在赞比亚卡泰特，利用首段晨尿进行高危型 HPV 检测，用于 HIV 阳性妇女的宫颈癌筛查。

Utilizing first void urine for high-risk HPV testing for cervical cancer screening in HIV-positive women in Katete, Zambia.

机构信息

Department of Obstetrics and Gynaecology, The Pan African University for Life and Earth Sciences Institute (Including Health and Agriculture), University of Ibadan, Ibadan, Nigeria.

Department of Obstetrics and Gynaecology, University College Hospital, University of Ibadan, Ibadan, Nigeria.

出版信息

BMC Womens Health. 2023 Feb 11;23(1):62. doi: 10.1186/s12905-023-02212-7.

DOI:10.1186/s12905-023-02212-7

PMID:36774526

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9922459/

Abstract

BACKGROUND

The World Health Organization targets to screen 70% of women worldwide twice for cervical cancer by the year 2030, first by age of 35, and again by the age of 45. However, with the current low screening coverage in many developing countries, this may not be achieved because the invasive sampling method is unacceptable to some. In Zambia, for instance, despite the availability of free cervical cancer screening through the establishment of the Cervical Cancer Prevention Programme, some women are still reluctant to go for screening. First void urine sampling is non-invasive and thus has the potential to increase screening coverage. We aimed to determine the performance of first void urine for high-risk human papillomavirus DNA detection, the prevalence of high-risk HPV, and the acceptability of first void urine sampling.

MATERIALS AND METHOD

A comparative cross-sectional study was conducted among 100 HIV- infected women at St Francis' Hospital in Zambia, attending the routine HIV/AIDS services and cervical cancer screening. 17 mL of first void urine sample collected by each participant was immediately mixed with 3 mL of 0.5 M EDTA preservative solution before cervical sample collection by the clinician. For testing, 2 mL of first void urine and 1 mL of the cervical sample were tested using the GeneXpert platform. An interview-based questionnaire was used to gather data on the acceptability of first void urine sampling. Data was analyzed using Stata version 17.

RESULTS

The mean age of the participants was 42.58 years (95% CI 40.98-44.19; SD 8.01). High-risk HPV prevalence was 34% (95% CI 24%-43.9%) in both cervical and first void urine samples. Sensitivity and specificity were 84.8% (95% CI 68.1%-94.9%) and 92.3% (83%-97.5%), respectively. There was 89.80% agreement between the samples (κ = 0.77; 95% CI 0.64-0.91). First void urine sampling was highly accepted.

CONCLUSION

High-risk HPV DNA can be detected in first void urine samples using the GeneXpert, with a substantial agreement with cervical samples. An affordable preservative such as Ethylenediamine tetraacetic acid can prevent DNA degradation. With optimization, first void urine sampling has the potential to increase screening coverage.

摘要

背景

世界卫生组织的目标是到 2030 年在全球范围内对 70%的女性进行两次宫颈癌筛查，第一次是在 35 岁，第二次是在 45 岁。然而，在许多发展中国家，目前的筛查覆盖率很低，因为一些国家无法接受这种有创性的取样方法。例如，在赞比亚，尽管通过建立宫颈癌预防计划提供了免费的宫颈癌筛查，但一些女性仍然不愿意进行筛查。首次排空尿液取样是非侵入性的，因此有可能增加筛查覆盖率。我们旨在确定首次排空尿液中高危型人乳头瘤病毒 DNA 的检测性能、高危型 HPV 的流行率以及首次排空尿液取样的可接受性。

材料和方法

在赞比亚圣弗朗西斯医院，对 100 名感染艾滋病毒的妇女进行了一项比较性横断面研究，这些妇女参加了常规的艾滋病毒/艾滋病服务和宫颈癌筛查。每位参与者收集 17 毫升的首次排空尿液样本，然后在临床医生采集宫颈样本前立即与 3 毫升 0.5M 乙二胺四乙酸（EDTA）防腐剂混合。为了进行检测，使用 GeneXpert 平台对 2 毫升首次排空尿液和 1 毫升宫颈样本进行检测。使用基于访谈的问卷收集关于首次排空尿液取样的可接受性的数据。使用 Stata 版本 17 进行数据分析。

结果

参与者的平均年龄为 42.58 岁（95%置信区间 40.98-44.19；标准差 8.01）。高危型 HPV 流行率在宫颈和首次排空尿液样本中均为 34%（95%置信区间 24%-43.9%）。灵敏度和特异性分别为 84.8%（95%置信区间 68.1%-94.9%）和 92.3%（83%-97.5%）。两种样本之间的一致性为 89.80%（κ=0.77；95%置信区间 0.64-0.91）。首次排空尿液取样具有很高的可接受性。