Search

Objective: To examine the feasibility of a community-based screening program using human papillomavirus (HPV) self-sampling in a low-income country with a high burden of cervical cancer., Methods: A pilot study was conducted among 205 women aged 30-69years in the Kisenyi district of Kampala, Uganda, from September 5 to October 30, 2011. Women were invited to provide a self-collected specimen for high-risk oncogenic HPV testing by outreach workers at their homes and places of gathering in their community. Specimens were tested for HPV, Neisseria gonorrhoeae and Chlamydia trachomatis. Women who tested positive for HPV were referred for colposcopy, biopsy, and treatment at a regional hospital., Results: Of the 199 women who provided a specimen, 35 (17.6%) tested positive for HPV. The outreach workers were able to provide results to 30 women (85.7%). In all, 26 (74.3%) of the women infected with HPV attended their colposcopy appointments and 4 (11.4%) women were diagnosed with grade 3 cervical intraepithelial neoplasia., Conclusion: Self-collection of samples for community-based HPV testing was an acceptable option; most women who tested positive attended for definitive treatment. Self-sampling could potentially allow for effective recruitment to screening programs in limited-resource settings., (Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine the prevalence of and factors associated with urologic complications among women with advanced cervical cancer before treatment in Uganda., Methods: In total, 283 women with histologically confirmed stage IIB-IVB cervical cancer who were admitted to Mulago Hospital over a 6-month period were studied. Abdominopelvic scan was carried out to check for hydronephrosis and hydroureter and to measure the tumor volume. Serum creatinine and urea levels were measured, and the presence of anuria and vesicovaginal fistula (VVF) was ascertained from self-reporting and clinical records., Results: Urologic complications were present in 138 (48.8%) women. Hydronephrosis, VVF, hydroureter, and anuria were present in 112 (39.6%), 21 (7.4%), 11 (3.9%), and 9 (3.2%) women, respectively; serum creatinine and urea levels were elevated in 48 (17.0%) women. Stage of disease was significantly associated with urologic complications: stage IIIB odds ratio (OR) 3.36 (95% confidence interval [CI], 1.57-7.20); stage IVA OR 17.10 (95% CI, 6.07-48.16); P<0.001., Conclusion: There is a high prevalence of urologic complications among women with advanced cervical cancer; these complications are significantly associated with the stage of cervical cancer., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To assess women's willingness to collect their own samples for HPV testing as the first part of a screening program for cervical cancer in Uganda., Methods: In March and April 2010, trained assistants from Kisenyi interviewed 300 women aged 30 to 65 years who lived and/or worked in this community. Descriptive data and multivariate modeling were used to identify the predictors of the women's willingness to collect their own cervical samples., Results: More than 80% of the 300 participants were willing to collect their own samples. In multivariate modeling, factors positively associated with this willingness were agreement to let outreach workers deliver the necessary swab at their homes (adjusted odds ratio [AOR], 4.10; 95% confidence interval [CI], 1.83-9.18) and willingness to undergo a pelvic examination if the sample was abnormal (AOR, 3.91; 95% CI,1.03-14.90). Factors negatively associated were embarrassment at collecting the sample at home where they lacked privacy (AOR, 0.09; 95% CI, 0.03-0.29) and concern of not collecting the sample properly (AOR, 0.1; 95% CI, 0.05-0.3)., Conclusion: Self-collection is an option in impoverished settings in Africa. To improve acceptability, women should be taught how to properly collect their own cervical sample and encouraged to find ways to make the collection less embarrassing., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)