Nonrandom return: lessons from women returning for follow-up results of cervical cancer screening in rural haiti.

PURPOSE: Few studies have evaluated approaches to improve patient follow-up in screening programs within resource-limited areas. This study investigated the patterns of return among women presenting for results from a cervical cancer screening program implemented in a resource-poor region to highlight areas for future research and potential interventions. METHODS: In the development of a cervical cancer screening program in rural Haiti, women aged 18-45 years were recruited from local churches to undergo cervical cancer screening and follow-up for results. A dot plot was used to analyze the distribution of women returning during the results phase compared to the random return rates based on the screening phase. RESULTS: Of the 250 women tested, 121 (48%) returned for follow-up. On the 2 result days with the most returnees, 46 and 63% of the women had been tested during only 3 of the 11 testing days which themselves accounted for 41% of the total number of women who returned. The highest volume return days, a Monday and a Friday, gave results to women tested on Monday, Wednesday and Friday, and on Monday, Tuesday and Thursday, respectively. The 2 result days with the lowest return numbers had 80% (8/10) of those who returned coming as the only returnee from their day of testing. CONCLUSION: Result days corresponding with the highest return rates had increased clustering of women from the screening phase, and the result days with fewer women returning had less clustering. These findings are among the first to implicate the importance of defining these patterns of return and the potential for recruitment techniques that exploit such groupings, potentially described by social connections, in limited-resource settings to improve follow-up for screening programs.

Group Medical Visits to Provide Gynecologic Care for Women Affected by Breast Cancer.

PURPOSE: Women with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer. METHODS: A group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to February 2014, 148 patients (3-6 per group) participated in a 1-hour informational session followed by a 15- to 30-minute individual visit with a physician that included history, physical examination and evaluation. We surveyed 101 women who attended these visits to evaluate a group model for providing gynecologic care and educational support to women with breast cancer. RESULTS: Of those who responded to the survey question, 100% agreed or somewhat agreed that their expectations for an initial intake visit were met during the group visit; 81% agreed or somewhat agreed that they felt a group visit was preferable to an individual introductory visit. More than 95% agreed or somewhat agreed that the information was understandable and their questions were answered during the visit. Only 5 respondents expressed dissatisfaction with the additional time commitment for this type of visit. CONCLUSIONS: The majority of women surveyed expressed satisfaction with their experience with a group visit format. The women who participated preferred this format compared to an individual intake appointment when establishing gynecology care after breast cancer diagnosis/treatment, regardless of age, menopausal status, cancer stage or hormone receptor status. While further studies are warranted to directly compare and further assess satisfaction and efficacy, gynecologists may consider using a group model to provide comprehensive education and care to this patient population.

The Exclusion of Sperm Donation on the Basis of Sexual Practices: Time for a Policy Update.

Currently, both the U.S. Food and Drug Administration and American Society for Reproductive Medicine exclude sperm donation from men who have sex with men. The recommended screening includes questioning donors about their sexual practices and performing a physical examination to look for signs of anal intercourse in addition to standard human immunodeficiency virus (HIV) laboratory testing. The rationale cited is concern over increased risk of HIV transmission in this higher prevalence population. We were unable to find evidence that excluding men who have sex with men or those with signs of anal intercourse on physical examination decreases the false-negative rate of laboratory testing. Current policy allows for men who have sex with men to be prohibited from donating sperm for the use of gestational carriers and therefore discriminates against this population for whom assisted reproductive technology may be their only means of genetic reproduction. We suggest policy revision to include the most advanced HIV laboratory tests and eliminating exclusionary demographics as part of screening.