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Interventions and Strategies to Increase Cervical Cancer Screening, Treatment, and Retention in Care among Persons
Riya Mittal1, Katherine E Kabel1, Madison R Fertig1
1Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
Insights
Integrating community leaders and non-physician providers in HIV clinics improves cervical cancer (CC) awareness, screening, and treatment for women living with HIV in low-income countries.
Area of Science:
- Public Health
- Oncology
- Infectious Diseases
Background:
- Cervical cancer (CC) and HIV are significant global health issues, disproportionately affecting low- and middle-income countries (LMICs).
- Women living with HIV (WWH) face a six-fold higher risk of developing CC and it is the leading cause of cancer death among them.
- Effective interventions are crucial to address the dual burden of HIV and CC in LMICs.
Purpose of the Study:
- To systematically review and identify effective intervention components for increasing CC awareness, screening, treatment, and retention in care among people with HIV in LMICs.
- To synthesize findings from peer-reviewed literature over the past decade.
Main Methods:
- A systematic review of four databases was conducted, focusing on interventions implemented in the last 10 years.
- Ten peer-reviewed articles describing and assessing the effectiveness of interventions were identified and analyzed.
- Interventions targeting CC awareness, screening, treatment, and retention in care among individuals with HIV were included.
Main Results:
- Interventions involving community/spiritual leaders, trained non-physician providers, and utilizing existing health facilities (HIV, family planning, reproductive health) showed higher engagement.
- "Screen and treat" approaches and visual inspection methods (VIA/VILI) were associated with improved CC awareness, screening, treatment initiation, and retention.
- Most studies emphasized awareness, screening, and initial engagement, highlighting a gap in interventions for sustained retention in CC care.
Conclusions:
- Integrated interventions leveraging community engagement and existing healthcare infrastructure are effective for improving CC care continuum for WWH.
- There is a critical need for interventions specifically designed to enhance long-term retention in CC care among WWH.
- Future research should incorporate longer follow-up periods to accurately assess sustained retention in care.
Abstract:
Cervical cancer (CC) and HIV pose two major public health challenges, with low and middle-income countries (LMICs) exhibiting the highest disease burden and mortality rate for both HIV and CC-related deaths worldwide. Populations with HIV in LMICs are six times more likely to develop CC compared to the general population. Further, CC is the most frequently detected cancer and leading cause of death among women with HIV (WWH). This systematic review synthesized the literature and identified key elements of interventions to increase CC awareness, screening, treatment, and retention in care among persons with HIV in LMICs. Four databases were searched for peer reviewed articles in the last 10 years that described and assessed the effectiveness of these interventions, and 10 articles were identified and reviewed. Interventions that included community/spiritual leaders, trained non-physician medical providers, used pre-existing facilities (e.g. HIV, family planning, reproductive health), integrated "screen and treat" approaches, and used visual inspection methods (VIA/VILI; excluding Pap smears) were associated with higher rates of CC awareness, screening, engagement in subsequent treatment, and overall retention in care. Most studies focused on increasing awareness, screening, and engagement in care, demonstrating the need for interventions that are also designed to increase retention in the CC continuum of care among WWH. Additionally, few interventions had long follow-up periods, which should be included to effectively track sustained retention in care.
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