Basic Health International

San Salvador, El Salvador

Basic Health International

San Salvador, El Salvador

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Maza M.,Basic Health International | Gage J.C.,U.S. National Cancer Institute
Preventive Medicine | Year: 2017

The accumulated scientific evidence now provides ample support for HPV primary screening as a superior method for detecting cervical precancer and preventing cervical cancer. Approximately half of the global burden of cervical cancer could be reduced in lower-middle income countries where attempts to implement traditional cytology-based programs have not experienced successes. In these countries screening programs have struggled with poor screening and diagnostic test sensitivity, difficulties maintaining quality control and adequate population coverage. HPV testing is not only more accurate and reliable, but also requires less training, quality assurance and expensive personnel. Because these countries are especially vulnerable to economic, political and societal instabilities, HPV tests must become more affordable and accessible in order to enable Ministries of Health to make long-term resource commitments. © 2016 Elsevier Inc.


PubMed | Ministry of Health of El Salvador, Cleveland Clinic, Basic Health International, University of Alabama at Birmingham and 4 more.
Type: | Journal: BMC public health | Year: 2015

Cervical cancer is the third most commonly occurring cancer among women and the fourth leading cause of cancer-related deaths in women worldwide, with more than 85 % of these cases occurring in developing countries. These global disparities reflect the differences in cervical cancer screening rates between high-income and medium- and low-income countries. At 19 %, El Salvador has the lowest reported screening coverage of all Latin American countries. The purpose of this study is to identify factors affecting public sector HPV DNA-based cervical cancer screening participation in El Salvador.This study was nested within a public sector screening program where health promoters used door-to-door outreach to recruit women aged 30-49 years to attend educational sessions about HPV screening. A subgroup of these participants was chosen randomly and questioned about demographic factors, healthcare utilization, previous cervical cancer screening, and HPV knowledge. Women then scheduled screening appointments at their public health clinics. Screening participants were adherent if they attended their scheduled appointment or rescheduled and were screened within 6 months. The association between non-adherence and demographic variables, medical history, history of cancer, sexual history, birth control methods, and screening barriers was assessed using Chi-square tests of significance and logistic regression.All women (n = 409) enrolled in the study scheduled HPV screening appointments, and 88 % attended. Non-adherence was associated with a higher number of lifetime partners and being under-screened-defined as not having participated in cervical cancer screening within the previous 3 years (p = 0.03 and p = 0.04, respectively); 22.8 % of participants in this study were under-screened.Adherence to cervical cancer screening after educational sessions was higher than expected, in part due to interactions with the community-based health promoters as well as the educational session itself. More effective recruitment methods targeted toward under-screened women are required.


Hohmann H.L.,University of Pittsburgh | Cremer M.L.,New York University | Cremer M.L.,Basic Health International | Gonzalez E.,Ministry of Health and Social Assistance | Maza M.,Basic Health International
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2011

In order to gain an understanding of Salvadoran health care providers' clinical knowledge, attitudes, and practice toward the intrauterine device (IUD), Ministry of Health providers completed a self-administered, anonymous survey. Surveys were completed by 135 participants. The majority (94.7% and 97.0%) agreed the IUD is a safe and effective form of contraception. Only 46.6% of participants had ever received training in IUD placement, and 32.0% of them had ever inserted more than 10 IUDs. The majority of providers (54.2%) believed that the IUD was associated with a higher rate of infection than is described in the literature. Lack of formal training and knowledge about persistent infection rates associated with IUDs may contribute to low IUD placement by Salvadoran providers. Health care providers surveyed are open to learning more about the IUD and sharing the information with their patients.


Rosenbaum A.J.,University of Pittsburgh | Gage J.C.,U.S. National Cancer Institute | Alfaro K.M.,Basic Health International | Ditzian L.R.,Basic Health International | And 8 more authors.
International Journal of Gynecology and Obstetrics | Year: 2014

Objective To determine the acceptability of self-collected versus provider-collected sampling among women participating in public sector HPV-based cervical cancer screening in El Salvador. Methods Two thousand women aged 30-49 years underwent self-collected and provider-collected sampling with careHPV between October 2012 and March 2013 (Qiagen, Gaithersburg, MD, USA). After sample collection, a random sample of women (n = 518) were asked about their experience. Participants were questioned regarding sampling method preference, previous cervical cancer screening, HPV and cervical cancer knowledge, HPV risk factors, and demographic information. Results All 518 women approached to participate in this questionnaire study agreed and were enrolled, 27.8% (142 of 511 responding) of whom had not received cervical cancer screening within the past 3 years and were considered under-screened. Overall, 38.8% (n = 201) preferred self-collection and 31.9% (n = 165) preferred provider collection. Self-collection preference was associated with prior tubal ligation, HPV knowledge, future self-sampling preference, and future home-screening preference (P < 0.05). Reasons for self-collection preference included privacy/embarrassment, ease, and less pain; reasons cited for provider-collection preference were result accuracy and provider knowledge/experience. Conclusion Self-sampling was found to be acceptable, therefore screening programs could consider offering this option either in the clinic or at home. Self-sampling at home may increase coverage in low-resource countries and reduce the burden that screening places upon clinical infrastructure. © 2014 International Federation of Gynecology and Obstetrics.


Masch R.,Beth Israel Deaconess Medical Center | Ditzian L.R.,Basic Health International | Ditzian L.R.,Mount Sinai Medical Center | April A.K.,Basic Health International | And 5 more authors.
Journal of Women's Health | Year: 2011

Background: Visual inspection with acetic acid (VIA) is a simple, low-cost alternative to traditional Pap smears that could greatly benefit the amount of screening and treatment available in low-resource areas, such as rural El Salvador. The objective of this study was to train Salvadoran health providers in VIA and cryotherapy using a week-long competency course. Methods: Health providers participated in the VIA training course, which consisted of 1 half-day of didactics, followed by 4 and 1 half days of clinical training. Pretests and posttests were administered. A 1-day didactic refresher course was administered to assess the quality of services being provided. Results: Sixty-eight nurses and physicians completed the training course. Each trainee screened approximately 120 women and performed, on average, seven cryotherapy treatments. The average trainee improved his or her score by 15% on the theoretical test and 16.7% on the image test. At the completion of the 1-day refresher, average test scores were the highest among all the courses. The final assessment was based on 41 providers. Conclusions: The course proved a successful tool for training healthcare providers in methods of cervical cancer screening and treatment. The course is replicable in other low-resource settings in different countries. It also provided trainees with the opportunity to adapt their clinical skills in their realistic work setting. © 2011 Copyright, Mary Ann Liebert, Inc.


Cremer M.L.,New York University | Cremer M.L.,Basic Health International | Peralta E.I.,Basic Health International | Dheming S.G.,Instituto Del Cancer Of El Salvador | And 5 more authors.
Journal of Lower Genital Tract Disease | Year: 2010

OBJECTIVE: This study aimed to compare digital camera assessment of the reproductive tract (DART) to colposcopy for the evaluation of abnormal Pap smears. MATERIALS AND METHODS: Participants included 207 women with abnormal Pap smears. Colposcopy and DART were performed on each patient by separate examiners with the goal of lesion detection. Analysis was performed per patient and per biopsy. RESULTS: Patients had an average of 2.9 biopsies. Forty-two patients and 81 biopsies were positive for cervical intraepithelial neoplasia 2+. Both DART and colposcopy detected 41 (97.6%) of 42 patients (95% CI = 85.9%-99.9%). Digital camera assessment of the reproductive tract detected 66/81 (81.4%; CI = 70.7%-88.9%) and colposcopy detected 69/81 (85.2%; CI = 73.2%-92.4%) of biopsies that were cervical intraepithelial neoplasia 2+. CONCLUSIONS: Digital camera assessment of the reproductive tract detects high-grade lesions of the cervix with similar sensitivity to colposcopy. It holds great promise to expand cervical cancer precursor lesion detection in areas with limited resources. © 2009 American Society for Colposcopy and Cervical Pathology.


Cremer M.,Mount Sinai School of Medicine | Conlisk E.,Hampshire College | Maza M.,Basic Health International | Bullard K.,Hampshire College | And 4 more authors.
International Journal of Gynecology and Obstetrics | Year: 2011

Objective: The present study assessed the adequacy and predictive performance of visual inspection with acetic acid (VIA) in women over the age of 50 years and compared the specificity and sensitivity of VIA with that of the conventional cytology. Methods: In total, 588 Salvadoran women ages 50-79 underwent VIA, Pap smear, and cervical biopsy. VIA was considered adequate if the squamocolumnar junction was completely visible. A positive biopsy was defined as cervical intraepithelial neoplasia (CIN) 2 or worse. Results: Age was negatively correlated with VIA adequacy (P = 0.04). Nevertheless, the majority of women-even in the older age groups-had adequate examinations. The adequacy of VIA was positively correlated with gravida (P = 0.01) and was higher in women who had been treated by cryotherapy (P = 0.02). The rate of positive biopsies was unexpectedly low (n = 6 [1%]) making it difficult to assess the predictive performance of VIA. In this small sample, the sensitivities of VIA (17%) and Pap (33%) were low; the high number of false negatives could not be fully explained by inadequacy of the examinations. Conclusions: Adequacy of VIA declined with age. However, the squamocolumnar junction was visible to the naked eye in the majority of women, indicating that they are good candidates for VIA. © 2011 International Federation of Gynecology and Obstetrics.


Ditzian L.R.,Basic Health International | David-West G.,Mount Sinai School of Medicine | Maza M.,Basic Health International | Hartmann B.,Basic Health International | And 2 more authors.
Mount Sinai Journal of Medicine | Year: 2011

Cervical cancer is a leading cause of death among women in the developing world. Conventional cytology-based cervical cancer screening programs have been largely ineffectual at reducing the cervical cancer burden in low-resource settings. In response, alternative strategies have been tested, such as visual inspection with acetic acid (VIA) screening and human papillomavirus (HPV) DNA-based testing. This manuscript reviews literature addressing the programmatic approaches to implementing cervical cancer screening programs in low-resource settings, highlighting the challenges, barriers, and successes related to the use of cytology, VIA, and HPV-DNA based screening programs. © 2011 Mount Sinai School of Medicine.


CASTLE P.E.,Yeshiva University | MAZA M.,Basic Health International
Epidemiology and Infection | Year: 2015

Human papillomavirus (HPV) is the necessary cause of cervical cancer, the fourth most common cancer and cause of cancer-related death in females worldwide. HPV also causes anal, vaginal, vulvar, penile, and oropharyngeal cancer. Prophylactic HPV vaccines based on recombinantly expressed virus-like particles have been developed. Two first-generation, U.S. Food and Drug Administration (FDA)-approved vaccines prevent infections and disease caused by HPV16 and HPV18, the two HPV genotypes that cause approximately 70% of cervical cancer, and one of these vaccines also prevents HPV6 and HPV11, the two HPV genotypes that cause 90% of genital warts. A next-generation vaccine, recently approved by the U.S. FDA, targets HPV16, HPV18, and five additional HPV genotypes that together causes approximately 90% of cervical cancer as well as HPV6 and HPV11. In clinical trials, these vaccines have shown high levels of efficacy against disease and infections caused by the targeted HPV genotypes in adolescent females and males and older females. Data indicate population effectiveness, and therefore cost effectiveness, is highest in HPV-naive young females prior to becoming sexually active. Countries that implemented HPV vaccination before 2010 have already experienced decreases in population prevalence of targeted HPV genotypes and related anogenital diseases in women and via herd protection in heterosexual men. Importantly, after more than 100 million doses given worldwide, HPV vaccination has demonstrated an excellent safety profile. With demonstrated efficacy, cost-effectiveness, and safety, universal HPV vaccination of all young, adolescent women, and with available resources at least high-risk groups of men, should be a global health priority. Failure to do so will result in millions of women dying from avertable cervical cancers, especially in low- and middle-income countries, and many thousands of women and men dying from other HPV-related cancers. Copyright © Cambridge University Press 2015


PubMed | Basic Health International and Yeshiva University
Type: Journal Article | Journal: Epidemiology and infection | Year: 2016

Human papillomavirus (HPV) is the necessary cause of cervical cancer, the fourth most common cancer and cause of cancer-related death in females worldwide. HPV also causes anal, vaginal, vulvar, penile, and oropharyngeal cancer. Prophylactic HPV vaccines based on recombinantly expressed virus-like particles have been developed. Two first-generation, U.S. Food and Drug Administration (FDA)-approved vaccines prevent infections and disease caused by HPV16 and HPV18, the two HPV genotypes that cause approximately 70% of cervical cancer, and one of these vaccines also prevents HPV6 and HPV11, the two HPV genotypes that cause 90% of genital warts. A next-generation vaccine, recently approved by the U.S. FDA, targets HPV16, HPV18, and five additional HPV genotypes that together causes approximately 90% of cervical cancer as well as HPV6 and HPV11. In clinical trials, these vaccines have shown high levels of efficacy against disease and infections caused by the targeted HPV genotypes in adolescent females and males and older females. Data indicate population effectiveness, and therefore cost effectiveness, is highest in HPV-naive young females prior to becoming sexually active. Countries that implemented HPV vaccination before 2010 have already experienced decreases in population prevalence of targeted HPV genotypes and related anogenital diseases in women and via herd protection in heterosexual men. Importantly, after more than 100 million doses given worldwide, HPV vaccination has demonstrated an excellent safety profile. With demonstrated efficacy, cost-effectiveness, and safety, universal HPV vaccination of all young, adolescent women, and with available resources at least high-risk groups of men, should be a global health priority. Failure to do so will result in millions of women dying from avertable cervical cancers, especially in low- and middle-income countries, and many thousands of women and men dying from other HPV-related cancers.

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