2018-2022年CDC-PEPFAR计划下，HIV阳性妇女的宫颈癌筛查阳性率。
Cervical cancer screening positivity among women living with HIV in CDC-PEPFAR programs 2018-2022.
发表日期：2023 Aug 23
作者：
Laura J McCormick, Steven Gutreuter, Oluwatosin Adeoye, Sarah X Alger, Celeste Amado, Zurnaid Bay, Catherine Motswere Chirwa, Omega Chituwo, Della Correia, Maria Deus, Emilio Dirlikov, Tim Efuntoye, Laurence Gunde, Alinune Kabaghe, Julius N Kalamya, Cesaltina Lorenzoni, Daniel Magesa, Celina Mate, Theopolina Mulokoshi, Josephine Connie Ninsiima, Mary Nyangasi, Ponesai Nyika, Munyaradzi Pasipamire, Mina Ssali, Fana Tefera, Lindsey A Torre, Marilena Urso, Ronald Wandira, Brigitte Zemburuka, Michele Montandon
来源：
Disease Models & Mechanisms
摘要：
美国总统抗击艾滋病紧急计划（PEPFAR）旨在通过在世界高负担地区提供高质量的筛查服务来解决妇女艾滋病病毒感染者（WLHIV）患宫颈癌的较高风险问题。我们分析了自2018年4月至2022年3月期间，在撒哈拉以南非洲地区的13个国家的CDC支持下的PEPFAR监测、评估和报告数据，针对年龄在15岁以上的WLHIV进行了宫颈癌筛查服务（主要是视觉检查，对于癌前病变提供烧灼或切除治疗）。我们计算了按年龄、国家和临床就诊类型（首次生涯筛查或例行复查）的阳性率。我们拟合了负二项式随机系数模型以估算阳性测试的概率，并确定阳性率的任何时间趋势。在280万次完成的癌症筛查中，5.4%的筛查结果显示有癌前病变，0.8%的筛查结果显示有可能是浸润性宫颈癌（综合为6.1%）。这些阳性率在研究期间，在进行宫颈癌筛查的初次筛查妇女以及前往抗逆转录病毒治疗（ART）诊所进行例行复查的妇女中有所下降。这些阳性率低于已发表文献的预期。需要进一步研究来确定这些较低的率是否归因于这些人群中高水平的持续ART使用，而系统的计划监测和质量保证活动对确保WLHIV能够获得最高质量的预防服务至关重要。版权所有©2023 Wolters Kluwer Health, Inc. 保留所有权利。
The US President's Emergency Plan for AIDS Relief (PEPFAR) aims to address the higher risk of cervical cancer among women living with HIV (WLHIV) by offering high quality screening services in the highest burden regions of the world.We analyzed PEPFAR Monitoring, Evaluation, and Reporting data from CDC-supported sites in 13 countries in sub-Saharan Africa for WHLIV aged 15+ years who accessed cervical cancer screening services (mostly visual inspection, with ablative or excisional treatment offered for precancerous lesions), April 2018-March 2022. We calculated the positivity by age, country, and clinical visit type (first lifetime screen, or routine rescreening). We fitted negative binomial random-coefficient models of log-linear trends in time to estimate the probabilities of testing positive, and any temporal trends in positivity.Among the 2.8 million completed cancer screens, 5.4% identified precancerous lesions, and 0.8% were positive for suspected invasive cervical cancers (6.1% overall). The positivity rates declined over the study period among those women screening for cervical cancer for the first time, and among those women presenting to antiretroviral therapy (ART) clinics for routine rescreening.These positivity rates are lower than expectations set by the published literature. Further research is needed to determine if these lower rates are attributable to the high level of consistent ART use among these populations, and systematic program monitoring and quality assurance activities are essential to ensure WLHIV have access to the highest possible quality prevention services.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.