Evidence-based policy choices for efficient and equitable cervical cancer screening programs in low-resource settings.
Evidence-based policy choices for efficient and equitable cervical cancer screening programs in low-resource settings.
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DOI：
10.1002/cam4.1123
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发表时间：
2017-08
期刊：
影响因子：
4
通讯作者：
Kim JJ
中科院分区：
文献类型：
--
作者：
Campos NG;Tsu V;Jeronimo J;Mvundura M;Kim JJ
发展中国家的妇女不成比例地承受着子宫颈癌的负担。针对16型和18型人乳头瘤病毒（HPV）的预防性疫苗（约70%的宫颈癌是由这两种病毒引起的）的可获得性使人们有理由感到乐观，因为疫苗接种在全球疫苗免疫联盟的支持下开始推广。然而，对于数亿超过HPV疫苗接种目标年龄的妇女来说，宫颈癌筛查以发现和治疗癌前病变仍然是唯一的预防形式。在这里，我们描述了在低资源环境下筛查项目所面临的挑战，包括：(1)优化筛查试验的有效性；(2)实现目标人群的高筛查覆盖率；(3)筛查阳性妇女的管理。对于这些挑战，我们总结了资源利用和编程属性之间的权衡。然后，我们强调了有效和公平规划的机会，并从印度、尼加拉瓜和乌干达适宜卫生技术方案示范项目的数据中获得了最近的数学建模分析的支持证据。
Women in developing countries disproportionately bear the burden of cervical cancer. The availability of prophylactic vaccines against human papillomavirus (HPV) types 16 and 18, which cause approximately 70% of cervical cancers, provides reason for optimism as roll‐out begins with support from Gavi, the Vaccine Alliance. However, for the hundreds of millions of women beyond the target age for HPV vaccination, cervical cancer screening to detect and treat precancerous lesions remains the only form of prevention. Here we describe the challenges that confront screening programs in low‐resource settings, including (1) optimizing screening test effectiveness; (2) achieving high screening coverage of the target population; and (3) managing screen‐positive women. For each of these challenges, we summarize the tradeoffs between resource utilization and programmatic attributes. We then highlight opportunities for efficient and equitable programming, with supporting evidence from recent mathematical modeling analyses informed by data from the PATH demonstration projects in India, Nicaragua, and Uganda.
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影响因子：
39.2
作者：
Kim JJ;Campos NG;Sy S;Burger EA;Cuzick J;Castle PE;Hunt WC;Waxman A;Wheeler CM;New Mexico HPV Pap Registry Steering Committee
通讯作者：
New Mexico HPV Pap Registry Steering Committee
影响因子：
10.3
作者：
Denny, Lynette;Kuhn, Louise;Wright, Thomas C., Jr.
通讯作者：
Wright, Thomas C., Jr.
影响因子：
3.2
作者：
Campos, Nicole G.;Tsu, Vivien;Kim, Jane J.
通讯作者：
Kim, Jane J.
影响因子：
3.8
作者：
Joshi, Smita;Sankaranarayanan, Rengaswamy;Divate, Uma
通讯作者：
Divate, Uma
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