Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention.

BACKGROUND: Cervical cancer is a preventable cancer; however, decreasing its prevalence requires early detection and treatment strategies that reduce rates of loss to follow-up. This study explores factors associated with loss to follow-up among HPV-positive women after implementation of a new HPV-based screen-and-treat approach for cervical cancer prevention in Iquitos, Peru. METHODS: We conducted semi-structured interviews with "obstetras" (i.e., midwives) (n = 15) working in cervical cancer prevention and women (n = 24) who were recorded as lost to follow-up after positive HPV results. We used the Health Care Access Barriers Model to guide analyses. We utilized manifest content analysis to describe barriers to follow-up according to the obstetras and thematic analysis to report themes from the women's perspectives. We also report the steps and time taken to contact women. RESULTS: We found an incomplete and fragmented patient monitoring system. This incomplete system, in conjunction with challenges in contacting some of the women, led to structural barriers for the obstetras when attempting to deliver positive results. Women in this study expressed a desire to receive treatment, however, faced cognitive barriers including a lack of understanding about HPV results and treatment procedures, fear or anxiety about HPV or treatment, and confusion about the follow-up process. Women also reported having important work matters as a barrier and reported frequently using natural medicine. Reported financial barriers were minimal. CONCLUSION: This study highlights the barriers to follow-up after implementation of a primary-level HPV-based screen-and-treat approach. While some barriers that have previously been associated with loss to follow-up were not as prominently observed in this study (e.g., financial), we emphasize the need for screen-and-treat programs to focus on strategies that can address incomplete registry systems, structural challenges in results delivery, cognitive barriers in understanding results and treatment, and work-related barriers.

Efficacy of Single-Dose Albendazole and Albendazole Plus Ivermectin for Soil-Transmitted Helminth Infection in Children in the Peruvian Amazon.

In countries where soil-transmitted helminth (STH) infections are endemic, deworming programs are recommended to reduce morbidity; however, increasing levels of resistance to benzimidazoles are of concern. In an observational study in Peru, we studied the clinical efficacy of 400 mg of albendazole 20 days after treatment among children aged 2-11 years. Of 426 participants who provided samples, 52.3% were infected with a STH, 144 (33.8%) were positive for Ascaris (41.8% light, 50.8% moderate, and 7.4% heavy infections), 147 (34.5%) were positive for Trichuris (75.2% light, 22.5% moderate, and 2.3% heavy infections), and 1.1% were positive for hookworm species (100% light infections). Additional stool samples were examined at 20, 90, and 130 days after the initial treatment. At 20 days post-administration of albendazole, the cure rate (CR) of Ascaris infection was 80.1% (95% CI: 73.5-86.7), and the egg reduction rate (ERR) was 70.8% (95% CI: 57.8-88.7); the CR for Trichuris infection was 27.1% (95% CI: 20.0-34.3), and the ERR was 29.8% (95% CI: -1.40 to 57.5). Among participants with persistent or recurrent infections with Trichuris, the combined therapy of albendazole (400 mg) and ivermectin at 600 µg/dose increased overall CR for Trichuris infection to 75.2% (95% CI: 67.3-83.2%) with an ERR of 84.2% (95% CI: 61.3-93.8%). Albendazole administration alone for the control of STH was associated with high rates of treatment failure, especially for Trichuris. Combined single doses of albendazole and ivermectin was observed to have improved efficacy.

Relaciones sexuales y gestación / Sexual relations and pregnancy

Objetivo: Precisar el comportamiento de la gestante respecto a las relaciones sexuales. Diseño: estudio prospectivo en 260 puérperas inmediatas atendidas en el Departamento de Gineco-Obstetricia del Hospital Regional de Loreto, mediante una encuesta aplicada por dos internas de obstetricia capacitadas previamente. Resultados: el 7,3 por ciento era menor de 15 años, 27,3 por ciento tuvo entre 15 y 19 años, el 57,3 por ciento entre 20 y 35 años y el 8,1 por ciento era mayor de 35 años. El 54 por ciento era multípara y el 46 por ciento primípara. El 92,4 por ciento inició sus relaciones sexuales antes de los 20 años. El 59,6 por ciento tuvo más de 2 relaciones al mes durante la primera mitad del embarazo y sólo el 34,6 por ciento durante la segunda mitad. El 87,3 por ciento disminuyó su frecuencia de relaciones sexuales respecto a su etapa pregravídica y el 70 por ciento presentó disminución de la libido; 17,7 por ciento tenía miedo de dañar al feto con las relaciones sexuales. En la segunda mitad del embarazo el 41 por ciento prefirió la posición de costado y el 12,7 por ciento practicó el felatio y el cunnilingus. El 41,2 por ciento contestó que su orgasmo había disminuido. El 24,6 por ciento reconoció que se masturbaba durante la gestación. El 11,5 por ciento tuvo su última relación sexual dentro de la semana antes del parto y el 17,7 por ciento dentro del mes antes del mismo. Conclusiones: durante el embarazo disminuyen la libido, la frecuencia de relaciones sexuales y el orgasmo. También existen cambios de posición en la segunda mitad de la gestación. Se recomienda proporcionar información a la gestante sobre las relaciones sexuales durante la gestación.