Munjoma Malvern, Gudukeya Stephano, Mavudze Jabulani, Chipfumbu Charity, Choi Hanul, Moga Tafara, Mutede Blessing, Leuschner Staci, Taruberekera Noah
Population Solutions for Health, Harare, Zimbabwe.
Population Services International, Harare, Zimbabwe.
Ecancermedicalscience. 2024 Aug 12;18:1736. doi: 10.3332/ecancer.2024.1736. eCollection 2024.
Thermal ablation, a technique that destroys precancerous cervical cells by extreme heat or cold, is predominantly used as a preventive cervical cancer treatment modality in high-income countries. Compared to other treatment methods thermal ablation has numerous advantages in its portability, minimal electricity use and comparable treatment rates, which is convenient for use in low- and middle-income countries (LMICs). Therefore, it is important to understand acceptability among providers and clients and the feasibility of achieving comparable treatment outcomes with other methods in LMICs.
We conducted a prospective longitudinal, open-label two-arm study from June 2021 to April 2022 at seven health delivery points. In this study, 182 clients were enrolled to receive preventive cancer treatment at baseline and followed up 6 months later to measure treatment outcomes and experiences on the procedure. Eligible consented clients were elected to a preferred method (either thermal ablation as an intervention or cryotherapy as a control group). We also conducted qualitative interviews with 14 service providers in either static or outreach settings.
At the 6-month follow-up, the efficacy was comparable among the two groups, 96.5% (95% CI 86.7%-99.1%) clients in the intervention group had successful lesion treatment rate compared to 80.8% (95% CI 69.9%-99.1%) of the control group. Furthermore, 99% of clients in the intervention group would recommend thermal ablation to their family members or peers. Service providers preferred thermal ablation due to its ease of use, lower costs, portability and lower likelihood of adverse events compared to cryotherapy.
The study showed the feasibility of implementing thermal ablation as a new preventive cervical cancer treatment modality in Zimbabwe. Furthermore, service providers indicated their preference for thermal ablation due to its ease of use, portability at static settings and lower likelihood of adverse events occurrence. Therefore, we recommend scaling up thermal ablation both at static and outreach sites.
热消融是一种通过极热或极冷来破坏宫颈癌前细胞的技术，在高收入国家主要用作预防性宫颈癌治疗方式。与其他治疗方法相比，热消融在便携性、低耗电量和相当的治疗率方面具有诸多优势，便于在低收入和中等收入国家（LMICs）使用。因此，了解提供者和客户的接受度以及在LMICs中与其他方法取得可比治疗效果的可行性很重要。
2021年6月至2022年4月，我们在七个医疗服务点进行了一项前瞻性纵向、开放标签的双臂研究。在本研究中，182名客户在基线时登记接受预防性癌症治疗，并在6个月后进行随访，以测量治疗效果和对该程序的体验。符合条件并同意的客户被选入首选方法（热消融作为干预组，冷冻疗法作为对照组）。我们还对14名在固定或外展环境中的服务提供者进行了定性访谈。
在6个月的随访中，两组的疗效相当，干预组96.5%（95%CI 86.7%-99.1%）的客户病变治疗成功率与对照组的80.8%（95%CI 69.9%-99.1%）相比。此外，干预组99%的客户会向家人或同龄人推荐热消融。与冷冻疗法相比，服务提供者更喜欢热消融，因为它使用方便、成本较低、便携且不良事件发生率较低。
该研究表明在津巴布韦将热消融作为一种新的预防性宫颈癌治疗方式实施的可行性。此外，服务提供者表示他们更喜欢热消融，因为它使用方便、在固定环境中便于携带且不良事件发生的可能性较低。因此，我们建议在固定和外展地点扩大热消融的应用。
