The Experts below are selected from a list of 13113 Experts worldwide ranked by ideXlab platform
Mulindi H. Mwanahamuntu - One of the best experts on this subject based on the ideXlab platform.
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Partnering with traditional Chiefs to expand access to Cervical Cancer Prevention services in rural Zambia.
International Journal of Gynecology & Obstetrics, 2019Co-Authors: Sharon Kapambwe, Mulindi H. Mwanahamuntu, Leeya F. Pinder, Samson Chisele, Susan Chirwa, Groesbeck P. ParhamAbstract:Objective To evaluate how the influence of traditional Chiefs can be leveraged to promote access to Cervical Cancer Prevention services in rural Zambia. Methods A retrospective review of outcome data was conducted for all screening outreach events that occurred in Zambian Chiefdoms between October 4, 2015, and October 3, 2016. Members of the health promotion team of the Cervical Cancer Prevention Program in Zambia visited local Chiefs to inform them of the importance of Cervical Cancer Prevention. The local Chiefs then summoned adults living within their Chiefdoms to assemble for Cervical Cancer Prevention health talks. Screen-and-treat services were implemented within each of the Chiefdoms over a 1-week period. Results VIA-enhanced digital imaging of the cervix (digital cervicography) was offered to 8399 women in ten Chiefdoms as part of a village-based screening (VBS) program. In all, 419 (4.9%) women had positive screening test results. Of these women, 276 (65.8%) were treated immediately with thermocoagulation and 143 (34.1%) were referred to provincial government hospitals to undergo either the loop electrosurgical excision procedure/large loop excision of the transformation zone (n=109, 26.0%) or punch biopsy (n=34, 8.1%). Conclusion The influence of traditional Chiefs was leveraged to facilitate access to Cervical Cancer Prevention services in rural Zambia.
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population level scale up of Cervical Cancer Prevention services in a low resource setting development implementation and evaluation of the Cervical Cancer Prevention program in zambia
PLOS ONE, 2015Co-Authors: Groesbeck P. Parham, Sharon Kapambwe, Mulindi H. Mwanahamuntu, Carla J. Chibwesha, Richard Muwonge, Allen C Bateman, Meridith Blevins, Krista S. PfaendlerAbstract:Background Very few efforts have been undertaken to scale-up low-cost approaches to Cervical Cancer Prevention in low-resource countries. Methods In a public sector Cervical Cancer Prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Findings Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25–49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with Cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive Cervical Cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have Cervical preCancer and Cancer than HIV-negative women. Interpretation We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of Cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps.
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Cervical Cancer Prevention in Low- and Middle-Income Countries: Feasible, Affordable, Essential
Cancer prevention research (Philadelphia Pa.), 2011Co-Authors: Vikrant V. Sahasrabuddhe, Mulindi H. Mwanahamuntu, Groesbeck P. Parham, Sten H. VermundAbstract:The annual worldwide burden of the preventable disease Cervical Cancer is more than 530,000 new cases and 275,000 deaths, with the majority occurring in low- and middle-income countries (LMIC), where Cervical Cancer screening and early treatment are uncommon. Widely used in high-income countries, Pap smear (cytology based) screening is expensive and challenging for implementation in LMICs, where lower-cost, effective alternatives such as visual inspection with acetic acid (VIA) and rapid human papillomavirus (HPV)-based screening tests offer promise for scaling up Prevention services. Integrating HPV screening with VIA in “screen-and-treat-or-refer” programs offers the dual benefits of HPV screening to maximize detection and using VIA to triage for advanced lesions/Cancer, as well as a pelvic exam to address other gynecologic issues. A major issue in LMICs is coinfection with human immunodeficiency virus (HIV) and HPV, which further increases the risk for Cervical Cancer and marks a population with perhaps the greatest need of Cervical Cancer Prevention. Public–private partnerships to enhance the availability of Cervical Cancer Prevention services within HIV/AIDS care delivery platforms through initiatives such as Pink Ribbon Red Ribbon present an historic opportunity to expand Cervical Cancer screening in LMICs. Cancer Prev Res; 5(1); 11–17. ©2011 AACR .
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Advancing Cervical Cancer Prevention initiatives in resource-constrained settings: insights from the Cervical Cancer Prevention Program in Zambia.
PLoS medicine, 2011Co-Authors: Mulindi H. Mwanahamuntu, Sharon Kapambwe, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Victor Mudenda, Michael L. Hicks, Sten H. Vermund, Jeffrey S. A. StringerAbstract:Groesbeck Parham and colleagues describe their Cervical Cancer Prevention Program in Zambia, which has provided services to over 58,000 women over the past five years, and share lessons learned from the program's implementation and integration with existing HIV/AIDS programs.
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EC3-A modern telecommunications matrix for Cervical Cancer Prevention in Zambia
Journal of lower genital tract disease, 2010Co-Authors: Groesbeck P. Parham, Sharon Kapambwe, Mulindi H. Mwanahamuntu, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Daniel Myung, Bianca Mwanza, Michael L. HicksAbstract:Objectives: Low physician density undercapacitated laboratory infrastructures and limited resources are major limitations to the development and implementation of widely accessible Cervical Cancer Prevention programs in sub-Saharan Africa. Materials and methods: We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector Cervical Cancer Prevention program in Zambia one of the worlds poorest countries. Results: Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic Cervical Cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring evaluation and continued education of primary health care providers patient education and medical records documentation. Conclusions: The electronic Cervical Cancer control system uses appropriate technology to bridge the gap between screening and diagnosis thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.
Groesbeck P. Parham - One of the best experts on this subject based on the ideXlab platform.
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Partnering with traditional Chiefs to expand access to Cervical Cancer Prevention services in rural Zambia.
International Journal of Gynecology & Obstetrics, 2019Co-Authors: Sharon Kapambwe, Mulindi H. Mwanahamuntu, Leeya F. Pinder, Samson Chisele, Susan Chirwa, Groesbeck P. ParhamAbstract:Objective To evaluate how the influence of traditional Chiefs can be leveraged to promote access to Cervical Cancer Prevention services in rural Zambia. Methods A retrospective review of outcome data was conducted for all screening outreach events that occurred in Zambian Chiefdoms between October 4, 2015, and October 3, 2016. Members of the health promotion team of the Cervical Cancer Prevention Program in Zambia visited local Chiefs to inform them of the importance of Cervical Cancer Prevention. The local Chiefs then summoned adults living within their Chiefdoms to assemble for Cervical Cancer Prevention health talks. Screen-and-treat services were implemented within each of the Chiefdoms over a 1-week period. Results VIA-enhanced digital imaging of the cervix (digital cervicography) was offered to 8399 women in ten Chiefdoms as part of a village-based screening (VBS) program. In all, 419 (4.9%) women had positive screening test results. Of these women, 276 (65.8%) were treated immediately with thermocoagulation and 143 (34.1%) were referred to provincial government hospitals to undergo either the loop electrosurgical excision procedure/large loop excision of the transformation zone (n=109, 26.0%) or punch biopsy (n=34, 8.1%). Conclusion The influence of traditional Chiefs was leveraged to facilitate access to Cervical Cancer Prevention services in rural Zambia.
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population level scale up of Cervical Cancer Prevention services in a low resource setting development implementation and evaluation of the Cervical Cancer Prevention program in zambia
PLOS ONE, 2015Co-Authors: Groesbeck P. Parham, Sharon Kapambwe, Mulindi H. Mwanahamuntu, Carla J. Chibwesha, Richard Muwonge, Allen C Bateman, Meridith Blevins, Krista S. PfaendlerAbstract:Background Very few efforts have been undertaken to scale-up low-cost approaches to Cervical Cancer Prevention in low-resource countries. Methods In a public sector Cervical Cancer Prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Findings Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25–49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with Cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive Cervical Cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have Cervical preCancer and Cancer than HIV-negative women. Interpretation We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of Cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps.
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Cervical Cancer Prevention in Low- and Middle-Income Countries: Feasible, Affordable, Essential
Cancer prevention research (Philadelphia Pa.), 2011Co-Authors: Vikrant V. Sahasrabuddhe, Mulindi H. Mwanahamuntu, Groesbeck P. Parham, Sten H. VermundAbstract:The annual worldwide burden of the preventable disease Cervical Cancer is more than 530,000 new cases and 275,000 deaths, with the majority occurring in low- and middle-income countries (LMIC), where Cervical Cancer screening and early treatment are uncommon. Widely used in high-income countries, Pap smear (cytology based) screening is expensive and challenging for implementation in LMICs, where lower-cost, effective alternatives such as visual inspection with acetic acid (VIA) and rapid human papillomavirus (HPV)-based screening tests offer promise for scaling up Prevention services. Integrating HPV screening with VIA in “screen-and-treat-or-refer” programs offers the dual benefits of HPV screening to maximize detection and using VIA to triage for advanced lesions/Cancer, as well as a pelvic exam to address other gynecologic issues. A major issue in LMICs is coinfection with human immunodeficiency virus (HIV) and HPV, which further increases the risk for Cervical Cancer and marks a population with perhaps the greatest need of Cervical Cancer Prevention. Public–private partnerships to enhance the availability of Cervical Cancer Prevention services within HIV/AIDS care delivery platforms through initiatives such as Pink Ribbon Red Ribbon present an historic opportunity to expand Cervical Cancer screening in LMICs. Cancer Prev Res; 5(1); 11–17. ©2011 AACR .
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Cervical Cancer Prevention in HIV-infected women in resource-limited settings
HIV Therapy, 2010Co-Authors: Groesbeck P. ParhamAbstract:Groesbeck Parham is Professor of Gynecologic Oncology and Infectious Diseases in the Department of Medicine at the University of Alabama at Birmingham (AL, USA) and Director of the Centre for Infectious Disease Research in Zambia’s Cervical Cancer Prevention Program. A native Alabamian, Parham received his BA (1970) from Oberlin College, OH, USA, and medical degree (1981) from the University of Alabama in Birmingham. He completed an obstetrics and gynecology residency (1985) at the University of Alabama in Birmingham, a urogynecology fellowship (1986) at the University of London, UK, and Khartoum Teaching Hospital, Sudan, and a gynecologic oncology fellowship (1988) at the University of California, Irvine, CA, USA. He is a board-certified gynecologic oncologist. Parham moved to Lusaka, Zambia, in 2005 to establish the Centre for Infectious Disease Research in Zambia’s Cervical Cancer Prevention Program, which targets HIV-infected women. Before moving to Lusaka he served as director of the divisions of gyn...
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EC3-A modern telecommunications matrix for Cervical Cancer Prevention in Zambia
Journal of lower genital tract disease, 2010Co-Authors: Groesbeck P. Parham, Sharon Kapambwe, Mulindi H. Mwanahamuntu, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Daniel Myung, Bianca Mwanza, Michael L. HicksAbstract:Objectives: Low physician density undercapacitated laboratory infrastructures and limited resources are major limitations to the development and implementation of widely accessible Cervical Cancer Prevention programs in sub-Saharan Africa. Materials and methods: We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector Cervical Cancer Prevention program in Zambia one of the worlds poorest countries. Results: Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic Cervical Cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring evaluation and continued education of primary health care providers patient education and medical records documentation. Conclusions: The electronic Cervical Cancer control system uses appropriate technology to bridge the gap between screening and diagnosis thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.
Krista S. Pfaendler - One of the best experts on this subject based on the ideXlab platform.
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population level scale up of Cervical Cancer Prevention services in a low resource setting development implementation and evaluation of the Cervical Cancer Prevention program in zambia
PLOS ONE, 2015Co-Authors: Groesbeck P. Parham, Sharon Kapambwe, Mulindi H. Mwanahamuntu, Carla J. Chibwesha, Richard Muwonge, Allen C Bateman, Meridith Blevins, Krista S. PfaendlerAbstract:Background Very few efforts have been undertaken to scale-up low-cost approaches to Cervical Cancer Prevention in low-resource countries. Methods In a public sector Cervical Cancer Prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Findings Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25–49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with Cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive Cervical Cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have Cervical preCancer and Cancer than HIV-negative women. Interpretation We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of Cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps.
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Advancing Cervical Cancer Prevention initiatives in resource-constrained settings: insights from the Cervical Cancer Prevention Program in Zambia.
PLoS medicine, 2011Co-Authors: Mulindi H. Mwanahamuntu, Sharon Kapambwe, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Victor Mudenda, Michael L. Hicks, Sten H. Vermund, Jeffrey S. A. StringerAbstract:Groesbeck Parham and colleagues describe their Cervical Cancer Prevention Program in Zambia, which has provided services to over 58,000 women over the past five years, and share lessons learned from the program's implementation and integration with existing HIV/AIDS programs.
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EC3-A modern telecommunications matrix for Cervical Cancer Prevention in Zambia
Journal of lower genital tract disease, 2010Co-Authors: Groesbeck P. Parham, Sharon Kapambwe, Mulindi H. Mwanahamuntu, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Daniel Myung, Bianca Mwanza, Michael L. HicksAbstract:Objectives: Low physician density undercapacitated laboratory infrastructures and limited resources are major limitations to the development and implementation of widely accessible Cervical Cancer Prevention programs in sub-Saharan Africa. Materials and methods: We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector Cervical Cancer Prevention program in Zambia one of the worlds poorest countries. Results: Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic Cervical Cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring evaluation and continued education of primary health care providers patient education and medical records documentation. Conclusions: The electronic Cervical Cancer control system uses appropriate technology to bridge the gap between screening and diagnosis thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.
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Implementation of Cervical Cancer Prevention services for HIV-infected women in Zambia:
2010Co-Authors: Groesbeck P, Sharon Kapambwe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Victor Mudenda, Vikrant, Andrew O. Westfall, Kristin E. King, Sten H. VermundAbstract:Background: Cervical Cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost Cervical Cancer Prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. Methods: In our public sector Cervical Cancer Prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered samevisit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of Cervical Cancer deaths prevented through screening and treatment. Results: Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), Cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive Cervical Cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 Cervical Cancer deaths (high/low range: 238–96) among the 6572 HIV-infected women screened, or one Cervical Cancer death prevented per 46 (corresponding range: 28–68) HIV-infected women screened. Conclusion: Our Prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from Cervical Cancer among HIV-infected women in Zambia. Financial support for implementing Cervical Cancer Prevention programs integrated within HIV/AIDS care programs is warranted. Our Prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future Prevention efforts.
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Implementation of Cervical Cancer Prevention services for HIV-infected women in Zambia: measuring program effectiveness.
HIV therapy, 2010Co-Authors: Groesbeck P. Parham, Mulindi H. Mwanahamuntu, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Victor Mudenda, Andrew O. Westfall, Kristin E. King, Sharon KapambweAbstract:Background: Cervical Cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost Cervical Cancer Prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. Methods: In our public sector Cervical Cancer Prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of Cervical Cancer deaths prevented through screening and treatment. Results: Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for hist...
Stephen S. Raab - One of the best experts on this subject based on the ideXlab platform.
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Lessons learned from successful Papanicolaou cytology Cervical Cancer Prevention in the socialist republic of Vietnam
Diagnostic cytopathology, 2011Co-Authors: Eric J. Suba, Stephen S. RaabAbstract:In 1996, we documented that the burden of Cervical Cancer in Vietnam was associated with troop movements during the Vietnam War. Subsequently, establishment of Papanicolaou screening in southern Vietnam was associated with reductions in Cervical Cancer incidence from 29.2/100,000 in 1998 to 16/100,000 in 2003. This is one of the first English-language reports of a real-world Cervical Cancer Prevention effort associated with a decisive impact on health outcomes in a contemporary developing country. Lessons learned: if our ideological commitment is to improve health outcomes as rapidly as possible among as many people as possible, then Papanicolaou screening (with or without HPV or visual screening) must be implemented without further delay in any setting where Cervical screening is appropriate but unavailable; consideration must be given to HPV vaccination after, rather than before, full coverage of target demographic groups by screening services has been achieved and/or the possibility has been excluded that HPV vaccination may be ineffective for Cancer Prevention. Competing ideological commitments engender imprudent yet commercially useful alternative strategies prone to decelerate global reductions in mortality by suppressing the more-rapid uptake of less-expensive open-source technology in favor of the less-rapid uptake of more-expensive proprietary technologies with uncertain real-world advantages and unfavorable real-world operational limitations. Global Cervical Cancer Prevention efforts will become more effective if global health leaders, including the Bill & Melinda Gates Foundation, embrace an ideological commitment to improving health outcomes as rapidly as possible among as many people as possible and assimilate the policy implications of that commitment.
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Frequency and outcome of Cervical Cancer Prevention failures in the United States.
American journal of clinical pathology, 2007Co-Authors: Stephen S. Raab, Dana M. Grzybicki, Richard J. Zarbo, Chris S. Jensen, Stanley J. Geyer, Janine E. Janosky, Frederick A. Meier, Colleen M. Vrbin, Gloria Carter, Kim R. GeisingerAbstract:We measured the frequency and outcome of Cervical Cancer Prevention failures that occurred in the Papanicolaou (Pap) and colposcopy testing phases involving 1,646,580 Pap tests in 4 American hospital systems between January 1, 1998, and December 31, 2004. We defined a screening failure as a 2-step or greater discordant Pap test result and follow-up biopsy diagnosis. A total of 5,278 failures were detected (0.321% of all Pap tests); 48% and 52% of failures occurred in the Pap test and colposcopy phases, respectively. Missed squamous Cancers (1 in 187,786 Pap tests), glandular Cancers (1 in 19,426 Pap tests), and high-grade lesions (1 in 6,870 Pap tests) constituted 4.1% of all failures. Unnecessary repeated tests or diagnostic delays occurred in 70.8% and 63.9% of failures involving high- and low-grade lesions, respectively. We conclude that Cervical Cancer Prevention practices are remarkably successful in preventing squamous Cancers, although a high frequency of failures results in low-impact negative outcomes.
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Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries
American journal of public health, 2006Co-Authors: Eric J. Suba, Sean K. Murphy, Amber D Donnelly, Lisa M. Furia, My Linh D. Huynh, Stephen S. RaabAbstract:Papanicolaou screening is feasible anywhere that screening for Cervical Cancer, the leading cause of Cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of Cervical Cancer in Vietnam, we participated in a grassroots effort to establish a nationwide Cervical Cancer Prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful Cervical Cancer Prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.
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Coming to terms with Vietnam: the Viet/American Cervical Cancer Prevention Project.
Diagnostic cytopathology, 2005Co-Authors: Eric J. Suba, Amber D Donnelly, Lisa M. Furia, My Linh D. Huynh, Stephen S. RaabAbstract:The Viet/American Cervical Cancer Prevention Project embraces a dual mission. We seek to develop sustainable, cost-effective Cervical Cancer Prevention services for women in Vietnam. Because the problem of Cervical Cancer in Vietnam is in part a legacy of the Second Indochinese War, we also seek to examine obstacles to reconciliation by presenting what most acknowledge to be a remedy in advance of what some will perceive to be an accusation. Certain research and commercial interests have produced obstacles to our dual mission in Vietnam. The Alliance for Cervical Cancer Prevention, supported by the Bill and Melinda Gates Foundation, has failed to endorse Pap screening for developing countries and is conducting clinical trials which may further disaffect medically underserved groups. Visual screening techniques combined with immediate ablative treatment methods are incompatible with the requirements of “first do no harm.” Because the Pap smear will probably be a component of any future human papillomavirus (HPV)-based or visual- based screening programs, it serves the interests of those promoting noncytologic screening methods to also support the development of Pap screening services. Research on HPV screening in developing countries raises concerns of commercial exploitation. Because Pap screening is feasible wherever Cervical screening is appropriate, it is inappropriate to delay the development of Pap screening services pending research into HPV vaccines or alternative screening technologies. Quality management is the point at which public health and diagnostic pathology intersect and will remain an indispensable element of Cervical screening programs irrespective of the screening test(s) eventually used. Pap screening in developing countries is an ethical imperative without a substantial political constituency and will benefit from the engagement of organized cytology. Diagn. Cytopathol. 2005;33:344–351. © 2005 Wiley-Liss, Inc.
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The cost-effectiveness of the cytology laboratory and new cytology technologies in Cervical Cancer Prevention.
American journal of clinical pathology, 1999Co-Authors: Stephen S. RaabAbstract:The effect of changes in cytology laboratory costs, including the costs of new technologies, on the cost-effectiveness of Cervical Cancer Prevention has not been studied. Using University of Iowa laboratory detection rates and costs, a decision model determined the cost-effectiveness of the laboratory with and without new technologies. Compared with not performing a cervicovaginal smear, the cost to increase the discounted life expectancy per patient by 1 year was $2,805 for the laboratory component alone and $19,655 for the entire Cervical Cancer Prevention strategy. In moderate- to high-risk women, Cervical Cancer screening was cost-effective even at high cytology laboratory costs (eg, $75 per smear). New technologies were cost-effective only if they resulted in a substantial increase in the detection of high-grade squamous intraepithelial lesions (eg, an additional 236 high-grade squamous intraepithelial lesions per 10,000 women). New technologies have not demonstrated these increased detection rates.
Jeffrey S. A. Stringer - One of the best experts on this subject based on the ideXlab platform.
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Advancing Cervical Cancer Prevention initiatives in resource-constrained settings: insights from the Cervical Cancer Prevention Program in Zambia.
PLoS medicine, 2011Co-Authors: Mulindi H. Mwanahamuntu, Sharon Kapambwe, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Carla J. Chibwesha, Gracilia Mkumba, Victor Mudenda, Michael L. Hicks, Sten H. Vermund, Jeffrey S. A. StringerAbstract:Groesbeck Parham and colleagues describe their Cervical Cancer Prevention Program in Zambia, which has provided services to over 58,000 women over the past five years, and share lessons learned from the program's implementation and integration with existing HIV/AIDS programs.
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implementation of see and treat Cervical Cancer Prevention services linked to hiv care in zambia
AIDS, 2009Co-Authors: Mulindi H. Mwanahamuntu, Vikrant V. Sahasrabuddhe, Krista S. Pfaendler, Victor Mudenda, Michael L. Hicks, Sten H. Vermund, Jeffrey S. A. StringerAbstract:Greater than 80% of the world's new cases and deaths due to Cervical Cancer occur in the developing world [1]. No more than 5% of women in these settings are screened for Cervical Cancer even once in their lifetimes [2]. Earlier attempts to establish population-based Cervical Cancer Prevention programs using cytology screening in resource-limited settings have inevitably fallen short or failed [3–5]. Although many of the reasons for failure can be attributed to lack of resources and trained manpower, the multiple visit requirements of cytology-based screening programs jeopardizes success and sustainability.
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Integrating Cervical Cancer Prevention in HIV/AIDS treatment and care programmes
Bulletin of the World Health Organization, 2008Co-Authors: Mulindi H. Mwanahamuntu, Vikrant V. Sahasrabuddhe, Jeffrey S. A. Stringer, Groesbeck P. ParhamAbstract:Peckham and Hann’s call for integrating Cervical Cancer Prevention as part of broader sexual and reproductive health Prevention services1 is especially relevant to sub-Saharan Africa where both Cervical Cancer and sexually transmitted infections, especially HIV/AIDS, are widely prevalent. Over the past decade, successful HIV/AIDS care and treatment programmes have been instituted in over a dozen hardest-hit sub-Saharan African countries, largely through bilateral and multilateral programmes like the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.2 HIV-infected women are at heightened risk for pre-invasive and invasive neoplasia of the cervix.3,4 HIV/AIDS care and treatment programmes thus provide an ideal platform to integrate Cervical Cancer Prevention activities in countries which face a dual burden of both AIDS and Cervical Cancer, an AIDS-defining disease. With steady donor support over the past 5 years, these programmes are slowly but steadily contributing to the development of health-care service delivery capacity in emerging nations by establishing infrastructures, training the health-care work force, and tackling complex and challenging problems in implementation and scale-up.5 Limited access to Cervical Cancer Prevention services, the usual circumstance for women in low-resource environments, serves as a counterforce to the life-prolonging potential of increased access to affordable antiretroviral therapy. Cervical Cancer Prevention strategies that use visual inspection with acetic acid (VIA) and same-visit cryotherapy (“see-and-treat”) are cost-effective alternatives to cytology-based screening programmes. These procedures can be performed by nurses and other non-physician health-care workers and allow screening and treatment to be linked to the same clinic visit. Our experience in Zambia has shown that VIA-based Prevention services that are nested within the context of antiretroviral therapy programmes allow early detection of Cervical Cancer in high-risk HIV-infected women in a cost-effective way.6,7 It also allows opportunities for the provision of broader gynaecologic and other health care for women. Eventual integration of low-cost, rapid screening tests for detecting human papillomavirus within VIA-based screening services will additionally increase programmatic efficiency. When Cervical Cancer Prevention services are offered to HIV-infected women in a venue attended by non-HIV-infected women, a scalable intervention is established that can reach out to all women regardless of HIV status. Horizontal and diagonal collaborations between agencies and individuals focusing on HIV/AIDS care and Cancer Prevention could open new vistas for expanding availability of care for women at risk of one or both of these conditions, thereby ensuring wider programme impact. The conjoint contributions of such collaborations may be larger than the sum of their parts. ■