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在肯尼亚试行一项系统层面的干预措施,以改善宫颈癌筛查、治疗及随访情况。

Piloting a systems level intervention to improve cervical cancer screening, treatment and follow up in Kenya.

作者信息

Mabachi Natabhona M, Wexler Catherine, Acharya Harshdeep, Maloba May, Oyowe Kevin, Goggin Kathy, Finocchario-Kessler Sarah

机构信息

Practice-Based Research, Innovation, and Evaluation Division, American Academy of Family Physicians, Leawood, KS, United States.

Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States.

出版信息

Front Med (Lausanne). 2022 Sep 15;9:930462. doi: 10.3389/fmed.2022.930462. eCollection 2022.

Abstract

Although preventable, Cervical Cancer (CC) is the leading cause of cancer deaths among women in Sub-Saharan Africa with the highest incidence in East Africa. Kenyan guidelines recommend an immediate screen and treat approach using either Pap smear or visual screening methods. However, system (e.g., inadequate infrastructure, weak treatment, referral and tracking systems) and patient (e.g., stigma, limited accessibility, finance) barriers to comprehensive country wide screening continue to exist creating gaps in the pathways of care. These gaps result in low rates of eligible women being screened for CC and a high loss to follow up rate for treatment. The long-term goal of 70% CC screening and treatment coverage can partly be achieved by leveraging electronic health (eHealth, defined here as systems using Internet, computer, or mobile applications to support the provision of health services) to support service efficiency and client retention. To help address system level barriers to CC screening treatment and follow up, our team developed an eHealth tool-the Cancer Tracking System (CATSystem), to support CC screening, treatment, and on-site and external referrals for reproductive age women in Kenya. Preliminary data showed a higher proportion of women enrolled in the CATSystem receiving clinically adequate (patients tested positive were treated or rescreened to confirm negative within 3 months) follow up after a positive/suspicious screening, compared to women in the retrospective arm.

摘要

尽管宫颈癌是可预防的,但它却是撒哈拉以南非洲地区女性癌症死亡的主要原因,在东非发病率最高。肯尼亚的指导方针建议采用直接筛查和治疗的方法,使用巴氏涂片或视觉筛查方法。然而,全面的全国性筛查仍存在系统(例如基础设施不足、治疗、转诊和追踪系统薄弱)和患者(例如耻辱感、可及性有限、资金问题)方面的障碍,导致护理路径出现缺口。这些缺口致使符合条件的女性接受宫颈癌筛查的比例较低,治疗失访率较高。通过利用电子健康(此处定义为使用互联网、计算机或移动应用程序来支持提供医疗服务的系统)来提高服务效率和留住客户,可部分实现70%的宫颈癌筛查和治疗覆盖率这一长期目标。为帮助解决宫颈癌筛查、治疗和随访方面的系统层面障碍,我们的团队开发了一种电子健康工具——癌症追踪系统(CATSystem),以支持肯尼亚育龄妇女的宫颈癌筛查、治疗以及现场和外部转诊。初步数据显示,与回顾性研究组的女性相比,纳入CATSystem的女性在筛查呈阳性/可疑后接受临床充分随访(检测呈阳性的患者接受治疗或重新筛查以在3个月内确认阴性)的比例更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d3a4/9520305/4e11c603eb9b/fmed-09-930462-g001.jpg

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