Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: prevention and screening innovation project toward elimination of cervical cancer (PRESCRIP-TEC)
Full text linkBackground:
High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence.
Methods:
PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy.
Discussion:
PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid
Interaction effects of maternal sexually transmitted infections with prenatal care utilization status on preterm birth and low birthweight: U.S. national data
Full text linkThis case-control study aimed to test interaction between the most common sexually transmitted infections (STIs) (i.e., chlamydia, gonorrhea, and syphilis) and prenatal care (PNC) utilization status on preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2500 g). We used data of participants with singleton live births (N = 3,418,028) from the 2019 United States National Vital Statistics System. There were 280,206 participants in the PTB group and 3,137,822 in the control group, and 221,260 participants in the LBW group and 3,196,768 in the control group. Nearly 1.9% of the participants had chlamydia, 0.3% had gonorrhea, and 0.2% had syphilis. Interaction effects of STIs with PNC utilization status on the risk of PTB and LBW were tested on the multiplicative and additive scales. Using measures of the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S), we observed the highest significant synergistic interaction between syphilis and inadequate PNC utilization increasing the risk of PTB (RERI 2.12, AP 38%, and SI 1.88), and between gonorrhea and inadequate PNC utilization increasing the risk of LBW (RERI 1.03, AP 28%, and SI 1.64). Findings from this study help improve our understanding of disease etiology and inform prevention planning
Online violence against young female workers : risks, threats and mitigation strategies
No full textThis brief is a part of the Solutions for Youth Employment (S4YE) Knowledge Brief series on the design and implementation of youth employment programs. The digital transformation is creating new job opportunities, especially for women, who are able to work from home and overcome time and mobility constraints. In the United States, 49.3 percent of women worked from home in 2020, while data from Organisation for Economic Co-operation and Development (OECD) countries show that women have been more likely to telework than men during the pandemic. However, digital technologies also bring new risks, one of these is online violence. In addition to psychological harm, this form of violence may undermine the positive jobs effects of the digital transformation by increasing the likelihood that young women forgo or leave digital jobs. This brief presents emerging evidence of the scale of such problems in low- and middle-income countries and their impact on the participation of young women in digital sectors. It then outlines suggested policy responses
Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis
Full text linkTo compare all available accuracy data on screening strategies for identifying cervical intraepithelial neoplasia grade ≥ 2 in healthy asymptomatic women, we performed a systematic review and network meta-analysis. MEDLINE and EMBASE were searched up to October 2020 for paired-design studies of cytology and testing for high-risk genotypes of human papillomavirus (hrHPV). The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, random-effects network meta-analysis of test accuracy, and GRADE rating. Twenty-seven prospective studies (185,269 subjects) were included. The combination of cytology (atypical squamous cells of undetermined significance or higher grades) and hrHPV testing (excepting genotyping for HPV 16 or 18 [HPV16/18]) with the either-positive criterion (OR rule) was the most sensitive/least specific, whereas the same combination with the both-positive criterion (AND rule) was the most specific/least sensitive. Compared with standalone cytology, non-HPV16/18 hrHPV assays were more sensitive/less specific. Two algorithms proposed for primary cytological testing or primary hrHPV testing were ranked in the middle as more sensitive/less specific than standalone cytology and the AND rule combinations but more specific/less sensitive than standalone hrHPV testing and the OR rule combination. Further research is needed to assess these results in population-relevant outcomes at the program level
Abortion travel within the united states: an observational study of cross-state movement to obtain abortion care in 2017
Full text linkBackground:
In the United States, abortion access is often more limited for people who live in states with few abortion facilities and restrictive abortion legislation. Pregnant people seeking an abortion thus often travel to access care.
Methods:
We calculated state-specific abortion rate (number of abortions per thousand women ages 15 to 44) and percentage of patients leaving for abortion care using CDC 2017 Abortion Surveillance data, the Guttmacher Institute's Abortion Provider Census and Pregnancies, Births and Abortions in the United States report, and US Census data. We categorized percent leaving by abortion policy landscape using the Guttmacher Institute's classification of state abortion laws, and by facility density (number of abortion facilities per million women ages 15 to 44), calculated using Census and Guttmacher data. We ran correlational tests between each of our variables (percent leaving, facility density, and policy environment), as well as between percent leaving and facility density within policy environment.
Findings:
In 2017, an average of 8% of US patients left their state of residence for abortion care. Percent leaving varied widely by state: 74% left Wyoming, 57% left South Carolina, and 56% left Missouri, while 13 states had fewer than 4% of patients leaving. States with more restrictive laws averaged 12% of patients leaving, while states with middle ground or supportive laws averaged 10% and 3% leaving, respectively. Pairwise correlations between percent leaving, facility density, and policy score were all statistically significant, though correlations between percent leaving and facility density within policy environment were not.
Interpretation
Many patients travel across state lines for abortion care. While patients may leave for a range of reasons, restrictive state-level abortion policy and facility scarcity are associated with patients leaving their state of residence.
Funding:
This study was supported by a philanthropic foundation that makes grants anonymously
Clinical validation of the fully automated NeuMoDx HPV assay for cervical cancer screening
Full text linkThe NeuMoDx HPV assay is a novel fully automated, real-time PCR-based assay for the qualitative detection of high-risk human papillomavirus (HPV) DNA in cervical specimens. The assay specifically identifies HPV16 and HPV18 and concurrently detects 13 other high-risk HPV types at clinically relevant infection levels. Following the international guidelines, the clinical performance of the NeuMoDx HPV assay for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) against the reference standard Hybrid Capture 2, as well as intra- and inter-laboratory reproducibility were assessed on PreservCyt samples. The clinical accuracy of the assay was additionally evaluated against the clinically validated Alinity m HR HPV and COBAS 4800 HPV Test on PreservCyt samples, and against the clinically validated HPV-Risk assay on SurePath samples. The NeuMoDx HPV assay performance for CIN2+ was non-inferior to the reference methods on both sample types (all p < 0.05), and showed excellent intra- and inter-laboratory reproducibility (95.7%; 95% CI: 93.9–97.3; kappa value 0.90 (95% CI: 0.86–0.94); and 94.5%; 95% CI: 92.6–96.2; kappa value 0.87 (95% CI: 0.82–0.92), respectively). In conclusion, the NeuMoDx HPV assay meets international guideline criteria for cross-sectional accuracy and reproducibility, and performs equally well on cervical screening specimens collected in two widely used collection media. The NeuMoDx HPV assay fulfils the requirements to be used for primary cervical screening
The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: a systematic review and meta-analysis
Full text linkBackground:
Respectful maternity care is the provision of woman-centered health care during childbirth that is friendly, abuse-free, timely, and discrimination-free. Although several epidemiological studies on the magnitude and determinants of Respectful maternity care in Ethiopia have been conducted, the results have been inconsistent and varied. This makes drawing equivocal conclusions and evidence at the national level harder. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of respectful maternity care and its determinants in Ethiopia.
Methods:
Studies conducted from 2013 to June 30, 2022, were searched by using PubMed, Google Scholar, Science Direct, Scopus, ProQuest, Web of Science, Cochrane Library, and Direct of Open Access Journals. Searching was carried out from May 15- June 30, 2022. In total, sixteen studies were considered in the final analysis. The data were extracted using Microsoft Excel and analyzed using STATA 16 software. The methodological quality of included studies was assessed by using Joanna Briggs Institute’s critical appraisal checklist for prevalence studies. To estimate the pooled national prevalence of respectful maternity care, a random effect model with a DerSimonian Laird method was used. To assess the heterogeneity of the included studies, the Cochrane Q test statistics and I2 tests were used. To detect the presence of publication bias, a funnel plot and Begg’s and Egger’s tests were used.
Results:
Sixteen studies were eligible for this systematic review and meta-analysis with a total of 6354 study participants. The overall pooled prevalence of respectful maternity care in Ethiopia was 48.44% (95% CI: 39.02–57.87). Receiving service by CRC-trained health care providers [AOR: 4.09, 95% CI: 1.73, 6.44], having ANC visits [AOR: 2.34, 95% CI: 1.62, 3.06], planning status of the pregnancy [AOR = 4.43, 95% CI: 2.74, 6.12], giving birth during the daytime [AOR: 2.61, 95% CI: 1.92, 3.31], and experiencing an obstetric complication[AOR: 0.46, 95% CI: 0.30, 0.61] were identified as determinants of RMC.
Conclusion:
As per this meta-analysis, the prevalence of respectful maternity care in Ethiopia was low. Managers in the health sector should give due emphasis to the provision of Compassionate, Respectful, and Care(CRC) training for healthcare providers, who work at maternity service delivery points. Stakeholders need to work to increase the uptake of prenatal care to improve client-provider relationships across a continuum of care. Human resource managers should assign an adequate number of health care providers to the night-shift duties to reduce the workload on obstetric providers
Three‐dimensional deep neural network for automatic delineation of cervical cancer in planning computed tomography images
Full text linkPurpose:
Radiation therapy is an essential treatment modality for cervical cancer, while accurate and efficient segmentation methods are needed to improve the workflow. In this study, a three‐dimensional V‐net model is proposed to automatically segment clinical target volume (CTV) and organs at risk (OARs), and to provide prospective guidance for low lose area.
Material and methods:
A total of 130 CT datasets were included. Ninety cases were randomly selected as the training data, with 10 cases used as the validation data, and the remaining 30 cases as testing data. The V‐net model was implemented with Tensorflow package to segment the CTV and OARs, as well as regions of 5 Gy, 10 Gy, 15 Gy, and 20 Gy isodose lines covered. The auto‐segmentation by V‐net was compared to auto‐segmentation by U‐net. Four representative parameters were calculated to evaluate the accuracy of the delineation, including Dice similarity coefficients (DSC), Jaccard index (JI), average surface distance (ASD), and Hausdorff distance (HD).
Results:
The V‐net and U‐net achieved the average DSC value for CTV of 0.85 and 0.83, average JI values of 0.77 and 0.75, average ASD values of 2.58 and 2.26, average HD of 11.2 and 10.08, respectively. As for the OARs, the performance of the V‐net model in the colon was significantly better than the U‐net model (p = 0.046), and the performance in the kidney, bladder, femoral head, and pelvic bones were comparable to the U‐net model. For prediction of low‐dose areas, the average DSC of the patients’ 5 Gy dose area in the test set were 0.88 and 0.83, for V‐net and U‐net, respectively.
Conclusions:
It is feasible to use the V‐Net model to automatically segment cervical cancer CTV and OARs to achieve a more efficient radiotherapy workflow. In the delineation of most target areas and OARs, the performance of V‐net is better than U‐net. It also offers advantages with its feature of predicting the low‐dose area prospectively before radiation therapy (RT)
Dosimetric and radiobiological evaluation of treatment plan for cervical cancer high-dose-rate intracavitary brachytherapy
Full text linkPurpose:
The purpose of the study was to consider and calculate dosimetric parameters during treatment planning to improve radiobiological outcomes for cervical cancer patients treated with high-dose-rate (HDR) intracavitary brachytherapy (ICBT).
Material and methods:
In the present study, dose volume histograms (DVH) of 30 cervical cancer patients treated with HDR brachytherapy using computer tomography (CT)-based planning were analyzed. High-risk clinical target volume (HR-CTV) was contoured as the main target volume for all the patients, with an assumption that there was no presence of gross tumor at the time of brachytherapy. Values of target coverage volumes (100%, 150%, and 200%) were obtained from DVH, which was used to calculate different quality indices (QIs), including coverage index (CI), dose homogeneity index (DHI), overdose volume index (ODI), and dose non-uniformity ratio (DNR). Values of these QIs were further used to calculate tumor control probability (TCP). Statistical correlation between all QIs with TCP was established. Also, normal tissue complication probabilities for bladder (NTCP_B) and rectum (NTCP_R) were calculated.
Results:
The mean values of the various calculated parameters, including CI, DHI, ODI, DNR, TCP, NTCP_B and NTCP_R were 0.92 ±0.07, 0.26 ±0.10, 0.50 ±0.10, 0.74 ±0.10, 0.92 ±0.07, 0.08 ±0.25, and 0.36 ±0.27, respectively. Pearson’s product moment correlation coefficient between CI, DHI, ODI, and DNR with regards to TCP was +0.85, –0.85, +0.84, and +0.85, respectively.
Conclusions:
The correlation between dosimetric and radiobiological parameters was found statistically significant, which shows the influence of dosimetric parameters on the radiobiological outcome. Therefore, these parameters should be considered during the treatment planning to improve the radiobiological outcome
Syndemics of sexually transmitted infections in a sample of racially diverse pregnant young women
Full text linkIntroduction:
Syndemic theory posits that poor health outcomes co-occur and amplify each other in the context of harmful conditions that must be addressed simultaneously to improve health equity. This analysis identifies perinatal syndemic factors and examine how factors are related to STI in a sample of racially diverse young pregnant women.
Methods:
Pregnant participants (n = 61) ages 14–21 from racially diverse backgrounds were recruited from a prenatal clinic for an ongoing longitudinal study between October 2019-February 2020. Participants completed a tablet survey assessing pregnancy intention, psychosocial factors (e.g., depression, stress, partner violence, pregnancy history) and consented to provide access to their medical records for STI and clinical urine samples screened for tobacco and cannabis use. Latent class analysis (LCA) was used to examine probabilities of co-occurring Syndemic indicators.
Results:
Half of the women were Black (52%) and primigravida (54%). Three classes were identified in the LCA, two of them reflecting syndemics related to STI from the medical record. The largest class was half Black (51%), with a high rate of STI (65%), and was characterized by factors including depressive symptoms (93%), stress (64%), and substance use (65% cannabis, 82% tobacco). Additionally, the class with the highest rates of STI (74%) also had higher rates of partner violence (48%), morning sickness (100%), and prenatal cannabis use (63%).
Conclusion:
Findings indicate evidence of a syndemic related to increased STI. A longitudinal evaluation of syndemics in this cohort may inform appropriately tailored intervention strategies to promote perinatal health in racially diverse young pregnant populations