Impact of Patient Adherence and Test Performance on the Cost-Effectiveness of Cervical Cancer Screening in Developing Countries

Perkins, Rebecca B.; Langrish, Sarah; Stern, Linda Jo; Burgess, James; Simon, Carol

doi:10.1016/j.whi.2009.09.001

Cited by 20 publications

(23 citation statements)

References 27 publications

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“…For example, a study in Honduras comparing adherence rates after screening with either Pap smears or visual inspection with acetic acid (VIA) found that only 38% of women with abnormal Pap results adhered to recommended follow-up versus 84% of women with abnormal VIA results. [18] A major strength of our study is that it pinpoints the exact step during which the majority of women did not continue their recommended follow-up. Since 62% of women were lost between receiving their abnormal Pap result and scheduling a follow-up colposcopy, the MOH had sufficient evidence to implement a direct referral system between the primary health units where women obtain their results and the nearest hospital where colposcopy services are provided.…”

Section: Discussionmentioning

confidence: 99%

Adherence to recommended follow-up care after high-grade cytology in El Salvador

Maza¹,

Matesanz

Alfaro³

et al. 2016

IJH

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Objective: To quantify adherence to recommended follow-up care among women in the Paracentral region of El Salvador who were diagnosed by cytology with high-grade squamous intraepithelial lesions (HSIL) of the cervix. Materials and methods: A retrospective chart review was conducted to determine follow-up in the first year after cytological diagnosis of high-grade cervical dysplasia (HSIL). A small sample of these women were also interviewed to determine barriers to care. Results: Patient charts were available for 99 study-eligible patients with HSIL. Only 44% (44/99) of women completed recommended follow-up. Among the 55 women who did not complete follow-up (56% of 99 reviewed), loss to follow-up occurred when women did not schedule a colposcopy appointment (61.8%), did not receive their cytology results (20%), did not return to the clinic to receive their biopsy results, (9.1%), or did not attend their scheduled colposcopy (1.8%). No other factors had a significant effect on adherence to recommended follow-up. An additional 7.3% did not complete their treatment within the one-year time frame designated by the study to represent completion of follow-up. Failure to follow-up among the 13 non-compliant women interviewed was due to lack of money (38%), appropriate referral (28%), and fear (15%). Conclusions: The likelihood of non-adherence increased with longer wait times for follow-up appointments. The data supports the need for systemic interventions to decrease wait time for colposcopy. Changes in both systems and infrastructure have been initiated in El Salvador in order to establish more reliable methods for efficient follow-up care. Further investigation of barriers to care at every point in the process of cervical cancer screening and treatment will highlight which steps require modification.

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Section: Discussionmentioning

confidence: 99%

Adherence to recommended follow-up care after high-grade cytology in El Salvador

Maza¹,

Matesanz

Alfaro³

et al. 2016

IJH

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“…HPV vaccination offers protection against the development of cervical cancer and associated morbidities and mortalities, and is especially valuable in resource-limited settings where secondary prevention methods such as cytology screening are not widely available and may not be a cost-effective [25]. Recent work focusing on HPV vaccine acceptability in resource-limited settings including Kenya, Tanzania, Uganda, Latin America, the Caribbean, Vietnam, Malaysia, China, and India have generally found high acceptability of HPV vaccines [26]–[30].…”

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional Study to Assess HPV Knowledge and HPV Vaccine Acceptability in Mali

et al. 2013

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Despite a high prevalence of oncogenic human papilloma virus (HPV) infection and cervical cancer mortality, HPV vaccination is not currently available in Mali. Knowledge of HPV and cervical cancer in Mali, and thereby vaccine readiness, may be limited. Research staff visited homes in a radial pattern from a central location to recruit adolescent females and males aged 12–17 years and men and women aged ≥18 years (N = 51) in a peri-urban village of Bamako, Mali. Participants took part in structured interviews assessing knowledge, attitudes, and practices related to HPV, cervical cancer, and HPV vaccination. We found low levels of HPV and cervical cancer knowledge. While only 2.0% of respondents knew that HPV is a sexually transmitted infection (STI), 100% said they would be willing to receive HPV vaccination and would like the HPV vaccine to be available in Mali. Moreover, 74.5% said they would vaccinate their child(ren) against HPV. Men were found to have significantly greater autonomy in the decision to vaccinate themselves than women and adolescents (p = 0.005), a potential barrier to be addressed by immunization campaigns. HPV vaccination would be highly acceptable if the vaccine became widely available in Bamako, Mali. This study demonstrates the need for a significant investment in health education if truly informed consent is to be obtained for HPV vaccination. Potential HPV vaccination campaigns should provide more information about HPV and the vaccine. Barriers to vaccination, including the significantly lower ability of the majority of the target population to autonomously decide to get vaccinated, must also be addressed in future HPV vaccine campaigns.

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“…VIA has proven to be feasible in low‐resource settings because of the simplicity and acceptance of this strategy, leading to increased adherence compared with cytology‐based screening . A CEA from Honduras found that VIA would cost $3198 per cancer case avoided compared with $36,802 with cytology‐based screening .…”

Section: Improving CC Control In Lamentioning

confidence: 99%

Cervical cancer control in Latin America: A call to action

Bychkovsky

Ferreyra²,

Strasser‐Weippl

et al. 2015

Cancer

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Cervical cancer (CC) is second most common cause of cancer in Latin America and is a leading cause of cancer mortality among women. In 2015, an estimated 74,488 women will be diagnosed with CC in Latin America and 31,303 will die of the disease. CC mortality is projected to increase by 45% by 2030 despite human papillomavirus (HPV) vaccination and screening efforts. In this setting, the goal was of the current study was to examine CC control efforts in Latin America and identify deficiencies in these efforts that could be addressed to reduce CC incidence and mortality. The authors found that HPV vaccination has been introduced in the majority of Latin American countries, and there is now a need to monitor the success (or shortcomings) of these programs and to ensure that these programs are sustainable. This topic was also reviewed in light of emerging data demonstrating that visual inspection with acetic acid and HPV DNA testing without Papanicolaou tests have efficacy from a screening perspective and are good alternatives to cytology-based screening programs. Overall, there is a need to build capacity for CC control in Latin America and the best strategy will depend on the country/region and must be tailored to meet the needs of the population as well as available resources. Cancer 2016;122:502-14.

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Impact of Patient Adherence and Test Performance on the Cost-Effectiveness of Cervical Cancer Screening in Developing Countries

Cited by 20 publications

References 27 publications

Adherence to recommended follow-up care after high-grade cytology in El Salvador

Adherence to recommended follow-up care after high-grade cytology in El Salvador

A Cross-Sectional Study to Assess HPV Knowledge and HPV Vaccine Acceptability in Mali

Cervical cancer control in Latin America: A call to action

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