Sexual and reproductive health and HIV services: Integrating HIV/AIDS and cervical cancer prevention and control

Belhadj, H.; Rasanathan, Jennifer; Denny, Lynette; Broutet, Nathalie

doi:10.1016/j.ijgo.2013.02.002

Cited by 16 publications

(12 citation statements)

References 51 publications

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“…Of all worldwide cases, 85% are associated with human papillomavirus (HPV) infection (5), the most common sexually transmitted infection worldwide (6). Similar to other HPV-related malignancies (7,8), a higher burden of anal cancer has been found in people living with HIV/AIDS than has been detected in the general population (3,7,9). There is a demand for an experienced workforce with expertise in the diagnosis and treatment of the anal cancer precursor, high-grade squamous intraepithelial lesion (HSIL) (10).…”

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confidence: 73%

30. Recognising and treating anal cancer: training medical students and physicians in Puerto Rico

et al. 2013

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Background Knowledge about epidemiology, diagnosis and treatment of anal neoplasia is limited among medical students and physicians from Puerto Rico (PR). Methods: Educational activity (1.5 contact hours) about anal cancer for a group of medical students, residents and faculty from the University of PR (n = 50). A 6-item pre- and post-test on anal cancer was given to assess the change in knowledge. Results: Thirty-four participants (68%) answered the survey. Overall, 78.8% had not received training in anal cancer screening and 93.9% were interested in receiving this training. Most (75.8%) were interested in participating in a clinical trial. An increase in the test scores was observed after the activity (pre-test: 3.4 ± 1.2; post-test: 4.7 ± 0.71). Three items showed an increment in the post-test that assessed participants’ knowledge regarding: (1) current status of guidelines for the screening/treatment of patients with HPV-related anal disease; (2) that anal intraepithelial neoplasia (AIN) 2 is considered to be a form of high-grade AIN (HGAIN); and (3) that warty growths in the anus are not necessarily a manifestation of HGAIN. Conclusions: This educational activity increased the participants’ knowledge of anal cancer and revealed that most of them were interested in future training and in collaborating in clinical trials. Training physicians from PR on anal cancer and clinical trials is essential to encourage recruitment of Hispanic patients in these studies now that the guidelines in anal cancer screening and treatment are on their way to being defined.

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confidence: 73%

30. Recognising and treating anal cancer: training medical students and physicians in Puerto Rico

et al. 2013

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“…This is not the case in South Africa’s public sector. Similar to many other low and middle income country settings, South Africa’s public sector is plagued by high numbers of inadequate cervical smears, often as the result of poor collection techniques [ 30 ]. Women with inadequate smears must be called back for a repeat test, presenting an opportunity for loss to follow up.…”

Section: Discussionmentioning

confidence: 99%

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa

et al. 2015

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BackgroundSouth Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa.MethodsMethod effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing.ResultsVIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition.ConclusionsWomen need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

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“…8 Although cervical cancer rates have declined to <10/100,000 person years in the USA, the rates in sub-Saharan Africa are 30–40/100,000 person years in the general population 9 and are 3–5 times higher among HIV-infected women. 10, 11 The prevalence of cervical HR-HPV infection is high among HIV-infected women from sub-Saharan Africa and multiple HR-HPV infections are often detected. 12, 13 Cervical HR-HPV infection and dysplasia have been shown to be correlated with anal HR-HPV infection and dysplasia.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa

Goeieman

Firnhaber

Jong³

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings. METHODS A cross-sectional study of HIV-infected women age 25–65 recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high resolution anoscopy (HRA) with biopsy of visible lesions. RESULTS Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On HRA, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%. CONCLUSION We found a significant burden of anal HR-HPV infection, abnormal anal cytology and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.

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Sexual and reproductive health and HIV services: Integrating HIV/AIDS and cervical cancer prevention and control

Cited by 16 publications

References 51 publications

30. Recognising and treating anal cancer: training medical students and physicians in Puerto Rico

30. Recognising and treating anal cancer: training medical students and physicians in Puerto Rico

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa

Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa

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