Clinical Trials

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Browsing Clinical Trials by Author "Amanuel, Hanna"

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    Self sampling HPV testing as cervical cancer screening approach among women living in low-middle-income -countries: Systematic review and Meta-analysis.
    (Addis Abeba University, 2021) Amanuel, Hanna; Dr.W/Amanuel, Yimtubezinash; Prof.Makonnen, Eyasu
    Background: More than 85% of cervical cancer deaths occur in low-middle-income countries, and 90% of the mortality burden is primarily attributed to low coverage of cervical cancer screening. Self-sampling HPV could increase the overall cervical screening and contribute to alleviating the burden of cervical cancer in LMICs (low-middle-income countries) Objective: The general objective of this review and meta-analysis was to see if self-sampling HPV screening method can increase uptake of cervical cancer screening in low-middle-income countries. Methods: CENTRAL (Cochrane Central Registry of controlled trials), MEDLINE (through PubMed), Clinicaltrial.gov, WHO Global Health Library, and EMBASE were searched. Reference lists of the relevant studies found were assessed to further search for relevant studies. The MeSH terms for HPV (MeSH (DNA Probes, HPV) (Human Papillomavirus DNA Tests)) and cervical cancer MeSH term (uterine cervical neoplasms) were found and as for the term self-sampling, there was no MeSH term found therefore method of text words/synonyms (Self-sampling, Selfcollection, Self-obtained) for self-sampling was used. For the LMIC, LMIC filter prepared by Cochrane from all LMIC countries listed by World bank was used. Where multiple studies reported the same comparable outcome of interest, we conducted a metaanalysis. Random-effects models was used to generate pooled effect size of relative risk with a 95% confidence interval using RevMan 5.4. Results: Six RCTs (randomized control trials) were included in this review. The studies were from Ethiopia, Kenya, Nigeria, Uganda, Argentina, and Mexico. These studies included a total of 39,274 participants with in the age group ranged from 25 – 65 years. All the studies compared an interventional group of HPV self-sampling method with a control group of a standard of care. HPV self-sampling was reported to be acceptable, and participants stated the device was easy to use and they would use HPV self-sampling instead of the regular hospital screening in the future. There were no adverse events associated with the self-sampling device. In the meta-analysis, uptake of cervical cancer screening services showed that the likelihood of participants to use self-sampling HPV screening method was 75% higher than with standard of care (RR: 1.72, 95% CI 1.58 to 1.87, Isquared: 72%) with insignificant I2, (MODERATE quality of evidence). However, there was no difference between linkage to care between the two groups (RR=1.18, 95% CI 0.77 to 1.81, I2= 87%) (VERY LOW quality of evidence). Conclusion: Self-sampling HPV screening technique has the potential to increase the uptake of cervical cancer screening in LMICs, and is acceptable by women. Moreover, this technique helps overcome many barriers to cervical cancer screening in LMICs such as lack of trained personnel, lack of laboratory supplies, infrastructure, socio-religious and cultural barriers to pelvic examination, limited physical access to patient populations, and the need for spousal permission. As this can reduce social inequalities in access to cervical screening, it helps alleviate the cervical cancer burden in LMICs.