2021 年，在津巴布韦马尼卡兰省和米德兰兹省的选定公立卫生机构中，使用醋酸视觉检查和 Cervicography 对筛查呈阳性的女性进行宫颈癌患病率和临床管理。
Prevalence of Cervical Cancer and Clinical Management of Women Screened positive using visual inspection with acetic acid and Cervicography in selected public sector health facilities of Manicaland and Midlands provinces of Zimbabwe, 2021.
机构信息
Technical Department, Zimbabwe Health Interventions, Harare, Zimbabwe.
AIDS and TB Programs, Ministry of Health and Child Care, Harare, Zimbabwe.
出版信息
PLoS One. 2023 Nov 29;18(11):e0294115. doi: 10.1371/journal.pone.0294115. eCollection 2023.
BACKGROUND
Zimbabwe has high cervical cancer (CC) burden of 19% and mortality rate of 64%. Zimbabwe uses Visual Inspection with Acetic Acid and Cervicography (VIAC) for CC screening. Manicaland and Midlands provinces recorded low VIAC positivity of 3% (target 5-25%) and treatment coverage of 78% (target = 90%) between October 2020 and September 2021.
OBJECTIVES
We explored VIAC positivity rate and clinical management of clients screening positive in Manicaland and Midlands provinces.
METHODS
We conducted a retrospective cross-sectional study using routine VIAC and CC management data for period October 2020 to September 2021. Two samples were used, 1) a sample drawn from 48,000 women VIAC screened to measure positivity rate, and 2) a sample of 1,763 VIAC positive women to assess clinical management. Kobo-based tool was used to abstract data from facility registers, and data were analyzed using STATA 15.
RESULTS
We analyzed data for 2,454 out of 48,000 women screened through VIAC. About 82% (2,007/2,454) were HIV positive, median ages were 40 and 38 years for HIV positives and negatives respectively. Most (64% and 77%) of HIV positive and negative clients respectively were married. VIAC positivity was 5.9% and 3.4% among HIV positive and negative women screened for the first time, and 3.2% and 5.6% for repeat visits respectively. Overall, 89.1% (1,571/1,763) of VIAC positive women received treatment. Most (41%) of those treated received thermocoagulation. Overall, 43.1% of clients received treatment on VIAC day, and 77.4% within 30 days. Six-month post-treatment coverage was 3.8%.
CONCLUSION
VIAC positivity among HIV positive women screening for the first time was 5.9%, within the expected 5-25%. Treatment coverage was high, and turnaround time from diagnosis to treatment met national standards. Post-treatment coverage was suboptimal. We recommend continued implementation of quality improvement initiatives, capacity building of clinicians, and optimization of post-treatment review of clients.
背景
津巴布韦宫颈癌（CC）负担率为 19%，死亡率为 64%。津巴布韦采用醋酸视觉检查和宫颈涂片检查（VIAC）进行 CC 筛查。马尼亚兰省和米德兰省在 2020 年 10 月至 2021 年 9 月期间，VIAC 阳性率记录为 3%（目标为 5-25%），治疗覆盖率为 78%（目标=90%）。
目的
我们探讨了马尼亚兰省和米德兰省 VIAC 筛查阳性客户的 VIAC 阳性率和临床管理情况。
方法
我们使用 2020 年 10 月至 2021 年 9 月期间的常规 VIAC 和 CC 管理数据进行了回顾性横断面研究。使用了两个样本，1）从接受 VIAC 筛查的 48000 名女性中抽取样本，以测量阳性率；2）从 1763 名 VIAC 阳性女性中抽取样本，以评估临床管理。使用基于 Kobo 的工具从设施登记册中提取数据，并使用 STATA 15 进行数据分析。
结果
我们对通过 VIAC 筛查的 2454 名 48000 名女性中的数据进行了分析。约 82%（2007/2454）为 HIV 阳性，HIV 阳性和阴性患者的中位年龄分别为 40 岁和 38 岁。大多数（分别为 64%和 77%）HIV 阳性和阴性患者已婚。首次接受 VIAC 筛查的 HIV 阳性和阴性女性中，VIAC 阳性率分别为 5.9%和 3.4%，重复就诊时分别为 3.2%和 5.6%。总体而言，1763 名 VIAC 阳性女性中，89.1%（1571 名）接受了治疗。大多数（41%）接受治疗的患者接受了热凝治疗。总体而言，43.1%的患者在 VIAC 当天接受了治疗，77.4%在 30 天内接受了治疗。治疗后 6 个月的覆盖率为 3.8%。
结论
首次接受 VIAC 筛查的 HIV 阳性女性的 VIAC 阳性率为 5.9%，处于预期的 5-25%范围内。治疗覆盖率较高，从诊断到治疗的周转时间符合国家标准。治疗后 6 个月的覆盖率为 3.8%，这一比例较低，我们建议继续实施质量改进计划，加强临床医生的能力建设，并优化对接受治疗的患者的后续治疗评估。
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