Educational interventions for cervical cancer prevention: a scoping review.

OBJECTIVES: to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women. METHODS: a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women. RESULTS: thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women's compliance with Pap smear was the Health Belief Model. CONCLUSIONS: group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women's health.

Educational interventions for cervical cancer prevention: a scoping review / Intervenciones educativas para la prevención del cáncer cervicouterino: revisión del alcance / Intervenções educativas para prevenção do câncer do colo do útero: revisão de escopo

ABSTRACT Objectives: to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women. Methods: a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women. Results: thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women's compliance with Pap smear was the Health Belief Model. Conclusions: group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women's health.

RESUMEN Objetivos: identificar, mapear y describir las características de las intervenciones educativas para la prevención del cáncer de cuello uterino en mujeres adultas. Métodos: revisión de alcance, realizada en once bases de datos y en la literatura gris, incluyendo estudios que describían intervenciones educativas dirigidas a la prevención del cáncer de cuello uterino en mujeres adultas. Resultados: se analizaron 33 artículos con 151.457 participantes. Las estrategias educativas más utilizadas fueron las discusiones participativas y los folletos educativos. La mayoría de las intervenciones se realizaron en una sola sesión, con una duración de 40 a 60 minutos. El modelo teórico más utilizado en las intervenciones para mejorar la adherencia de las mujeres al Papanicolaou fue el Modelo de Creencias de Salud. Conclusiones: las discusiones grupales, las conferencias y los folletos educativos pueden aumentar el conocimiento y reducir las barreras para la prevención del cáncer de cuello uterino. Las intervenciones basadas en teorías y culturalmente sensibles pueden tener un impacto positivo en la salud de las mujeres.

RESUMO Objetivos: identificar, mapear e descrever as características de intervenções educativas para a prevenção do câncer cervical em mulheres adultas. Métodos: revisão de escopo, conduzida em onze bases de dados e na literatura cinzenta, incluindo estudos que descreveram intervenções educativas voltadas à prevenção do câncer cervical em mulheres adultas. Resultados: 33 artigos com 151.457 participantes foram analisados. As estratégias educativas mais utilizadas foram as discussões participativas e folhetos educativos. A maior parte das intervenções ocorreu em sessão única, com variação de 40 a 60 minutos. O modelo teórico mais utilizado nas intervenções para melhorar a adesão das mulheres ao exame Papanicolau foi o Modelo de Crenças em Saúde. Conclusões: discussões em grupo, palestras e folhetos educativos podem aumentar o conhecimento e reduzir barreiras para a prevenção do câncer do colo do útero. Intervenções baseadas em teoria e culturalmente sensíveis podem ter impacto positivo na saúde das mulheres.

Self-sampling coupled to the detection of HPV 16 and 18 E6 protein: A promising option for detection of cervical malignancies in remote areas.

OBJECTIVE: To evaluate both the performance and acceptability of a method coupling self-sampling with detection of cervical malignancy via elevated HPV 16 and 18 E6 oncoproteins (OncoE6™ Cervical Test) in remote areas in Brazil. METHODS: Women living in rural villages in proximity to Coari city, Amazonas, Brazil were invited to participate in a cervical cancer screening study. 412 subjects were enrolled; there were no refusals. In addition to E6 protein detection, DNA was extracted from the brushes and evaluated for HPV genotypes by PCR (PGMY09/11), followed by typing by the Papillocheck™ if positive. Subjects who were found to be positive for OncoE6 or HPV-DNA were referred for colposcopy. RESULTS: For 110 subjects (27%) this was the first cervical cancer exam. Overall the HPV-DNA prevalence was 19.1% (n = 79); 1.4% (n = 6) were positive by the OncoE6 Test. Fifty-six women attended the invitation for colposcopy where nine had an abnormal cervix and were subsequently biopsied. Histopathological analysis revealed 2 CIN3, 2 carcinomas and 5 CIN1. OncoE6 called two out of the three HPV 16 or 18 associated CIN3+ lesions. CONCLUSIONS: The findings suggest that self-administered sample collection in combination with OncoE6 Test is feasible in this population. This could enable expanded screening coverage while ensuring a high specificity which is imperative given the remote geographic location, since women bearing abnormal test results would necessitate travel and logistical burden to access colposcopy and treatment.

"Hidden" sexually transmitted infections among women in primary care health services, Amazonas, Brazil.

This study describes the prevalence of infection by Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in a female population in Amazonas, Brazil. We collected cervical samples from 361 women examined at 10 primary care health services in the city of Coari, Amazonas, Brazil. The women were interviewed about socio-economic data, clinical history and sexual behaviour. Pelvic examinations were performed and cervical specimens were collected for detection of pathogens by PCR. The prevalence of infection was: 12.7% for Trichomonas vaginalis, 6.4% for Chlamydia trachomatis and 1.4% for Neisseria gonorrhoeae. There were no statistically significant associations between infections by any of the pathogens nor by any pathogen alone with any clinical variable, socio-demographic data or sexual behaviour. This study draws attention to the need for surveillance and possible need for screening for Chlamydia trachomatis, which often progresses asymptomatically. For the significant prevalence found, attention should also be given to asymptomatic infection by Trichomonas vaginalis, since this pathogen has recently been implicated as a risk factor for HIV infection.

[Detection of Human Cytomegalovirus and Herpes Simplex Virus type 2 in cervical sample]. / Detecção de Citomegalovírus Humano e Herpesvírus Simples tipo 2 em amostras cervicais.

PURPOSE: To detect the presence of Human Cytomegalovirus (HCMV) and Herpes Simplex Virus type 2 (HSV-2) DNA in cervical samples from women assisted in a primary health care clinic in the city of Coari, Amazonas, Brazil. METHODS: Participated in this study 361 sexually active women between 18 and 78 years. They were been assisted in a Basic Health Care Clinic for routine gynecological exam. The cervical samples were collected using endocervical brush. The viruses were detected using real-time Polymerase Chain Reaction (PCR) technique. RESULTS: Mean age was 36.4 years (standard deviation (SD)=13.4). HCMV DNA was found in cervical samples from 30 women (8.3%; IC95% 5.8 - 11.8) and HSV 2 DNA in 2 women (0.6%; IC95% 0.1 - 2.2). Two women related being HIV positive, one of them infected with HCMV. There were no statistically significant associations between infections by the pathogens studied and socioeconomic, clinical or behavioral variables. CONCLUSIONS: The prevalence of the HCMV infection found in the sample points to the need for screening of the virus during pregnancy and surveillance in immunocompromised patients. The low prevalence of HSV-2 found is probably due to the fact that cervical sampling is not appropriate for this type of study because of the characteristics of viral biology related to neurovirulence.

Detecção de Citomegalovírus Humano e Herpesvírus Simples tipo 2 em amostras cervicais / Detection of Human Cytomegalovirus and Herpes Simplex Virus type 2 in cervical sample

OBJETIVO: Testar a presença de DNA de Citomegalovírus Humano (HCMV) e Herpesvírus Simples tipo 2 (HSV-2) em amostras cervicais de mulheres atendidas em um serviço de atenção primária à saúde no município de Coari, Amazonas, Brasil. MÉTODOS: Participaram deste estudo 361 mulheres sexualmente ativas, variando entre 18 e 78 anos, atendidas em Unidades Básicas de Saúde para exame ginecológico de rotina. As amostras cervicais foram coletadas por meio de escova endocervical. A detecção dos vírus deu-se por meio de Reação em Cadeia da Polimerase (PCR) em tempo real. RESULTADOS: A média de idade das mulheres participantes foi de 36,4 anos (desvio-padrão (DP)=13,4). Foi encontrado DNA de HCMV em amostras cervicais de 30 mulheres (8,3%; IC95% 5,8 - 11,8) e de HSV-2 em 2 mulheres (0,6%; IC95% 0,1 - 2,2). Duas mulheres relataram ser portadoras do HIV, estando uma delas infectada com o HCMV. Não foram encontradas associações estatisticamente significativas entre a infecção pelos patógenos estudados e as variáveis socioeconômicas, clínicas e comportamentais. CONCLUSÕES: A prevalência de infecção pelo HCMV encontrada na amostra estudada chama a atenção para a necessidade do rastreio desse vírus na gestação e da vigilância nos pacientes imunocomprometidos. A baixa prevalência do HSV-2 deve-se provavelmente ao fato de a amostra cervical não ser adequada para este tipo de estudo por causa das características da biologia viral relacionadas à neurolatência.

PURPOSE: To detect the presence of Human Cytomegalovirus (HCMV) and Herpes Simplex Virus type 2 (HSV-2) DNA in cervical samples from women assisted in a primary health care clinic in the city of Coari, Amazonas, Brazil. METHODS: Participated in this study 361 sexually active women between 18 and 78 years. They were been assisted in a Basic Health Care Clinic for routine gynecological exam. The cervical samples were collected using endocervical brush. The viruses were detected using real-time Polymerase Chain Reaction (PCR) technique. RESULTS: Mean age was 36.4 years (standard deviation (SD)=13.4). HCMV DNA was found in cervical samples from 30 women (8.3%; IC95% 5.8 - 11.8) and HSV 2 DNA in 2 women (0.6%; IC95% 0.1 - 2.2). Two women related being HIV positive, one of them infected with HCMV. There were no statistically significant associations between infections by the pathogens studied and socioeconomic, clinical or behavioral variables. CONCLUSIONS: The prevalence of the HCMV infection found in the sample points to the need for screening of the virus during pregnancy and surveillance in immunocompromised patients. The low prevalence of HSV-2 found is probably due to the fact that cervical sampling is not appropriate for this type of study because of the characteristics of viral biology related to neurovirulence.