Implementation of Multicolor Melt Curve Analysis for High-Risk Human Papilloma Virus Detection in Low- and Middle-Income Countries: A Pilot Study for Expanded Cervical Cancer Screening in Honduras

Purpose Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. Methods A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women’s health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. Results hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. Conclusion In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.

Download Full-text

Optimizing high risk HPV-based primary screening for cervical cancer in low- and middle-income countries: opportunities and challenges

Minerva Ginecologica ◽

10.23736/s0026-4784.19.04468-x ◽

2019 ◽

Vol 71 (5) ◽

Author(s):

Sharmila A. Pimple ◽

Gauravi A. Mishra

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Middle Income ◽

Middle Income Countries ◽

Primary Screening ◽

High Risk Hpv ◽

Low And Middle Income

Download Full-text

Finding Children with High Risk of Non-Vaccination in 92 Low- and Middle-Income Countries: A Decision Tree Approach

Vaccines ◽

10.3390/vaccines9060646 ◽

2021 ◽

Vol 9 (6) ◽

pp. 646

Author(s):

Thiago M. Santos ◽

Bianca O. Cata-Preta ◽

Cesar G. Victora ◽

Aluisio J. D. Barros

Keyword(s):

High Risk ◽

Decision Tree ◽

Immunization Coverage ◽

Risk Groups ◽

Demographic And Health Surveys ◽

Middle Income ◽

Agenda 2030 ◽

Middle Income Countries ◽

Tree Approach ◽

Low And Middle Income

Reducing vaccination inequalities is a key goal of the Immunization Agenda 2030. Our main objective was to identify high-risk groups of children who received no vaccines (zero-dose children). A decision tree approach was used for 92 low- and middle-income countries using data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys, allowing the identification of groups of children aged 12–23 months at high risk of being zero dose (no doses of the four basic vaccines—BCG, polio, DPT and measles). Three high-risk groups were identified in the analysis combining all countries. The group with the highest zero-dose prevalence (42%) included 4% of all children, but almost one in every four zero-dose children in the sample. It included children whose mothers did not receive the tetanus vaccine during and before the pregnancy, who had no antenatal care visits and who did not deliver in a health facility. Separate analyses by country presented similar results. Children who have been missed by vaccination services were also left out by other primary health care interventions, especially those related to antenatal and delivery care. There is an opportunity for better integration among services in order to achieve high and equitable immunization coverage.

Download Full-text

Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries

PLoS ONE ◽

10.1371/journal.pone.0134618 ◽

2015 ◽

Vol 10 (9) ◽

pp. e0134618 ◽

Cited By ~ 16

Author(s):

Margaret M. Demment ◽

Karen Peters ◽

J. Andrew Dykens ◽

Ann Dozier ◽

Haq Nawaz ◽

...

Keyword(s):

Cervical Cancer ◽

Best Practice ◽

Evidence Base ◽

Middle Income ◽

Scoping Study ◽

Middle Income Countries ◽

Breast And Cervical Cancer ◽

Low And Middle Income

Download Full-text

Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0217775 ◽

2019 ◽

Vol 14 (7) ◽

pp. e0217775

Author(s):

Emma R. Allanson ◽

Aime Powell ◽

Max Bulsara ◽

Hong Lim Lee ◽

Lynette Denny ◽

...

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Surgical Management ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Download Full-text

Early Intervention for Children at High Risk of Developmental Disability in Low- and Middle-Income Countries: A Narrative Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224449 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4449 ◽

Cited By ~ 5

Author(s):

Maya Kohli-Lynch ◽

Cally J. Tann ◽

Matthew E. Ellis

Keyword(s):

High Risk ◽

Developmental Disability ◽

Best Practice ◽

Risk Groups ◽

Community Based ◽

Middle Income ◽

Critical Window ◽

Middle Income Countries ◽

High Risk Infants ◽

Low And Middle Income

In low- and middle-income countries (LMICs), while neonatal mortality has fallen, the number of children under five with developmental disability remains unchanged. The first thousand days are a critical window for brain development, when interventions are particularly effective. Early Childhood Interventions (ECI) are supported by scientific, human rights, human capital and programmatic rationales. In high-income countries, it is recommended that ECI for high-risk infants start in the neonatal period, and specialised interventions for children with developmental disabilities as early as three months of age; more data is needed on the timing of ECI in LMICs. Emerging evidence supports community-based ECI which focus on peer support, responsive caregiving and preventing secondary morbidities. A combination of individual home visits and community-based groups are likely the best strategy for the delivery of ECI, but more evidence is needed to form strong recommendations, particularly on the dosage of interventions. More data on content, impact and implementation of ECI in LMICs for high-risk infants are urgently needed. The development of ECI for high-risk groups will build on universal early child development best practice but will likely require tailoring to local contexts.

Download Full-text