Filade Temitope E, Dareng Eileen O, Olawande Toyosi, Fagbohun Tolani A, Adebayo Amos O, Adebamowo Clement A
Institute of Human Virology, Abuja, Nigeria.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Front Public Health. 2017 Sep 6;5:226. doi: 10.3389/fpubh.2017.00226. eCollection 2017.
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.
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.
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.
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.
在发达国家，基于人乳头瘤病毒（HPV）脱氧核糖核酸（DNA）的检测越来越多地用于宫颈癌筛查，但在低收入和中等收入国家（LMIC）如何最佳地利用该检测尚不清楚。将基于HPV DNA的检测纳入常规产前护理（ANC）是LMIC宫颈癌筛查中一种有潜力但尚未充分探索的策略。我们探讨了尼日利亚医护人员和孕妇对将基于HPV DNA的检测纳入常规ANC的态度。
我们在尼日利亚阿布贾的四个医疗机构与82名孕妇进行了九次焦点小组讨论，并对产科医生和助产士进行了13次深入访谈。我们使用定性内容分析来分析数据，并以计划行为理论作为理论框架来审视这些回答。
孕妇对将HPV DNA检测作为常规ANC的一部分用于宫颈癌筛查持积极态度。这种方法的可接受性源于宫颈癌早期检测和治疗的预期益处。最常被提及的可能影响基于HPV DNA检测的可接受性和采用率的因素是护理人员的建议以及将检测作为ANC服务的一部分强制要求。讨论者提到缺乏认识和可负担性是可能抑制基于HPV DNA的宫颈癌筛查采用率的因素。助产士对孕期采样程序的安全性表示担忧，而产科医生完全支持将基于HPV DNA的检测纳入常规ANC。
我们的结果表明，将基于HPV DNA的宫颈癌筛查纳入常规ANC对孕妇和医护人员来说是可以接受的。使检测价格可承受，并就其在ANC期间进行时的功效和安全性对医护人员进行教育，将提高他们推荐该检测的意愿并增加其采用率。
