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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Utilization of Cervical Cancer Screening Services and Trends in Screening Positivity Rates in a 'Screen-And-Treat' Program Integrated with HIV/AIDS Care in Zambia
PLoS ONE, Volume 8, No. 9, Article e74607, Year 2013
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Description
Background:In the absence of stand-alone infrastructures for delivering cervical cancer screening services, efforts are underway in sub-Saharan Africa to dovetail screening with ongoing vertical health initiatives like HIV/AIDS care programs. Yet, evidence demonstrating the utilization of cervical cancer prevention services in such integrated programs by women of the general population is lacking.Methods:We analyzed program operations data from the Cervical Cancer Prevention Program in Zambia (CCPPZ), the largest public sector programs of its kind in sub-Saharan Africa. We evaluated patterns of utilization of screening services by HIV serostatus, examined contemporaneous trends in screening outcomes, and used multivariable modeling to identify factors associated with screening test positivity.Results:Between January 2006 and April 2011, CCPPZ services were utilized by 56,247 women who underwent cervical cancer screening with visual inspection with acetic acid (VIA), aided by digital cervicography. The proportion of women accessing these services who were HIV-seropositive declined from 54% to 23% between 2006-2010, which coincided with increasing proportions of HIV-seronegative women (from 22% to 38%) and women whose HIV serostatus was unknown (from 24% to 39%) (all p-for trend<0.001). The rates of VIA screening positivity declined from 47% to 17% during the same period (p-for trend <0.001), and this decline was consistent across all HIV serostatus categories. After adjusting for demographic and sexual/reproductive factors, HIV-seropositive women were more than twice as likely (Odds ratio 2.62, 95% CI 2.49, 2.76) to screen VIA-positive than HIV-seronegative women.Conclusions:This is the first 'real world' demonstration in a public sector implementation program in a sub-Saharan African setting that with successful program scale-up efforts, nurse-led cervical cancer screening programs targeting women with HIV can expand and serve all women, regardless of HIV serostatus. Screening program performance can improve with adequate emphasis on training, quality control, and telemedicine-support for nurse-providers in clinical decision making. © 2013 Mwanahamuntu et al.
Authors & Co-Authors
Mwanahamuntu, Mulindi H.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
Sahasrabuddhe, Vikrant V.
United States, Nashville
Vanderbilt University
Blevins, Meridith L.
United States, Nashville
Vanderbilt University
Kapambwe, Sharon
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Shepherd, Bryan Earl
United States, Nashville
Vanderbilt University
Chibwesha, Carla J.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Pfaendler, Krista S.
United States, Cincinnati
University of Cincinnati
Mkumba, Gricelia
Zambia, Lusaka
University Teaching Hospital Lusaka
Vwalika, Bellington
Zambia, Lusaka
University Teaching Hospital Lusaka
Hicks, Michael L.
United States, Pontiac
Michigan Cancer Institute
Vermund, Sten Havlor
United States, Nashville
Vanderbilt University
Stringer, Jeffrey S.A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Parham, Groesbeck Preer
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 70
Authors: 13
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0074607
e-ISSN:
19326203
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Case-Control Study
Study Locations
Zambia
Participants Gender
Female