Effectiveness of an mHealth intervention to increase adherence to triage of HPV DNA positive women who have performed self-collection (the ATICA study): A hybrid type I cluster randomised effectiveness-implementation trial.

Background: Human Papillomavirus (HPV) self-collection offered by community health workers (CHWs) during home visits has been hampered by low levels of triage Pap among HPV-positive women. We investigated effectiveness of a mHealth intervention to increase adherence to triage Pap. Methods: We conducted a hybrid type I cluster randomised effectiveness-implementation trial in Jujuy, Argentina. CHWs (clusters) were eligible if actively offering HPV self-collection and served at least 26 women aged 30 years and over. Women were eligible if they conducted self-collection and provided a mobile phone number. 260 CHWs were randomly allocated (3:2 ratio) to a multi-component intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), or control group (Usual care: Women instructed to attend their health centre 30 days after HPV self-collection to pick-up results). The primary effectiveness outcome was percentage of HPV-positive women with triage 120 days after the HPV-test result. We evaluated implementation of the intervention using the RE-AIM framework. Findings: 221 CHWs (132 intervention, 89 control group) contacted 5389 women; and 5351 agreed to participate (3241 intervention, 2110 control group). In total 314/445 (70·5%) HPV-positive women of the intervention group had triage at 120 days after the HPV result, compared to 163/292 (55·1%) in the control group: 15·5% point improvement; 95%CI: 6·8-24·1; relative risk: 1·28; 95%CI: 1·11-1·48. 97·2% of women accepted the intervention and 86·9% of CHWs agreed to its adoption. Interpretation: The multicomponent mHealth intervention was effective in increasing the percentage of HPV-positive women who had triage Pap, allowing for many more women at risk of cervical cancer to receive timely follow-up. Funding: National Cancer Institute of the National Institutes of Health (USA) under Award Number R01CA218306.

Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study.

BACKGROUND: Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011-14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection was introduced as a programmatic strategy in 2014. We aimed to evaluate the effectiveness of programmatic HPV testing to detect cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) in comparison with cytology-based screening. METHODS: We did a population-based, before-and-after retrospective cohort study using data from the National Cervical Cancer Prevention Program for the Jujuy province in northwest Argentina. We obtained data for the cytology-based screening period from Jan 1, 2010, until Dec 31, 2011, and for the HPV-based screening period from Jan 1, 2012, until Dec 31, 2014. The primary outcome was detection of histologically diagnosed CIN2+ among women aged 30 years and older. To assess the outcomes in all individuals included in the study, we used multivariable logistic regression and propensity score matching. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used for the before-and-after analysis of programmatic dimensions. FINDINGS: Of the 29 631 women who underwent cytology-based screening in 2010-11, CIN2+ was detected in 236 (0·8%) individuals. Of the 49 565 women HPV tested in 2012-14 (clinician-collected tests, n=44 700; self-collection tests, n=4865), 693 (1·4%; 658 clinician-collected tests; 35 self-collection tests) were found to have CIN2+ after the first round of screening. Compared with cytology-based screening, the odds ratio of being diagnosed with a CIN2+ lesion was 2·34 (95% CI 2·01-2·73; p<0·0010) with clinician-collected tests, and 1·08 (0·74-1·52; p=0·68) when screened with self-collection tests, after controlling for age and health insurance status. Screening coverage was similar in both periods (52·7% vs 53·2%); improvements of programmatic indicators were observed in the HPV testing period in relation to laboratory centralisation, lower overscreening (6·6% vs 0·0%), higher adherance to age recommendations (79·3% vs 98·8%), and a decrease of inadequate samples (3·6% vs 0·2%). INTERPRETATION: HPV testing in middle-income settings increases detection of CIN2+ lesions and allows for improvement of programmatic indicators. Evidence suggests that the introduction of HPV testing will accelerate the reduction of cervical cancer burden. FUNDING: Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.

Itinerarios terapéuticos en salud mental: estudio exploratorio en sujetos con padecimientos psíquicos severos en la Quebrada de Humahuaca, Argentina / Therapeutic itineraries in mental health: an exploratory study in subjects with severe mental illnesses in the Quebrada de Humahuaca, Argentina

INTRODUCCION: En Argentina, pese a las recientes acciones emprendidas desde la Dirección Nacional de Salud Mental y Adicciones y a la importancia atribuida por algunos organismos internacionales, poco se sabe respecto a la magnitud, el impacto, los riesgos y las características que conlleva el proceso de salud/enfermedad mental y atención.OBJETIVO: Describir y analizar, a la luz de experiencias concretas, los itinerarios terapéuticos desarrollados por sujetos con padecimientos psíquicos severos/esquizofrenia en el área programática XVI, dependiente del Hospital Maimará en la provincia de Jujuy.METODOS: Se realizó un estudio descriptivo exploratorio de corte cualitativo, que contempló diversas técnicas de recolección de datos: observación participante en puestos de salud, entrevistas abiertas tanto a efectores del sistema formal e informal de atención como a familiares de usuarios de los servicios de salud mental y relatos de vida a través de entrevistas en profundidad. Se buscó delinear la configuración del campo de la salud mental en la zona, describir dinámicas estructurales del sistema formal de atención, analizar acciones de los efectores de salud frente a los sujetos afectados y comprender el contexto sociocultural de los usuarios.RESULTADOS: Se identificaron dos modelos coexistentes de atención a la enfermedad: el biomédico y el tradicional o popular. Esto puso en evidencia que las organizaciones formales no son el único territorio donde se despliegan las prácticas de salud.CONCLUSIONES: Los circuitos y recursos aplicados para sostenerse y enfrentar la cotidianeidad con un padecimiento mental involucran aspectos sociorelacionales, que incluyen desde relaciones de vecindad hasta la inserción en espacios religiosos. A su vez, se verificaron limitaciones y deudas por parte del sistema formal de atención, así como la inexistencia de prácticas dirigidas a promover la salud mental y prevenir enfermedades en ese campo.

INTRODUCTION: In Argentina, despite recent action undertaken by the National Department of Mental Health and Addictions and the importance attributed by some international organizations, little is known about the magnitude, impact, risk and characteristics associated with the process of health / mental illnes and care.OBJECTIVE: To describe and analyze, in light of concrete experiences, therapeutic itineraries developed by individuals with severe mental disorders / schizophrenia living in the program area XVI, which depends on the Hospital Maimará in the province of Jujuy.METHODS: A descriptive, exploratory, qualitative study was conducted, which included various data collection techniques: participant observation at health posts, open interviews with both effectors of the formal and informal health care system and relatives of users of mental health services, adn life stories through in-depth interviews. These components were aimed at outlining the configuration of the mental health field in the area, describing structural dynamics of the formal care system, analyzing the actions of health effectors towards affected subjects, understanding the socio-cultural context of users, and dealing with the applied practices to manage the disease from their own perspective.RESULTS: Two co-existing models of care were identified: the biomedical model and the popular or traditional one, showing that formal organizations are not the only territory in which health practices take place.CONCLUSIONS: The circuits and resources necessary to stand and face the everyday life with a mental illnes involve socio-relational aspects, ranging from neighborhood relations to integration in religious spaces. In turn, the formal system of care shows restrictions and drawbacks as well as lack of experience in promoting mental health and preventing diseases in this field.

Itinerarios terapéuticos en salud mental: estudio exploratorio en sujetos con padecimientos psíquicos severos en la Quebrada de Humahuaca, Argentina / Therapeutic itineraries in mental health: an exploratory study in subjects with severe mental illnesses in the Quebrada de Humahuaca, Argentina

INTRODUCCION: En Argentina, pese a las recientes acciones emprendidas desde la Dirección Nacional de Salud Mental y Adicciones y a la importancia atribuida por algunos organismos internacionales, poco se sabe respecto a la magnitud, el impacto, los riesgos y las características que conlleva el proceso de salud/enfermedad mental y atención.OBJETIVO: Describir y analizar, a la luz de experiencias concretas, los itinerarios terapéuticos desarrollados por sujetos con padecimientos psíquicos severos/esquizofrenia en el área programática XVI, dependiente del Hospital Maimará en la provincia de Jujuy.METODOS: Se realizó un estudio descriptivo exploratorio de corte cualitativo, que contempló diversas técnicas de recolección de datos: observación participante en puestos de salud, entrevistas abiertas tanto a efectores del sistema formal e informal de atención como a familiares de usuarios de los servicios de salud mental y relatos de vida a través de entrevistas en profundidad. Se buscó delinear la configuración del campo de la salud mental en la zona, describir dinámicas estructurales del sistema formal de atención, analizar acciones de los efectores de salud frente a los sujetos afectados y comprender el contexto sociocultural de los usuarios.RESULTADOS: Se identificaron dos modelos coexistentes de atención a la enfermedad: el biomédico y el tradicional o popular. Esto puso en evidencia que las organizaciones formales no son el único territorio donde se despliegan las prácticas de salud.CONCLUSIONES: Los circuitos y recursos aplicados para sostenerse y enfrentar la cotidianeidad con un padecimiento mental involucran aspectos sociorelacionales, que incluyen desde relaciones de vecindad hasta la inserción en espacios religiosos. A su vez, se verificaron limitaciones y deudas por parte del sistema formal de atención, así como la inexistencia de prácticas dirigidas a promover la salud mental y prevenir enfermedades en ese campo.

INTRODUCTION: In Argentina, despite recent action undertaken by the National Department of Mental Health and Addictions and the importance attributed by some international organizations, little is known about the magnitude, impact, risk and characteristics associated with the process of health / mental illnes and care.OBJECTIVE: To describe and analyze, in light of concrete experiences, therapeutic itineraries developed by individuals with severe mental disorders / schizophrenia living in the program area XVI, which depends on the Hospital Maimará in the province of Jujuy.METHODS: A descriptive, exploratory, qualitative study was conducted, which included various data collection techniques: participant observation at health posts, open interviews with both effectors of the formal and informal health care system and relatives of users of mental health services, adn life stories through in-depth interviews. These components were aimed at outlining the configuration of the mental health field in the area, describing structural dynamics of the formal care system, analyzing the actions of health effectors towards affected subjects, understanding the socio-cultural context of users, and dealing with the applied practices to manage the disease from their own perspective.RESULTS: Two co-existing models of care were identified: the biomedical model and the popular or traditional one, showing that formal organizations are not the only territory in which health practices take place.CONCLUSIONS: The circuits and resources necessary to stand and face the everyday life with a mental illnes involve socio-relational aspects, ranging from neighborhood relations to integration in religious spaces. In turn, the formal system of care shows restrictions and drawbacks as well as lack of experience in promoting mental health and preventing diseases in this field.