Wirtz Charlotte, Mohamed Yasmin, Engel Danielle, Sidibe Anissa, Holloway Megan, Bloem Paul, Kumar Somesh, Brotherton Julia, Reis Veronica, Morgan Christopher
School of Population and Global Health, University of Melbourne, Victoria 3010, Australia; Burnet Institute, 85 Commercial Road, Melbourne, Victoria 2004, Australia.
Burnet Institute, 85 Commercial Road, Melbourne, Victoria 2004, Australia.
Vaccine. 2022 Mar 31;40 Suppl 1:A116-A123. doi: 10.1016/j.vaccine.2021.11.013. Epub 2021 Dec 1.
A WHO global strategy launched in November 2020 sets out an ambitious pathway towards the worldwide elimination of cervical cancer as a public health problem within the next 100 years. Achieving this goal will require investment in innovative approaches. This review aims to describe integrated approaches that combine human papillomavirus (HPV) vaccination and cervical cancer screening in low- and middle-income countries (LMIC), and their efficacy in increasing uptake of services. A systematic review was conducted analyzing relevant papers from Embase, Medline, CINAHL and CAB Global Health databases, as well as grey literature. Narrative synthesis was performed on the included studies. Meta-analysis was not appropriate due to the heterogeneity and nature of included studies. From 5,278 titles screened, 11 uncontrolled intervention studies from four countries (from Africa and east Asia) were included, all from the past 12 years. Four distinct typologies of integration emerged that either increased awareness of HPV and/or cervical cancer screening, and/or coupled the delivery of HPV vaccination and cervical cancer screening programs. The synthesis of findings suggests that existing HPV vaccination programs can be a useful pathway for educating mothers and other female caregivers about cervical cancer screening; through in person conversations with care providers (preferred) or take-home communications products. Integrated service delivery through outreach and mobile clinics may overcome geographic and economic barriers to access for both HPV vaccination and cervical cancer screening, however these require significant program and system resources. One study promoted HPV vaccination as part of integrated service delivery, but there were no other examples found that examined use of cervical cancer screening platforms to promote or educate on HPV vaccination. This review has demonstrated gaps in published literature on attempts to integrate HPV vaccination and cervical cancer screening. The most promising practices to date seem to relate to integrated health communications for cervical cancer prevention. Future research should further explore the opportunities for integrated health communications to support the efforts towards the new global cervical cancer elimination agenda, and costs and feasibility of integrated service delivery for underserved populations.
2020年11月发布的一项世界卫生组织全球战略规划了一条宏伟路径,目标是在未来100年内将宫颈癌作为一个公共卫生问题在全球范围内消除。要实现这一目标,需要对创新方法进行投资。本综述旨在描述在低收入和中等收入国家(LMIC)将人乳头瘤病毒(HPV)疫苗接种与宫颈癌筛查相结合的综合方法,以及这些方法在提高服务利用率方面的效果。我们进行了一项系统综述,分析了来自Embase、Medline、CINAHL和CAB全球卫生数据库的相关论文以及灰色文献。对纳入的研究进行了叙述性综合分析。由于纳入研究的异质性和性质,不适合进行荟萃分析。在筛选的5278篇标题中,纳入了来自四个国家(非洲和东亚)的11项非对照干预研究,均来自过去12年。出现了四种不同类型的整合方式,这些方式要么提高了对HPV和/或宫颈癌筛查的认识,和/或使HPV疫苗接种与宫颈癌筛查计划的实施相结合。研究结果的综合分析表明,现有的HPV疫苗接种计划可以成为教育母亲和其他女性护理人员进行宫颈癌筛查的有效途径;通过与医护人员进行面对面交流(首选)或提供带回家的宣传资料。通过外展和流动诊所提供综合服务,可能会克服HPV疫苗接种和宫颈癌筛查在地理和经济方面的获取障碍,然而这需要大量的项目和系统资源。一项研究将HPV疫苗接种作为综合服务的一部分进行推广,但未发现其他利用宫颈癌筛查平台来推广或开展HPV疫苗接种教育的例子。本综述揭示了在HPV疫苗接种与宫颈癌筛查整合尝试方面已发表文献存在的差距。迄今为止,最有前景的做法似乎与宫颈癌预防的综合健康传播有关。未来的研究应进一步探索综合健康传播的机会,以支持新的全球消除宫颈癌议程所做的努力,以及为服务不足人群提供综合服务的成本和可行性。