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首页> 外文期刊>Gynecologic Oncology Reports >Public health approach to prevent cervical cancer in HIV-infected women in Kenya: Issues to consider in the design of prevention programs
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Public health approach to prevent cervical cancer in HIV-infected women in Kenya: Issues to consider in the design of prevention programs

机译：肯尼亚预防感染艾滋病毒的妇女子宫颈癌的公共卫生方法：设计预防方案时应考虑的问题

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Women living with HIV in Africa are at increased risk to be co-infected with Human Papilloma Virus (HPV), persistent high risk (HR) HPV infection and bacterial vaginosis (BV), which compounds HPV persistence, thereby increasing the risk for cervical dysplasia. New guidance from WHO in 2014 advocating for a “screen and treat” approach in resource poor settings is becoming a more widely recommended screening tool for cervical cancer prevention programs in such contexts. This review article summarizes the risk factors to be considered when designing a primary and secondary cervical prevention program in a post-vaccination era for HIV-infected women in Kenya. This review article is based on our prior research on the epidemiology of pHR/HR-HPV genotypes in HIV-infected women and CIN 2+ in Kenya and other sub-Saharan contexts. In order to contextualize the findings, a literature search was carried out in March 2017 by means of four electronic databases: PUBMED, EMBASE, SCOPUS, and PROQUEST. Risk factors for potential (pHR)/HR HPV acquisition, including CD4 count, HAART initiation, Female Sex Worker status (FSW) and BV need to be considered. Furthermore, there may be risk factors for abnormal cytology, including FSW status, multiple potential (p)HR/HR HPV genotypes, which may require that HIV-infected women be subjected to screening at more frequent intervals than the three year recommended by the WHO. The quadruple synergistic interaction between HIV, HPV and BV and its related cervicitis may need to be reflected within a larger prevention framework at the community level. The opportunities brought forth by the roll out of HAART could lead to task shifting of HIV-HPV-BV care to nurses, which may increase access in poorly-served areas. Highlights ? Bacterial Vaginosis treatment should be an integral component of cervical cancer prevention. ? A larger cervical cancer prevention framework at the community level is needed. ? Task shifting to nurses of Bacterial Vaginosis management in HIV-HPV co-infected women should be explored.
机译：非洲感染艾滋病毒的妇女与人乳头瘤病毒（HPV），持续性高危（HR）HPV感染和细菌性阴道病（BV）合并感染的风险增加，这加剧了HPV的持久性，从而增加了宫颈不典型增生的风险。世卫组织在2014年提出的在资源贫乏地区倡导“筛查和治疗”方法的新指南正日益成为在这种情况下预防子宫颈癌的筛查工具。这篇综述文章总结了在肯尼亚针对艾滋病毒感染妇女的疫苗接种后时代设计一级和二级宫颈预防计划时应考虑的风险因素。这篇评论文章基于我们先前对肯尼亚和其他撒哈拉以南非洲地区的HIV感染女性和CIN 2+的pHR / HR-HPV基因型流行病学的研究。为了对调查结果进行背景介绍，2017年3月通过四个电子数据库进行了文献检索：PUBMED，EMBASE，SCOPUS和PROQUEST。需要考虑潜在（pHR）/ HR HPV采集的风险因素，包括CD4计数，HAART启动，女性性工作者身份（FSW）和BV。此外，可能存在细胞学异常的危险因素，包括FSW状态，多种潜在的（p）HR / HR HPV基因型，这可能需要比HIV推荐的三年期更频繁地进行HIV感染妇女的筛查。 。 HIV，HPV和BV及其相关宫颈炎之间的四重协同相互作用可能需要在社区一级更大的预防框架内得到体现。 HAART的推出带来的机会可能导致将HIV-HPV-BV护理的任务转移给护士，这可能会增加服务差的地区的使用率。强调 ？细菌性阴道病的治疗应成为宫颈癌预防的组成部分。 ？需要在社区一级建立更大的宫颈癌预防框架。 ？应探讨将任务转移给感染HIV-HPV的女性细菌性阴道病护理的护士。

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