提高中低收入国家宫颈癌筛查率的干预措施：系统评价和荟萃分析。

Interventions to increase the uptake of cervical cancer screening in low- and middle-income countries: a systematic review and meta-analysis.

机构信息

Maternal and Reproductive Health Division, Department of Public Health, Ministry of Health, Naypyidaw, Myanmar.

Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.

出版信息

BMC Womens Health. 2023 Mar 23;23(1):120. doi: 10.1186/s12905-023-02265-8.

BACKGROUND

To identify effective interventions to increase the uptake of cervical cancer screening (CCS) for low-and middle-income countries (LMICs).

METHODS

We searched PubMed, CENTRAL, ISI Web of Sciences, Scopus, OVID (Medline), CINAHL, LILACS, CNKI and OpenGrey for randomized controlled trials (RCTs) and cluster RCTs conducted in LMICs from January 2000 to September 2021. Two reviewers independently screened studies, extracted data, assessed risk of bias and certainty of evidence. Meta-analyses with random-effects models were conducted for data synthesis.

RESULTS

We included 38 reports of 24 studies involving 318,423 participants from 15 RCTs and nine cluster RCTs. Single interventions may increase uptake of CCS when compared with control (RR 1.47, 95% CI 1.19 to 1.82). Self-sampling of Human Papillomavirus (HPV) testing may increase uptake of CCS relative to routine Visual Inspection with Acetic Acid (RR 1.93, 95% CI 1.66 to 2.25). Reminding with phone call may increase uptake of CCS than letter (RR 1.72, 95% CI 1.27 to 2.32) and SMS (RR 1.59, 95% CI 1.19 to 2.13). Sending 15 health messages may increase uptake of CCS relative to one SMS (RR 2.75, 95% CI 1.46 to 5.19). Free subsidized cost may increase uptake of CCS slightly than $0.66 subsidized cost (RR 1.60, 95% CI 1.10 to 2.33). Community based HPV test may increase uptake of CCS slightly in compared to hospital collected HPV (RR 1.67, 95% CI 1.53 to 1.82). The evidence is very uncertain about the effect of combined interventions on CCS uptake relative to single intervention (RR 2.20, 95% CI 1.54 to 3.14).

CONCLUSIONS

Single interventions including reminding with phone call, SMS, community self-sampling of HPV test, and free subsidized services may enhance CCS uptake. Combined interventions, including health education interventions and SMS plus e-voucher, may be better than single intervention. Due to low-certainty evidences, these findings should be applied cautiously.

背景

为了确定在中低收入国家（LMICs）增加宫颈癌筛查（CCS）采用率的有效干预措施。

方法

我们检索了 PubMed、CENTRAL、ISI Web of Sciences、Scopus、ovid（Medline）、CINAHL、LILACS、CNKI 和 OpenGrey 中 2000 年 1 月至 2021 年 9 月在 LMICs 进行的随机对照试验（RCT）和整群 RCT。两位评审员独立筛选研究、提取数据、评估偏倚风险和证据确定性。采用随机效应模型进行荟萃分析以进行数据综合。

结果

我们纳入了 15 项 RCT 和 9 项整群 RCT 中 38 份报告的 24 项研究，涉及 318423 名参与者。与对照组相比，单一干预措施可能会增加 CCS 的采用率（RR 1.47，95%CI 1.19 至 1.82）。人乳头瘤病毒（HPV）自我采样检测可能比常规醋酸视觉检查（RR 1.93，95%CI 1.66 至 2.25）更能增加 CCS 的采用率。电话提醒可能比信件（RR 1.72，95%CI 1.27 至 2.32）和短信（RR 1.59，95%CI 1.19 至 2.13）更能增加 CCS 的采用率。发送 15 条健康信息可能比发送一条短信（RR 2.75，95%CI 1.46 至 5.19）更能增加 CCS 的采用率。免费补贴费用可能会略微增加 CCS 的采用率，而不是 0.66 美元的补贴费用（RR 1.60，95%CI 1.10 至 2.33）。与医院采集的 HPV 相比，基于社区的 HPV 检测可能会略微增加 CCS 的采用率（RR 1.67，95%CI 1.53 至 1.82）。关于联合干预措施对 CCS 采用率的影响的证据非常不确定，与单一干预措施相比（RR 2.20，95%CI 1.54 至 3.14）。