Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status.
Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status.
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DOI：
10.1186/1471-2458-12-237
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发表时间：
2012-03-23
影响因子：
4.5
通讯作者：
IeDEA West Africa Collaboration
中科院分区：
文献类型：
--
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
在非洲，宫颈癌筛查还不是前往艾滋病毒护理诊所就诊的妇女的标准护理，这带来了需要解决的业务挑战。在科特迪瓦阿比让提供抗逆转录病毒治疗(ART)的诊所进行了基于肉眼检查方法的宫颈癌筛查计划。一个助产士巡回小组负责向在ART诊所登记的所有艾滋病毒阳性妇女以及在阿比让国家献血者诊所就诊的艾滋病毒阴性妇女提出宫颈癌筛查的建议。筛查阳性的妇女被系统地转介到镜检查。实施了基于电话的跟踪程序，以接触到没有参加医疗咨询的阳性筛查妇女。艾滋病毒状况和宫颈癌筛查结果之间的关联使用多变量Logistic模型进行了评估。2998例HIV阳性妇女目测阳性率为9.0%(95%CI 8.0~10.0)，1047例HIV阴性妇女目测阳性率为3.9%(95%CI 2.7~5.1)(P<；10~4)。在多因素分析中，HIV感染与目视检查阳性的风险[OR=2.28(95%可信区间1.61~3.23)]以及宫颈管内病变范围较大[OR=2.42(95%可信区间1.15~5.08)]相关。使用基于电话的跟踪程序使初次阳性筛查后不去看医生的妇女显著减少，从36.5%降至19.8%(p<；10-4)。艾滋病毒阳性妇女的阳性目视检查频率较高，这表明有必要将宫颈癌筛查计划扩展到西非的所有艾滋病毒诊所。在宫颈筛查项目中，女性在接受积极筛查后失去随访是一个主要问题，但在一定程度上要服从电话跟踪程序。
Cervical cancer screening is not yet standard of care of women attending HIV care clinics in Africa and presents operational challenges that need to be addressed. A cervical cancer screening program based on visual inspection methods was conducted in clinics providing antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire. An itinerant team of midwives was in charge of proposing cervical cancer screening to all HIV-positive women enrolled in ART clinics as well as to HIV-negative women who were attending the Abidjan national blood donor clinic. Positively screened women were systematically referred to a colposcopic examination. A phone-based tracking procedure was implemented to reach positively screened women who did not attend the medical consultation. The association between HIV status and cervical cancer screening outcomes was estimated using a multivariate logistic model. The frequency of positive visual inspection was 9.0% (95% CI 8.0-10.0) in the 2,998 HIV-positive women and 3.9% (95% CI 2.7-5.1) in the 1,047 HIV-negative ones (p < 10-4). In multivariate analysis, HIV infection was associated with a higher risk of positive visual inspection [OR = 2.28 (95% CI 1.61-3.23)] as well as more extensive lesions involving the endocervical canal [OR = 2.42 (95% CI 1.15-5.08)]. The use of a phone-based tracking procedure enabled a significant reduction of women not attending medical consultation after initial positive screening from 36.5% to 19.8% (p < 10-4). The higher frequency of positive visual inspection among HIV-positive women supports the need to extend cervical cancer screening program to all HIV clinics in West Africa. Women loss to follow-up after being positively screened is a major concern in cervical screening programs but yet, partly amenable to a phone tracking procedure.
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DOI：
10.1016/j.bpobgyn.2011.08.003
发表时间：
2012-04-01
影响因子：
5.5
作者：
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影响因子：
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影响因子：
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