坦桑尼亚达累斯萨拉姆 VIA 阳性的风险因素和筛查就诊的决定因素。
Risk factors for VIA positivity and determinants of screening attendances in Dar es Salaam, Tanzania.
机构信息
Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
出版信息
BMC Public Health. 2012 Dec 7;12:1055. doi: 10.1186/1471-2458-12-1055.
BACKGROUND
Tanzania is among the countries in the world where the cervical cancer incidence is estimated to be highest. Acknowledging an increase in the burden of cervical cancer, VIA was implemented as a regional cervical cancer screening strategy in Tanzania in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this paper present the results from a comparative analysis performed among women who are reached and not reached by the screening program".
METHODS
14 107 women aged 25-59 enrolled in a cervical cancer screening program in Dar es Salaam in the period 2002 - 2008. The women underwent VIA examination and took part in a structured questionnaire interview. Socioeconomic characteristics, sexual behavior, HIV status and high-risk (HR) HPV infection were determined in a subpopulation of 890 who participated and 845 who did not participate in the screening.
RESULTS
Being widowed/separated OR=1.41 (95% CI: 1.17-1.66), of high parity OR=3.19 (95% CI: 1.84-5.48) of low education OR= 4.30 (95% CI: 3.50-5.31) and married at a young age OR=2.17 (95% CI: 1.37-3.07) were associated with being VIA positive. Women who participated in the screening were more likely to be HIV positive OR=1.59 (95% CI. 1.14-2.25) in comparison with women who had never attended screening, while no difference was found in the prevalence of HR-HPV infection among women who had attended screening and women who had not attended screening.
CONCLUSION
Women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. The study further documents that a referral linkage between the HIV care and treatment program and the cervical cancer screening program is in place in the setting studied, where HIV positive were more likely to participate in the cervical cancer screening program than HIV negative women.
背景
坦桑尼亚是世界上宫颈癌发病率估计最高的国家之一。鉴于宫颈癌负担的增加，2002 年，VIA 作为区域宫颈癌筛查策略在坦桑尼亚实施。本文旨在描述 VIA 阳性的危险因素和坦桑尼亚筛查参与者的决定因素，呈现了在一个筛查项目中达到和未达到的女性之间进行的比较分析结果。
方法
2002 年至 2008 年期间，在达累斯萨拉姆的一个宫颈癌筛查项目中，招募了 14107 名年龄在 25-59 岁的妇女。这些妇女接受了 VIA 检查，并参加了结构化问卷访谈。在参加和未参加筛查的 890 名女性亚群中，确定了社会经济特征、性行为、HIV 状况和高危（HR）HPV 感染情况。
结果
丧偶/离异者的比值比（OR）为 1.41（95%CI：1.17-1.66），多产妇的比值比（OR）为 3.19（95%CI：1.84-5.48），低教育程度的比值比（OR）为 4.30（95%CI：3.50-5.31），早婚的比值比（OR）为 2.17（95%CI：1.37-3.07），这些都与 VIA 阳性相关。与从未参加过筛查的妇女相比，参加筛查的妇女 HIV 阳性的比值比（OR）为 1.59（95%CI.1.14-2.25），而在参加和未参加筛查的妇女中，HR-HPV 感染的患病率没有差异。
结论
丧偶/离异、多产妇、低教育程度和早婚的妇女更容易 VIA 阳性，因此有发展宫颈癌的风险。该研究进一步证明，在所研究的环境中，艾滋病毒护理和治疗方案与宫颈癌筛查方案之间建立了转介联系，艾滋病毒阳性的妇女比艾滋病毒阴性的妇女更有可能参加宫颈癌筛查项目。
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