Feasibility and acceptability of an HPV self-testing strategy: lessons from a research context to assess for ability to implement into primary care at a national level in Botswana.
Feasibility and acceptability of an HPV self-testing strategy: lessons from a research context to assess for ability to implement into primary care at a national level in Botswana.
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DOI：
10.3389/fgwh.2023.1300788
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发表时间：
2023
影响因子：
--
通讯作者：
Larson, Elysia
中科院分区：
文献类型：
--
作者：
Luckett, Rebecca;Ramogola-Masire, Doreen;Harris, Devon A.;Gompers, Annika;Gaborone, Kelebogile;Mochoba, Lorato;Ntshese, Lapelo;Mathoma, Anikie;Kula, Maduke;Shapiro, Roger;Larson, Elysia
关键词：
世卫组织消除宫颈癌战略力争通过高效宫颈筛查实现70%的覆盖率。虽然很少有低收入和中等收入国家做到了这一点，但高危人乳头瘤病毒（hrHPV）自我检测为在资源环境中迅速扩大获得高效宫颈筛查的机会创造了可能性。然而，有效的hrHPV筛查需要与随访联系起来，这在以前的研究中是可变的。这项研究制定并测试了一项实施战略，旨在改善博茨瓦纳东南区的筛查和与后续护理的联系。本研究进行了初次hrHPV自我检测;结果呈阳性的患者被转诊进行分诊访视。还记录了任何原因的患者、hrHPV检测和分诊访视之间的失访以及尝试提供hrHPV结果的电话次数。该计划对患者的可接受性被测量为在指示时完成分诊访视的患者比例，满足80%的先验阈值。可行性被定义为收到结果和参加后续行动的参与者比例。为了评估受试者特征与失访之间的相关性，我们使用对数二项回归来估计风险比和95%置信区间（CI）。2021年2月至2022年8月，共招募了3,000名女性。总共有10名参与者退出，另外33名参与者在知情同意后被确定为不合格，剩下2，957名参与者接受了自我拭子hrHPV检测。半数（50%）参与者的hrHPV检测结果呈阳性，几乎所有（98%）参与者主要通过电话收到hrHPV检测结果。参与者很少需要通过电话交流结果：2，397（82%）人需要一次电话，386（13%）人需要两次电话，只有151（5%）人需要3-5次电话。从标本采集到受试者收到结果的中位时间为44天（IQR，27-65）。在所有hrHPV阳性参与者中，1，328人（90%）参加了分诊访视。在一个大型队列中，我们的失访率较低，为10%，表明该策略是可以接受的。电话结果报告与高筛查完成率相关，需要给参与者打电话很少，并支持在初级保健中进行hrHPV自我检测，然后进行间隔分诊的可行性。
The WHO strategy for cervical cancer elimination strives to achieve 70% coverage with high-performance cervical screening. While few low- and middle-income countries have achieved this, high-risk human papillomavirus (hrHPV) self-testing creates the possibility to rapidly upscale access to high-performance cervical screening across resource settings. However, effective hrHPV screening requires linkage to follow-up, which has been variable in prior studies. This study developed and tested an implementation strategy aimed at improving screening and linkage to follow-up care in South East District in Botswana. This study performed primary hrHPV self-testing; those with positive results were referred for a triage visit. Withdrawals for any reason, loss-to follow-up between hrHPV test and triage visit, and number of call attempts to give hrHPV results were also documented. Acceptability of the program to patients was measured as the proportion of patients who completed a triage visit when indicated, meeting the a priori threshold of 80%. Feasibility was defined as the proportion of participants receiving the results and attending follow-up. To assess the associations between participant characteristics and loss-to-follow-up we used log-binomial regressions to estimate risk ratios and 95% confidence intervals (CI). Enrollment of 3,000 women occurred from February 2021 to August 2022. In total, 10 participants withdrew and an additional 33 were determined ineligible after consent, leaving a final cohort of 2,957 participants who underwent self-swab hrHPV testing. Half (50%) of participants tested positive for hrHPV and nearly all (98%) of participants received their hrHPV results, primarily via telephone. Few calls to participants were required to communicate results: 2,397 (82%) required one call, 386 (13%) required 2 calls, and only 151 (5%) required 3–5 calls. The median time from specimen collection to participant receiving results was 44 days (IQR, 27–65). Of all hrHPV positive participants, 1,328 (90%) attended a triage visit. In a large cohort we had low loss-to-follow-up of 10%, indicating that the strategy is acceptable. Telephonic results reporting was associated with high screening completion, required few calls to participants, and supports the feasibility of hrHPV self-testing in primary care followed by interval triage.
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影响因子：
5
作者：
Vink, Margaretha A.;Bogaards, Johannes A.;Berkhof, Johannes
通讯作者：
Berkhof, Johannes
影响因子：
34.3
作者：
Arbyn, Marc;Weiderpass, Elisabete;Bray, Freddie
通讯作者：
Bray, Freddie
影响因子：
4.5
作者：
通讯作者：
--
DOI：
10.1016/s2214-109x(20)30459-9
发表时间：
2021-03
期刊：
The Lancet. Global health
影响因子：
--
作者：
Stelzle D;Tanaka LF;Lee KK;Ibrahim Khalil A;Baussano I;Shah ASV;McAllister DA;Gottlieb SL;Klug SJ;Winkler AS;Bray F;Baggaley R;Clifford GM;Broutet N;Dalal S
通讯作者：
Dalal S
影响因子：
6.4
作者：
SIGURDSSON, K
通讯作者：
SIGURDSSON, K