Affordable primary health care in low-income countries: can it be achieved?

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Predictors of late presentation of cervical cancer in HIV-positive Ugandan women

Thesis (Master's)--University of Washington, 2012Predictors of late stage presentation of cervical cancer in HIV-positive Ugandan women Background Cervical cancer is one of the leading causes of cancer deaths in women globally and it is the number one cause of cancer morbidity and mortality in Ugandan women. No data on predictors of late stage cervical cancer in HIV-positive women presenting for oncologic care in Uganda is available. It is also not known how HIV care providers in Uganda view integration of cervical cancer screening in routine HIV care. Methods This was a cross sectional study of HIV-positive women with cervical cancer. Data were collected on demographics, HIV history, including CD4+ T-cell count, and cervical cancer history and stage. In addition, focus group discussions were held with staff in HIV clinics. Results Forty women completed study procedures, with a median age of 40 years (range 25 - 68). Thirty-two (40%) had late stage cervical cancer (FIGO stage III and IV). In bivariate analysis, there was an association between young age at sexual debut (16 years and younger) and presentation with late stage cervical cancer (OR = 0.273, p = 0.043). Having 2 or more lifetime sexual partners was also associated with 80% increased odds (OR=1.800, p=0.045). Importantly, CD4+ T-cell count were not associated with late stage cervical cancer. Qualitative data showed that HIV care staffs know that HIV-positive women are at high risk of cervical cancer, there is lack of awareness among the HIV- positive women and some of the key reasons why cervical cancer screening is not done routinely in HIV care are absence of a policy and HIV care guidelines that integrate the intervention. Conclusions Many HIV-positive women present with late stage cervical cancer. Women with low SES (poor, low education) with early sexual debut and multiple sexual partners were more likely to presen

Mobile cancer prevention and early detection outreach in Uganda: Partnering with communities toward bridging the cancer health disparities through “asset‐based community development model”

Abstract Background Communities in low‐income countries are characterized by limited access to cancer prevention and early detection services, even for the commonest types of cancer. Limited resources for cancer control are one of the contributors to cancer health disparities. We explored the feasibility and benefit of conducting outreaches in partnership with local communities using the “asset‐based community development (ABCD)” model. Methods We analyzed the quarterly Uganda cancer institute (UCI) community outreach cancer health education and screening output reported secondary data without individual identifiers from July 2016 to June 2019 to compare the UCI‐hospital‐based and community outreach cancer awareness and screening services based on the ABCD model. Results From July 2016 to June 2019, we worked with 107 local partners and conducted 151 outreaches. Of the total number of people who attended cancer health education sessions, 201 568 (77.9%) were reached through outreaches. Ninety‐two (95%) cancer awareness TVs and radio talk‐shows conducted were sponsored by local partners. Of the total people screened; 22 795 (63.0%) cervical, 22 014 (64.4%) breast, and 4904 (38.7%) prostate screening were reached through community outreach model. The screen‐positive rates were higher in hospital‐based screening except for Prostate screening; cervical, 8.8%, breast, 8.4%, prostate, 7.1% than in outreaches; cervical, 3.2%, breast, 2.2%, prostate, 8.2%. Of the screened positive clients who were eligible for precancer treatment like cryotherapy for treatment of precervical cancer lesions, thousands‐folds monetary value and productive life saved relative to the market cost of cancer treatment and survival rate in Uganda. When the total number of clients screened for cervical, breast, and prostate cancer are subjected to the incremental cost of specific screening, a greater portion (98.7%) of the outreach cost was absorbed through community partnership. Conclusions Outreaching and working in collaboration with communities as partners through asset‐based community development model are feasible and help in cost‐sharing and leverage for scarce resources to promote primary prevention and early detection of cancer. This could contribute to bridging the cancer health disparities in the target populations

Acceptability of cervical cancer screening using visual inspection among women attending a childhood immunization clinic in Uganda

Objective: To evaluate the acceptability and performance of cervical cancer (CC) screening using visual inspection with acetic acid (VIA) integrated into a rural immunization clinic in Uganda. Methods/materials: We conducted a cross-sectional pilot study in rural Uganda. We explored associations between women's characteristics and acceptance of VIA testing. We collected samples for Papanicolaou (Pap) smear testing in a random subset of women and used results from this test as a comparator for assessing VIA performance. Results: We enrolled 625 women of whom 571 (91.4%) accepted and 54 (8.6%) refused CC screening. In the univariate model, age (Odds Ratio (OR)=1.10; p-value<0.001) and employment status (OR 2.00; p-value=0.019) were significantly associated with acceptance of VIA screening. In the multivariate model, no characteristic was independently associated with acceptance of VIA screening after adjusting for other factors. Compared to reference Pap smear, CC screening with VIA had a sensitivity of 50% and a specificity of 97.7%. Conclusions: CC screening with VIA is highly acceptable in the setting of rural immunization clinics in Uganda. Studies to assess which screening method would be the most effective and cost-effective are needed before stakeholders can consider adopting screening programs at scale