Kassa Rahel Nega, Shifti Desalegn Markos, Alemu Kassahun, Omigbodun Akinyinka O
Pan African University Life and Earth Sciences Institute (including Health and Agriculture), University of Ibadan, Ibadan, Oyo State, Nigeria.
School of Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
PLOS Glob Public Health. 2024 May 14;4(5):e0003183. doi: 10.1371/journal.pgph.0003183. eCollection 2024.
Cervical cancer is a prevalent disease among women, especially in low- and middle-income countries (LMICs), where most deaths occur. Integrating cervical cancer screening services into healthcare facilities is essential in combating the disease. Thus, this review aims to map evidence related to integrating cervical cancer screening into existing primary care services and identify associated barriers and facilitators in LMICs. The scoping review employed a five-step framework as proposed by Arksey and O'Malley. Five databases (MEDLINE, Maternity Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were systematically searched. Data were extracted, charted, synthesized, and summarised. A total of 28 original articles conducted in LMICs from 2000 to 2023 were included. Thirty-nine percent of the reviewed studies showed that cervical cancer screening (CCS) was integrated into HIV clinics. The rest of the papers revealed that CCS was integrated into existing reproductive and sexual health clinics, maternal and child health, family planning, well-baby clinics, maternal health clinics, gynecology outpatient departments, and sexually transmitted infections clinics. The cost-effectiveness of integrated services, promotion, and international initiatives were identified as facilitators while resource scarcity, lack of skilled staff, high client loads, lack of preventive oncology policy, territorial disputes, and lack of national guidelines were identified as barriers to the services. The evidence suggests that CCS can be integrated into healthcare facilities in LMICs, in various primary care services, including HIV clinics, reproductive and sexual health clinics, well-baby clinics, maternal health clinics, and gynecology OPDs. However, barriers include limited health system capacity, workload, waiting times, and lack of coordination. Addressing these gaps could strengthen the successful integration of CCS into primary care services and improve cervical cancer prevention and treatment outcomes.
宫颈癌是女性中的一种常见疾病，在大多数死亡病例发生的低收入和中等收入国家（LMICs）尤为如此。将宫颈癌筛查服务纳入医疗保健机构对于抗击该疾病至关重要。因此，本综述旨在梳理与将宫颈癌筛查纳入现有初级保健服务相关的证据，并确定LMICs中的相关障碍和促进因素。该范围综述采用了阿克西和奥马利提出的五步框架。系统检索了五个数据库（医学文献数据库、母婴护理数据库、Scopus数据库、护理及相关健康文献累积索引数据库（CINAHL）和科学网）。对数据进行了提取、制表、综合和总结。共纳入了2000年至2023年在LMICs开展的28篇原创文章。39%的综述研究表明宫颈癌筛查（CCS）已纳入艾滋病毒诊所。其余论文显示，CCS已纳入现有的生殖和性健康诊所、母婴健康、计划生育、婴儿健康诊所、孕产妇健康诊所、妇科门诊和性传播感染诊所。综合服务的成本效益、推广和国际倡议被确定为促进因素，而资源稀缺、缺乏技术人员、服务对象负担过重、缺乏预防性肿瘤政策、领土争端和缺乏国家指南被确定为服务的障碍。证据表明，在LMICs的各种初级保健服务中，包括艾滋病毒诊所、生殖和性健康诊所、婴儿健康诊所、孕产妇健康诊所和妇科门诊，可以将CCS纳入医疗保健机构。然而，障碍包括卫生系统能力有限、工作量、等待时间和缺乏协调。解决这些差距可以加强CCS成功纳入初级保健服务，并改善宫颈癌的预防和治疗效果。
