Acceptability and safety of thermal ablation for the treatment of precancerous cervical lesions in Honduras.

OBJECTIVE: To evaluate the acceptability and safety of thermal ablation (TA) for the treatment of precancerous cervical lesions in women in Honduras. METHODS: Human papillomavirus (HPV) and visual inspection with acetic acid (VIA) screen-positive eligible women received TA. After treatment, women rated the level of pain experienced during treatment using the Wong-Baker FACES® pain-rating scale from 0 to 10. Short-term safety outcomes that could require medical attention were assessed one month after treatment. RESULTS: A total of 319 women received TA treatment. The average pain rating was 2.5 (95% CI: 2.3-2.8), and 85% rated their pain levels as less than 6. No significant differences in low (below 6) or high (6 and above) pain were found by age or number of biopsies performed, but there was a significant difference by the number of TA applications (P < 0.01). When asked if they would recommend this treatment, all women said they would. At the one-month follow-up visit, the most common reported discomforts were bleeding (10%) and cramping (8.4%); 11 women reported severe lower abdominal pain, and none required medical attention. CONCLUSIONS: TA is safe and acceptable to patients as a treatment option for precancerous cervical lesions in low-resource settings.

OBJECTIF: Evaluer l'acceptabilité et la sécurité de l'ablation thermique (AT) pour le traitement des lésions cervicales précancéreuses chez les femmes au Honduras. MÉTHODES: Les femmes éligibles, portant le virus du papillome humain (VPH) et avec une inspection visuelle positive au test de dépistage à l'acide acétique (IVA) ont reçu une AT. Après le traitement, les femmes ont estimé le niveau de douleur ressenti au cours du traitement à l'aide de l'échelle d'évaluation de la douleur Wong-Baker FACES® de 0 à 10. Les résultats de sécurité à court terme pouvant nécessiter une attention médicale ont été évalués un mois après le traitement. RÉSULTATS: 319 femmes ont reçu un traitement d'AT. L'estimation moyenne de la douleur était de 2,5 (IC95%: 2,3-2,8) et 85% estimaient que leur niveau de douleur était inférieur à 6. Aucune différence significative dans la douleur faible (moins de 6) ou élevée (6 et plus) n'a été constatée en fonction de l'âge ou du nombre de biopsies réalisées, mais il y avait une différence significative selon le nombre d'applications d'AT (P < 0,01). Lorsqu'on leur a demandé si elles recommanderaient ce traitement, toutes les femmes ont répondu qu'elles le feraient. Lors de la visite de suivi à un mois, les malaises les plus fréquents signalés étaient les saignements (10%) et les crampes (8,4%). Onze femmes ont rapporté des douleurs sévères dans le bas de l'abdomen et aucune n'a nécessité de soins médicaux. CONCLUSIONS: L'AT est sûre et acceptable pour les patientes comme option de traitement pour les lésions cervicales précancéreuses dans les régions à faibles ressources.

Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach.

BACKGROUND: Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown. METHODS: In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women's and providers' experiences with self-sampling, women's opinions of sampling at home, and their future needs. RESULTS: Among surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn't mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%). CONCLUSION: Self-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women's preference for self-sampling.