Safety and Acceptability of Thermal Ablation for Treatment of Human Papillomavirus Among Women Living With HIV in Western Kenya
| Autor: | Craig R. Cohen, Jeniffer Ambaka, Cirilus Ogollah Osongo, Chemtai Mungo, Megan J. Huchko, Magdalene Randa, Jackton Omoto |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
0301 basic medicine Cancer Research medicine.medical_specialty medicine.medical_treatment MEDLINE Human immunodeficiency virus (HIV) Thermal ablation HIV Infections Cryotherapy Alphapapillomavirus medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Original Reports medicine Humans 030212 general & internal medicine Human papillomavirus Papillomaviridae Aged Cervical cancer Obstetrics business.industry Papillomavirus Infections Middle Aged medicine.disease Kenya 030104 developmental biology Oncology Female business |
| Zdroj: | JCO Global Oncology JCO global oncology, vol 6, iss 6 |
| ISSN: | 2687-8941 |
| Popis: | PURPOSE The WHO now recommends thermal ablation as an alternative to cryotherapy within “screen-and-treat” cervical cancer programs in low- and middle-income countries (LMICs). We conducted a safety and acceptability clinical trial of thermal ablation in a Kenyan Ministry of Health hospital among women living with HIV (WLWH; ClinicalTrials.gov identifier: NCT04191967 ). METHODS Between August 2019 and February 2020, WLWH age 25-65 years underwent human papillomavirus (HPV) self-collection in western Kenya. HPV-positive women underwent visual inspection with acetic acid, biopsy, and treatment with thermal ablation performed by a nonphysician clinician, if eligible by standard guidelines. A questionnaire was administered after treatment to assess for pain and treatment acceptability. Adverse events (AEs) were evaluated 4-6 weeks after treatment with a standardized grading tool. RESULTS A total of 293 HPV-positive WLWH underwent thermal ablation in the study period. The mean age was 40.4 years (standard deviation, 8.7 years). After treatment, 15 (5.1%), 231 (78.8%), 42 (14.3%), and 5 (1.8%) reported none, mild, moderate, and severe pain with treatment, respectively. At follow-up, spotting, vaginal discharge, and pelvic pain were reported by 99 (37.8%), 258 (98.5%), and 46 (17.6%), respectively, for a median of 3.3 (interquartile range [IQR], 2-3), 14 (IQR, 7-21), and 7 (IQR, 3-7) days, respectively. Most participants graded their AEs as mild (grade 1): 94 (95.0%) for bleeding, 125 (48.5%) for vaginal discharge, and 37 (80.4%) for pelvic pain. No grade 3 or 4 AEs were reported. The vast majority (99.2%) were satisfied with the treatment and would recommend it to a friend. CONCLUSION Thermal ablation performed by nonphysicians in the public health sector in Kenya proved safe and highly acceptable in treating HPV-positive WLWH. |
| Databáze: | OpenAIRE |
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