamizaje del Cáncer del Cuello Uterino (CCU) poco estudiadas en nuestro medio. Objetivo: Determinar las características del tamizaje para cáncer CCU en 08 establecimientos de salud (EESS) de Lima Metropolitana sedes del Internado Médico de la FAMURP en el 2017.Métodos: Descriptivo, transversal. Muestreo por conveniencia. Se entrevistó a los Jefes de los Servicios de Patología. Resultados: Participaron 8 EESS de Nivel III del MINSA, EsSalud y FFAA. Todos realizaron la CC, ninguno CBL. Las muestras son extraídas por el Ginecólogo o la Obstetriz, y en 1 caso por enfermería, la primera lectura es realizada por el Tecnólogo Médico y en un caso por el Anátomo Patólogo; el diagnóstico, por el Anátomo Patólogo. Se usa el Sistema de Bethesda para el Reporte Final. No se usan pruebas de detección para ADN del VPH. En 8, se hace seguimiento para hallazgos ASCUS. Conclusión: La CBL, la lectura automatizada, y la identificación del ADN de VPH no están implementados. Se recomienda realizar estudios costo-efectivo para proponer su implementación futura, y realizar estudios respecto de las fases del proceso del Tamizaje.

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Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review

Dykens

Smith

Demment

et al. 2020

Cancer Causes Control

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Purpose Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. Methods We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. Results Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demandside (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. Conclusions The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.

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Evaluation of a Low-Cost Liquid-Based Pap Test in Rural El Salvador

Abstract: The low-cost ClearPrep Pap test demonstrated equivalent detection of squamous intraepithelial lesions when compared with the conventional Pap smear and demonstrated the potential for ancillary molecular testing. The test seems a viable option for implementation in low-resource settings.

Cited by 4 publications

References 19 publications

Tritesting in Battor, Ghana: an integrated cervical precancer screening strategy to mitigate the challenges of multiple screening visits and loss to follow-up

Tritesting in Battor, Ghana: an integrated cervical precancer screening strategy to mitigate the challenges of multiple screening visits and loss to follow-up

Características Del Tamizaje Para Cáncer Cérvico-Uterino en 08 Establecimientos De Salud, Lima Metropolitana 2017

Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review

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