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      Attitude to Human Papillomavirus Deoxyribonucleic Acid-Based Cervical Cancer Screening in Antenatal Care in Nigeria: A Qualitative Study

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          Abstract

          Objectives

          Human papillomavirus (HPV) deoxyribonucleic acid (DNA)-based testing is increasingly used for cervical cancer screening in developed countries, but the best approach to utilizing it in low- and middle-income countries (LMIC) is unclear. Incorporation of HPV DNA-based testing into routine antenatal care (ANC) is a potential yet poorly explored strategy for cervical cancer screening in LMIC. We explored the attitude of health care workers and pregnant women to the incorporation of HPV DNA-based tests into routine ANC in Nigeria.

          Methods

          We conducted nine focus group discussions with 82 pregnant women and 13 in-depth interviews with obstetricians and midwives at four health care facilities in Abuja, Nigeria. We used qualitative content analysis to analyze the data and the theory of planned behavior as a theoretical framework to examine the responses.

          Results

          Pregnant women expressed a favorable attitude toward HPV DNA testing for cervical cancer screening as part of routine ANC. Acceptability of this approach was motivated by the expected benefits from early detection and treatment of cervical cancer. The factors most commonly cited as likely to influence acceptability and uptake of HPV DNA-based tests are recommendations by their care providers and mandating testing as part of ANC services. Discussants mentioned lack of awareness and affordability as factors that may inhibit uptake of HPV DNA-based cervical cancer screening. Midwives expressed concerns about the safety of sampling procedure in pregnancy, while obstetricians fully support the integration of HPV DNA-based testing into routine ANC.

          Conclusion

          Our results show that incorporating HPV DN-based cervical cancer screening into routine ANC is acceptable to pregnant women and health care providers. Making the test affordable and educating health care workers on its efficacy and safety if performed during ANC will enhance their willingness to recommend it and increase its uptake.

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          Most cited references35

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          HPV screening for cervical cancer in rural India.

          In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix with acetic acid (VIA) on the incidence of cervical cancer and the associated rates of death in the Osmanabad district in India. In this cluster-randomized trial, 52 clusters of villages, with a total of 131,746 healthy women between the ages of 30 and 59 years, were randomly assigned to four groups of 13 clusters each. The groups were randomly assigned to undergo screening by HPV testing (34,126 women), cytologic testing (32,058), or VIA (34,074) or to receive standard care (31,488, control group). Women who had positive results on screening underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment. In the HPV-testing group, cervical cancer was diagnosed in 127 subjects (of whom 39 had stage II or higher), as compared with 118 subjects (of whom 82 had advanced disease) in the control group (hazard ratio for the detection of advanced cancer in the HPV-testing group, 0.47; 95% confidence interval [CI], 0.32 to 0.69). There were 34 deaths from cancer in the HPV-testing group, as compared with 64 in the control group (hazard ratio, 0.52; 95% CI, 0.33 to 0.83). No significant reductions in the numbers of advanced cancers or deaths were observed in the cytologic-testing group or in the VIA group, as compared with the control group. Mild adverse events were reported in 0.1% of screened women. In a low-resource setting, a single round of HPV testing was associated with a significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancer. 2009 Massachusetts Medical Society
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            Human papillomavirus testing in the prevention of cervical cancer.

            Strong evidence now supports the adoption of cervical cancer prevention strategies that explicitly focus on persistent infection with the causal agent, human papillomavirus (HPV). To inform an evidence-based transition to a new public health approach for cervical cancer screening, we summarize the natural history and cervical carcinogenicity of HPV and discuss the promise and uncertainties of currently available screening methods. New HPV infections acquired at any age are virtually always benign, but persistent infections with one of approximately 12 carcinogenic HPV types explain virtually all cases of cervical cancer. In the absence of an overtly persistent HPV infection, the risk of cervical cancer is extremely low. Thus, HPV test results predict the risk of cervical cancer and its precursors (cervical intraepithelial neoplasia grade 3) better and longer than cytological or colposcopic abnormalities, which are signs of HPV infection. The logical and inevitable move to HPV-based cervical cancer prevention strategies will require longer screening intervals that will disrupt current gynecologic and cytology laboratory practices built on frequent screening. A major challenge will be implementing programs that do not overtreat HPV-positive women who do not have obvious long-term persistence of HPV or treatable lesions at the time of initial evaluation. The greatest potential for reduction in cervical cancer rates from HPV screening is in low-resource regions that can implement infrequent rounds of low-cost HPV testing and treatment.
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              Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities

              Emmanuela Gakidou and colleagues find that coverage of cervical cancer screening in developing countries is on average 19% compared to 63% in developed countries.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/436777
                URI : http://frontiersin.org/people/u/371085
                URI : http://frontiersin.org/people/u/451715
                URI : http://frontiersin.org/people/u/470090
                URI : http://frontiersin.org/people/u/470054
                URI : http://frontiersin.org/people/u/22975
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                06 September 2017
                2017
                : 5
                : 226
                Affiliations
                [1] 1Institute of Human Virology , Abuja, Nigeria
                [2] 2Department of Public Health and Primary Care, University of Cambridge , Cambridge, United Kingdom
                [3] 3Department of Obstetrics and Gynaecology, Asokoro District Hospital , Abuja, Nigeria
                [4] 4Institute of Human Virology and Greenebaum Comprehensive Cancer Centre, University of Maryland School of Medicine , Baltimore, MD, United States
                [5] 5Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, MD, United States
                Author notes

                Edited by: Rafael T. Mikolajczyk, Martin Luther University of Halle-Wittenberg, Germany

                Reviewed by: Kirstin Grosse Frie, Martin Luther University of Halle-Wittenberg, Germany; Silvia Carlos, Universidad de Navarra, Spain

                *Correspondence: Clement A. Adebamowo, cadebamowo@ 123456som.umaryland.edu

                These authors have contributed equally to this work.

                Specialty section: This article was submitted to Population, Reproductive and Sexual Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2017.00226
                5592338
                28932735
                999301a1-1367-4eb9-9317-913e9c3d41ee
                Copyright © 2017 Filade, Dareng, Olawande, Fagbohun, Adebayo and Adebamowo.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 May 2017
                : 14 August 2017
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 47, Pages: 10, Words: 8453
                Funding
                Funded by: African Collaborative Center for Microbiome and Genomics Research
                Award ID: NIH/NHGRI U54HG006947
                Categories
                Public Health
                Original Research

                human papillomavirus,hpv dna testing,cervical cancer,cervical cancer screening,antenatal care,pregnant women,pregnancy

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