Evaluation of the effectiveness of high-risk human papilloma self-sampling test for cervical cancer screening in Bolivia.

BACKGROUND: In Bolivia the incidence and mortality rates of uterine cervix cancer are the highest in America. The main factor contributing to this situation is the difficulty of establishing and maintaining quality prevention programs based on cytology. We aimed to evaluate the effectiveness of HR-HPV testing on self-collected samples to detect cervical intra-epithelial neoplasia and identify the best combination of screening tests. METHODS: A total of 469 women, divided in two groups, were included in this study. The first group included 362 women that underwent three consecutively primary screening tests: self-collected sampling for HR-HPV detection, conventional cervical cytology and visual inspection under acetic acid (VIA). The second group included 107 women referred with a positive HR-HPV test that underwent conventional cervical cytology and VIA. The presence of high grade intraepithelial lesion (CIN 2+) or invasive cancer was verified by colposcopy and biopsy. RESULT: In the screening group the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer were 100, 76, 44% for the VIA, HR-HPV test and cytology, respectively. In the referred group, the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer by VIA and cytology were 100 and 81%, respectively. CONCLUSIONS: VIA and HR-HPV self-sampling were the best combination to detect CIN2+ lesions. Cytology analysis gave the poorest performance.

Evaluation of the self-sampling for cervical cancer screening in Bolivia.

BACKGROUND: Incidence and mortality rates of cervical cancer in Bolivia are the highest in Latin America. Vaginal cell self-sampling can improve screening coverage. Information on common reasons for low screening coverage and preferences for future screening are essential to reduce cervical cancer incidence. We aimed to evaluate the knowledge about human papillomavirus (HPV) and cervical cancer of Bolivian women from urban, peri-urban and rural areas of Cochabamba and to determine their degree of acceptability and confidence towards vaginal HPV self-sampling. In addition, we assessed the impact of self-sampling on cervical cancer screening coverage in a selected peri-urban area. METHODS: We gathered information from women living in urban, peri-urban and rural areas of Cochabamba province in Bolivia using two different structured questionnaires. In Survey1, we collected information from 222 women about their knowledge on HPV and cervical cancer. In Survey 2, the acceptance and confidence towards vaginal HPV self-sampling compared to the physician-sampling was assessed in 221 women. A non-probabilistic stratified sampling by areas was carried out for the two questionnaires. In the third phase of the study, we determined the impact of HPV self-sampling collection on screening coverage in a peri-urban area of Cochabamba. RESULTS: Bolivian women knew little or nothing about cervical cancer and HPV infection in all areas. They all found self-sampling collection easier to perform (86.9 to 93.2%) and more comfortable (79.4 to 83.3%) compared to physician sampling. Sampling accuracy to detect cervical cancer was probably higher in their point of view when it was taken by physician (35.1 to 63.5%). However in rural areas women preferred self-sampling. Accordingly, the campaign of vaginal HPV self-sampling in this peri-urban area increased screening coverage, reaching in three months the annual rate average. CONCLUSIONS: The knowledge about cervical cancer and HPV infection is poor in Bolivia. Despite greater acceptance of the vaginal HPV self-sampling in all areas, women kept greater confidence in the screening performed by the gynecologist although HPV self-sampling improved coverage rate.

Self-sampling for human papillomavirus DNA detection: a preliminary study of compliance and feasibility in BOLIVIA.

BACKGROUND: Cervical cancer incidence and mortality rates in Bolivia are among the highest in Latin America. This investigation aims to evaluate the possibility of using simple devices, e.g. a cotton swab and a glass slide, for self-sampling in order to detect human papillomavirus (HPV) DNA by PCR in cervico-vaginal cells. METHODS: In the first phase of our study we evaluated the use of a glass slide as a transport medium for cervical cells. A physician took paired-cervical samples from 235 women. One sample was transported in Easyfix® solution and the other sample was smeared over a glass slide. Both were further analyzed and compared for human DNA recovery and HPV detection. A kappa value was determined to evaluate the agreement between the HPV DNA detection rates. In the second phase of the study, 222 women from the urban, peri-urban and rural regions of Cochabamba were requested to perform self-sampling using the following devices: a cotton swab combined with a glass slide, and a vaginal tampon. Women gave their opinion about the self-sampling technique. Finally, the agreement for high risk-HPV detection between self- and physician-collected samples was performed in 201 samples in order to evaluate the self-sampling technique. RESULTS: Firstly, the comparison between Easyfix® solution and the glass slide to transport clinical samples gave a good agreement for HPV DNA detection (κ = 0.71, 95% CI 0.60-0.81). Secondly, self-sampling, especially with cotton swab combined with glass slide, would generally be preferred over clinician sampling for a screening program based on HPV detection. Finally, we showed a good agreement between self- and physician collected samples for high risk-HPV detection (κ = 0.71, 95% CI 0.55-0.88). CONCLUSIONS: Simple devices such as a cotton swab and a glass slide can be used to perform self-sampling and HPV DNA detection. Furthermore, most Bolivian women preferred self-sampling over clinician-sampling for cervical cancer screening.

LA ESCUELA DE SALUD PUBLICA: SUS ORÍGENES22° parte / SCHOOL OF HEALTH PUBLISHER: ORIGINS 22 ° parte

Breve relato de la historia síntesis informativa de las acciones desarrolladas durante este vigésimo segundo año consecutivo de formación de posgrado, bajo la direccióndel Prof. Dr. Luis César Abed de la Escuela de Salud Pública de la Facultad de Ciencias Médicas de laUniversidad Nacional de Córdoba.

Brief account of the history informative synthesis of the actions developed during this twenty-second year of postgraduate training under the direccióndel Prof. Dr. Luis César Abed School of Public Health, Faculty of Medical Sciences The University of Cordoba National.

La Escuela de Salud Pública: sus orígenes 23º nota / School of Public Health: its origins 23º note

Al finalizar las actividades del ciclo lectivo1996 laEscuela de Salud Pública de la Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba, eleva lasíntesis informativa de las acciones desarrolladas duranteeste vigésimo tercer año consecutivo de formación de posgrado, bajo la dirección del Prof. Dr. Luis CésarAbed.” Así comienza la memoria anual del año 1996.Este aporte para una nueva edición de la Revista de la Escuela de Salud Pública es otra entrega de quieneshemos sido testigos presenciales en la gestación y derrotero de esta importante institución de postgradode la Facultad de Ciencias Médicas, contando además con los anales memoriosos que permite rescatar lainformación presente...

La escuela de salud publica: sus orígenes: 11a. parte / School of public health: their origins. 11a. part

Para esta edición de la Revista de Salud Pública de la Escuela de Salud Pública una nueva entrega de quienes hemos sido testigos de la gestación y derrotero de estaimportante institución de la Facultad de Ciencias Médicasde la Universidad Nacional de Córdoba. Siempre con el mismo objetivo y utilizando las fuentesdocumentales, con los aportes y testimonios de los buceadoresde la memoria histórica que nos ayudan a comprender la realidad institucional y para ser sinceros con los lectores, hacerlos también partícipes del gran esfuerzo para conseguir la documentación pertinente. Siguiendo la cronología impuesta en las anteriores entregas veremos en la presente el ciclo lectivo 1984, y es al término de un año académico más, donde se elabora una ajustada síntesis informativa de las actividades docentes desarrolladas a lo largo del mismo.

Actualizaciones institucionales: la escuela de salud pública: su devenir histórico: 10a. parte / School of public health historis

La finalidad primordial del informe mencionado fue presentar una síntesis informativa de los aspectos académicos más relevantes de la Escuela de Salud Pública.

Regimenes profilacticos y de terapia inicial en cirugia abdominal / Prophylaxis and initial therapy in abdominal surgery

Se efectuo una revision de 126 historias clinicas de un total de 507 pertenecientes a pacientes intervenidos quirurgicamente en el IGBJ en el periodo 1990-1991, de los cuales en 90 historias se analizan los regimenes profilacticos y en 36 se analizan los regimenes de terapia inicial en pacientes con infecciones intra-abdominales. Concurrentemente se efectuo una revision de las sensibilidades in vitro de los micro-organismos aislados en 4 tipos de muestras; herida operatoria, bilis, secrecion peritoneal y secrecion de abscesos intra-abdominales, efectuados en el laboratorio de microbiologia de este Instituto. Se concluye que no se cumplieron criterios razonables en el uso de antibioticos profilacticos y de terapia inicial utilizandose esquemas con antiobioticos inadecuados en ralacion al perfil de resistencia detectados en este estudio. Se sugieren pautas para el uso de antibioticos profilacticos y regimenes en terapia inicial segun los patrones de sensibilidad local.