Evaluation of video-assisted HPV education in government-supported clinics in Western Kenya.

Despite prevalent preventative methods of human papillomavirus (HPV), cervical cancer remains the foremost cause of cancer-related death among women of reproductive age in Western Kenya. HPV self-sampling is a preventative measure that can improve accessibility and availability to cervical cancer screening. Correct education about HPV is crucial to combating stigma and increasing HPV screening uptake. In this study, we evaluated the workflow impact of a video-assisted HPV education to promote self-sampling in clinical settings in Kisumu, Kenya. We conducted a descriptive workflow study nested in a two-part cluster-randomized control trial in six government-supported health clinics in Kisumu County. We observed the workflow of HPV screening video-assisted and standard health educations. and evaluated community and clinic health assistant facilitation (CCHA), duration, and feasibility of the intervention. Thirty HPV screening-eligible women who participated in the video intervention were recruited for three focus group discussions (FGDs). The FGDs aimed to better understand women's experience with the video screening, their impressions on the content, and feedback about intervention logistics. Across 33 observations, 16.5 women per day watched the educational video at intervention clinics, and 14 women per day heard standard Ministry of Health cervical cancer prevention education talks at control clinics. Sixty-three percent of women participated in HPV self-sampling in the intervention sites, compared to forty-six percent who screened after standard health talks at control sites. The workflow observations identified variable video projection and viewing space, access to power supply, and CCHA availability and ability to utilize the projector as major factors impacting education workflow. Women in FGDs appreciated the video modality, length of video, and education location. HPV video education is a suitable intervention, with further research recommended to determine the viability of sustainably implementing the intervention in a clinic environment. This research is fully funded by the Duke University Global Health Institute.

Developing a framework to describe stigma related to cervical cancer and HPV in western Kenya.

BACKGROUND: Despite a high prevalence of human papillomavirus (HPV) and cervical cancer in low and middle-income countries, stigma remains an issue. Addressing HPV and cervical cancer stigma could significantly improve health outcomes for these conditions. The objective of this study was to identify the manifestations of stigma and their potential impacts on health-seeking behavior. METHODS: Twenty-six in-depth interviews were conducted with women living with HIV, HIV-negative women, community health volunteers, and health care providers in Kisumu, Kenya in 2019. The interviews were designed to draw out existing attitudes or experiences related to stigma within the community. We conducted a thematic analysis of the interviews to identify internalized, anticipated, and discriminatory attitudes. RESULTS: Within internalized attitudes, a prominent observed theme was a fear of death associated with a positive HPV test. This stemmed from a lack of understanding of differences between HPV and cervical cancer and posed a significant barrier for women deciding to seek screening or to continue with treatment. Discriminatory attitudes of community members, including assumptions of promiscuity, infidelity, or HIV status, were perceived to prevent women from accessing screening and treatment opportunities. The interviews also exhibited a limited awareness of HPV in this region, which may have contributed to a lack of enacted stigma towards people living with HPV or cervical cancer. CONCLUSION: Stigma has the potential to lead to decreased screening and treatment uptake through its drivers. This includes a decreased perception of personal risk due to a lack of knowledge, which results in increased HPV-risk behaviors. Future research must focus on creating and integrating stigma-reducing interventions, primarily to encourage women to seek out primary and secondary preventative measures.

Radiographic evaluation of the pregnant trauma patient: What are We willing to miss?

OBJECTIVE: Trauma is the leading cause of non-obstetrical causes of death in pregnant patients. The use of radiographic imaging for evaluation in the trauma bay is a controversial topic. However, in some cases the benefits of using radiographic imaging to ensure maternal survival outweigh the risks of radiation exposure to the fetus. This study explores whether sparing fetal exposure to radiation by minimizing use of ionizing radiographic imaging to the mother will put the mother at risk for a delayed diagnosis of injury. We hypothesize that minimizing the use of radiographic imaging in the initial assessment of pregnant trauma patients does not lead to a higher incidence of delayed diagnosis. STUDY DESIGN: A retrospective chart review at an urban level 1 trauma center reviewing pregnant patients involved in blunt trauma and a cohort of non-pregnant patients matched for age and ISS. Data points included: number and type of imaging studies performed on initial presentation and the number and type of imaging studies that were delayed. The primary outcome was incidence of delayed diagnosis in the pregnant trauma patient compared to the non-pregnant patient. RESULTS: 83 pregnant and 167 non-pregnant patients were examined. Average average ISS was 2.7 in both groups. 95.2% of the pregnant population had at least one imaging study done versus 100% of the control group (p = 0.004). The pregnant population had an average of 4.3 images performed compared with an average of 6.8 images in the non-pregnant cohort (p=<0.001). 18 (21.7%) pregnant patients had delayed imaging and 58 (34.7%) control patients had delayed imaging (p = 0.03). This led to an incidence of delayed diagnosis in 1% of pregnant patients and 5% control patients (p = 0.17). CONCLUSION: Our study shows that bluntly injured pregnant trauma patients receive significantly fewer radiographic images upon presentation than their non-pregnant counterparts. However, this led to insignificant difference in delay of injury diagnosis between pregnant and non-pregnant patients when matched for age and ISS. Though the ISS was low for both patient cohorts, this study suggests that mitigated radiographic imaging in the pregnant trauma patient is safe and does not result in delayed diagnosis of injury.