A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities.
A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities.
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DOI：
10.3389/fpubh.2021.670032
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发表时间：
2021
影响因子：
5.2
通讯作者：
Barnabas RV
中科院分区：
文献类型：
--
作者：
Shin MB;Liu G;Mugo N;Garcia PJ;Rao DW;Bayer CJ;Eckert LO;Pinder LF;Wasserheit JN;Barnabas RV
世界卫生组织宣布雄心勃勃地呼吁在全球消除宫颈癌。通过现有的预防和治疗方式，高收入国家消除宫颈癌已是触手可及。尽管中低收入国家的资金和能力有限，但可以通过综合服务和新技术支持防控工作。我们进行了这次范围界定审查，以概述中低收入国家消除宫颈癌的路线图，并强调加速消除宫颈癌的循证干预措施和研究重点。我们回顾并综合了 2010 年至 2020 年有关宫颈癌一级和二级预防策略的文献。此外，我们还对妇科和传染病提供者、研究人员以及中低收入国家卫生官员进行了专家访谈。利用这些数据，我们开发了一个逻辑模型来总结当前的科学状况，并确定每种预防策略的证据差距和优先研究问题。消除宫颈癌的逻辑模型反映了政策制定者、生产和供应、医疗保健系统、提供者、卫生工作者和社区之间改善合作的需求。该模型阐明了利益相关者的责任，并将流程可视化，以增加预防方法的获取和覆盖范围。我们讨论背景因素的挑战并强调创新需求。有效的预防方法包括 HPV 疫苗接种、目视检查和 HPV 检测筛查以及热凝。然而，中低收入国家的疫苗覆盖率仍然很低。包括单剂疫苗接种在内的新策略可以增强影响。随访损失和治疗延误可以通过改进的当天筛查和治疗技术来解决。我们提供了一个实用的框架来指导中低收入国家消除宫颈癌。范围界定审查强调了现有的和创新的战略、未满足的需求以及在实施环境中实现消除所需的合作。
The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
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作者：
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通讯作者：
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DOI：
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