Integrating cervical cancer with HIV healthcare services: A systematic review.
Integrating cervical cancer with HIV healthcare services: A systematic review.
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DOI：
10.1371/journal.pone.0181156
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Legido-Quigley H
中科院分区：
文献类型：
--
作者：
Sigfrid L;Murphy G;Haldane V;Chuah FLH;Ong SE;Cervero-Liceras F;Watt N;Alvaro A;Otero-Garcia L;Balabanova D;Hogarth S;Maimaris W;Buse K;Mckee M;Piot P;Perel P;Legido-Quigley H
宫颈癌是一个重大的公共卫生问题。尽管很容易预防，但它是全球妇女死亡的第四大原因。感染艾滋病毒的妇女患浸润性宫颈癌的风险增加，突出表明需要为这一人群提供筛查和治疗。已提议将服务一体化作为改善宫颈癌筛查的有效途径，特别是在艾滋病毒流行率高的地区以及资源较低的环境中。本文介绍了一个系统的审查结果的方案整合宫颈癌和艾滋病毒服务的全球范围内，包括可行性，可接受性，临床结果和促进服务提供。这是关于艾滋病毒和非传染性疾病服务一体化的更大系统审查的一部分。为了考虑纳入研究，必须报告在服务提供层面整合宫颈癌和艾滋病毒服务的计划。我们检索了多个数据库，包括Global Health、Medline和Embase，从开始到2015年12月。由两名评审员独立筛选文章，提取数据并评估偏倚风险。初步确定了11，057条记录。通过标题和摘要筛选了7，616篇文章。共有21篇报告将宫颈癌护理和艾滋病毒服务相结合的干预措施的论文符合纳入标准。除一项研究外，所有研究都描述了将宫颈癌筛查服务纳入现有艾滋病毒服务的情况。大多数项目还提供了小病变的治疗，一种“筛查和治疗”的方法，有些项目还在同一次就诊中提供了较大病变的治疗。确定了三种不同的一体化模式。一种模式描述了通过培训现有工作人员在同一诊所内进行整合。另一种模式描述了通过服务的协同定位的整合，第三种模式描述了通过整个护理途径的复杂协调的整合方案。研究表明，采用所有模式将宫颈癌服务与艾滋病毒服务相结合是可行的，也是患者可以接受的。然而，报告了几个障碍，包括后续进一步治疗的高损失，有限的人力资源以及后勤和链管理支持。使用视觉筛查方法可以促进在单次“筛查和治疗”访视中对较小至较大病变的筛查和治疗。单次访视中的复杂整合被证明可以减少随访损失。利用现有的卫生基础设施和资金，加上全面的工作人员培训和监督、社区参与和数字技术，是各种模式报告的促进一体化的许多其他因素。这项审查表明，采用不同的服务提供模式将宫颈癌筛查和治疗与艾滋病毒服务结合起来是可行的，也是感染艾滋病毒的妇女可以接受的。然而，大多数论文的描述性和缺乏对艾滋病毒或宫颈癌的长期结果的影响的数据限制了对综合方案的有效性的推断。有必要加强整个护理连续体的卫生系统，并进行高质量的研究，评估一体化对艾滋病毒和宫颈癌结果的影响。
Cervical cancer is a major public health problem. Even though readily preventable, it is the fourth leading cause of death in women globally. Women living with HIV are at increased risk of invasive cervical cancer, highlighting the need for access to screening and treatment for this population. Integration of services has been proposed as an effective way of improving access to cervical cancer screening especially in areas of high HIV prevalence as well as lower resourced settings. This paper presents the results of a systematic review of programs integrating cervical cancer and HIV services globally, including feasibility, acceptability, clinical outcomes and facilitators for service delivery. This is part of a larger systematic review on integration of services for HIV and non-communicable diseases. To be considered for inclusion studies had to report on programs to integrate cervical cancer and HIV services at the level of service delivery. We searched multiple databases including Global Health, Medline and Embase from inception until December 2015. Articles were screened independently by two reviewers for inclusion and data were extracted and assessed for risk of bias. 11,057 records were identified initially. 7,616 articles were screened by title and abstract for inclusion. A total of 21 papers reporting interventions integrating cervical cancer care and HIV services met the criteria for inclusion. All but one study described integration of cervical cancer screening services into existing HIV services. Most programs also offered treatment of minor lesions, a ‘screen-and-treat’ approach, with some also offering treatment of larger lesions within the same visit. Three distinct models of integration were identified. One model described integration within the same clinic through training of existing staff. Another model described integration through co-location of services, with the third model describing programs of integration through complex coordination across the care pathway. The studies suggested that integration of cervical cancer services with HIV services using all models was feasible and acceptable to patients. However, several barriers were reported, including high loss to follow up for further treatment, limited human-resources, and logistical and chain management support. Using visual screening methods can facilitate screening and treatment of minor to larger lesions in a single ‘screen-and-treat’ visit. Complex integration in a single-visit was shown to reduce loss to follow up. The use of existing health infrastructure and funding together with comprehensive staff training and supervision, community engagement and digital technology were some of the many other facilitators for integration reported across models. This review shows that integration of cervical cancer screening and treatment with HIV services using different models of service delivery is feasible as well as acceptable to women living with HIV. However, the descriptive nature of most papers and lack of data on the effect on long-term outcomes for HIV or cervical cancer limits the inference on the effectiveness of the integrated programs. There is a need for strengthening of health systems across the care continuum and for high quality studies evaluating the effect of integration on HIV as well as on cervical cancer outcomes.
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影响因子：
4.5
作者：
Horo A;Jaquet A;Ekouevi DK;Toure B;Coffie PA;Effi B;Messou E;Minga A;Moh R;Kone M;Dabis F;Sasco AJ;IeDEA West Africa Collaboration
通讯作者：
IeDEA West Africa Collaboration
影响因子：
3.2
作者：
Atun, Rifat;de Jongh, Thyra;Adeyi, Olusoji
通讯作者：
Adeyi, Olusoji
影响因子：
3.7
作者：
Anderson, Jean;Wysong, Megan;Lu, Enriquito
通讯作者：
Lu, Enriquito
57个国家 /地区的宫颈癌筛查覆盖范围：平均水平低和较大的不平等。
影响因子：
15.8
作者：
Gakidou, Emmanuela;Nordhagen, Stella;Obermeyer, Ziad
通讯作者：
Obermeyer, Ziad
DOI：
10.1016/j.ijgo.2011.02.009
发表时间：
2011-08-01
影响因子：
3.8
作者：
Huchko, Megan J.;Bukusi, Elizabeth A.;Cohen, Craig R.
通讯作者：
Cohen, Craig R.