PDF(Pubmed)
Abstract：
BACKGROUND: To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics.
METHODS: Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA.
RESULTS: Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment.
CONCLUSIONS: Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.
METHODS: Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA.
RESULTS: Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment.
CONCLUSIONS: Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.
摘要：
背景：为了消除宫颈癌（CC），必须监测预防和护理服务的获取和质量，特别是对于感染艾滋病毒的妇女（WLHIV）。我们评估了撒哈拉以南非洲（SSA）HIV诊所的实施实践，以确定护理级联中的差距，并使用汇总的患者数据来填充WLHIV参加HIV诊所的级联。
方法：我们的基于设施的调查于2020年11月至2021年7月在SSA的30家HIV诊所进行，这些诊所参与了国际流行病学数据库评估艾滋病（IeDEA）联盟。我们对CC预防和护理服务进行了定性的现场水平评估，并分析了SSA中WLHIV常规护理的数据。
结果：33％的地点提供了人乳头瘤病毒（HPV）疫苗接种。CC诊断（42％）和治疗（70％）的转诊很常见，但在大约50％的网站上不是免费的。大多数网站都有电子健康信息系统(90%)，但是,在这些站点中,没有常规收集数据以告知监测WLHIV中消除CC的全球目标的指标.仅36%的提供HPV疫苗接种的地点常规收集数据，提供子宫颈筛查的站点的33％和提供癌前和CC治疗的站点的20％。
结论：尽管在SSA的一些HIV诊所中早已提供了CC预防和护理服务，患者和方案监测需要改进。各国应考虑利用其现有的卫生信息系统，并使用世界卫生组织提供的监测工具，以改善CC预防计划和获取，并跟踪他们在消除CC目标方面的进展。
方法：我们的基于设施的调查于2020年11月至2021年7月在SSA的30家HIV诊所进行，这些诊所参与了国际流行病学数据库评估艾滋病（IeDEA）联盟。我们对CC预防和护理服务进行了定性的现场水平评估，并分析了SSA中WLHIV常规护理的数据。
结果：33％的地点提供了人乳头瘤病毒（HPV）疫苗接种。CC诊断（42％）和治疗（70％）的转诊很常见，但在大约50％的网站上不是免费的。大多数网站都有电子健康信息系统(90%)，但是,在这些站点中,没有常规收集数据以告知监测WLHIV中消除CC的全球目标的指标.仅36%的提供HPV疫苗接种的地点常规收集数据，提供子宫颈筛查的站点的33％和提供癌前和CC治疗的站点的20％。
结论：尽管在SSA的一些HIV诊所中早已提供了CC预防和护理服务，患者和方案监测需要改进。各国应考虑利用其现有的卫生信息系统，并使用世界卫生组织提供的监测工具，以改善CC预防计划和获取，并跟踪他们在消除CC目标方面的进展。
