Center for Indigenous Health Research, Wuqu' Kawoq, Maya Health Alliance, Tecpán, Guatemala.
Friendship Bridge, Panajachel, Sololá, Guatemala.
JCO Glob Oncol. 2022 Feb;8:e2100286. doi: 10.1200/GO.21.00286.
More than 80% of cervical cancer cases and deaths occur in low- and middle-income countries. Here, we analyze a large geographically extensive cross-sectional data set from the Western rural highlands of Guatemala. Our objective is to better characterize weak points in care along the cervical cancer care continuum and investigate sociodemographic and clinical correlates of loss to follow-up.
We conducted a retrospective review of electronic health records data from July 21, 2015, through December 10, 2020 for a cytology-based screening and cervical cancer treatment program. We used a care cascade analysis to characterize the progression of individuals through screening, confirmatory testing, and treatment. We examined demographic and clinical factors correlated with screening and loss to follow-up using multivariate logistic regression.
A total of 8,872 individuals were included in the analysis. Five thousand nine hundred thirteen cervical cancer screenings were conducted. 4.1% of all screening tests were abnormal, including 0.61% cervical intraepithelial neoplasia or overt cervical cancer. Care cascade analysis showed that 67% of eligible women accepted screening. Of those requiring confirmatory testing or treatment, 73% completed recommended follow-up. In adjusted multivariable analysis, prior history of sexual transmitted infection, prior experience with cervical cancer screening, older age, and current contraceptive use were associated with accepting screening. Age and contraceptive use were also associated with retention in care after a positive first screen.
In a large rural Guatemalan retrospective cohort, a care continuum analysis showed that both declining the opportunity to receive cervical cancer screening as well as declining confirmatory testing after a first positive screen were both important weak points along the care continuum. These data support the need for comprehensive and culturally appropriate initiatives to improve screening uptake and retention in care.
超过 80%的宫颈癌病例和死亡发生在中低收入国家。在这里，我们分析了来自危地马拉西部农村高地的一个大型、广泛的地理横断面数据集。我们的目的是更好地描述宫颈癌护理连续体中的薄弱环节，并调查社会人口学和临床因素与失访的相关性。
我们对 2015 年 7 月 21 日至 2020 年 12 月 10 日的电子健康记录数据进行了回顾性审查，该数据来自一个基于细胞学的筛查和宫颈癌治疗计划。我们使用护理级联分析来描述个体通过筛查、确认性检测和治疗的进展。我们使用多变量逻辑回归检查与筛查和失访相关的人口统计学和临床因素。
共纳入 8872 人进行分析。进行了 5913 次宫颈癌筛查。所有筛查试验中有 4.1%异常，包括 0.61%的宫颈上皮内瘤变或明显宫颈癌。护理级联分析显示，67%符合条件的女性接受了筛查。在需要确认性检测或治疗的人群中，73%完成了推荐的随访。在调整后的多变量分析中，既往性传播感染史、既往宫颈癌筛查经历、年龄较大和当前使用避孕药具与接受筛查相关。年龄和避孕药具的使用也与首次阳性筛查后的保留护理相关。
在一项大型的危地马拉农村回顾性队列研究中，护理连续体分析表明，拒绝接受宫颈癌筛查的机会以及在首次阳性筛查后拒绝进行确认性检测，都是护理连续体中的重要薄弱环节。这些数据支持需要全面和文化上适当的举措，以提高筛查的参与度和保留护理。
