Background: The burden of Human papillomavirus (HPV)-related cancers is expected to rise in Indonesia as there has been an increase in the availability of medication that prolongs the survival of women infected with the human immunodeficiency virus (HIV+). There is an urgent need for cervical cancer (CC) screening to address this concern.
Objective: The objectives of the current study were to determine the burden of HPV infections and cervical pre-cancer lesions and evaluate the effectiveness of an education program to improve HPV and CC knowledge among women attending HIV clinics in Bali, Indonesia.
Methods: A questionnaire focused on HPV and CC was administered to 200 HIV+ women before (pre-education) and after the education program (post-education). Cervical cells were used to perform the Papanicolaou (Pap) and test for 13 high-risk (HR) HPV genotypes. Women diagnosed with Pap diagnoses of greater than atypical squamous cells of undetermined significance (≥ASCUS+) were identified as abnormal Pap.
Results: Fifty-four percent of women were diagnosed with ASCUS+ and 81% of those women were positive for any one of the 13 HR-HPV genotypes while 71% were positive for any HPV genotype included in the 9-valent (9V) HPV vaccine. The percentages of women who answered questions correctly at the pre-education interview was 3-25% while 97-100% gave the correct answers to the same questions at the post-education interview (P<0.0001).
Conclusion: Our study for the first-time documented that a significant proportion of women who attend HIV clinics in Bali are diagnosed with ASCUS+ and HR-HPVs which put them at high risk for developing CC. It would have been possible to prevent the development of ASCUS+ in at least 70% of those women if 9V HPV vaccine was given to these women. Since all 200 women educated by our program consented for screening, we clearly demonstrated that HIV+ women attending HIV clinics can be successfully educated to participate in CC screening.
Keywords: cervical cancer; education; screening.
Plain language summary
When women infected with the human immunodeficiency virus (HIV) live longer because of the availability of HIV medications, more women are likely to develop cervical cancer (CC) caused by another virus called the human papillomavirus (HPV), a common infection in HIV infected women. Therefore, there is an urgent need for CC screening to address this concern. Participation in CC screening is low in developing countries like Indonesia. Since several studies have shown the need for education programs to improve cancer screening rates of women at high risk for developing CC in such countries, we conducted a study to test the burden of HPV infections and cervical pre-cancer lesions and evaluate the effectiveness of an education program to improve HPV and CC knowledge among women attending HIV clinics in Bali, Indonesia. We observed that more than 50% of women have cervical pre-cancer lesions and 81% of those women are also infected with cancer causing HPVs. We also observed that the percentages of women who answered questions correctly at the pre-education interview was 3–25% while 97–100% gave the correct answers to the same questions at the post-education interview. Since all 200 women educated by our program consented for screening, we clearly demonstrated that women attending HIV clinics can be successfully educated to participate in CC screening, an important step to lower the risk of developing CC in HIV infected women.
© 2024 Lestari et al.
Keywords：educational program; cervical cancer knowledge; hiv-positive women; bali; indonesia
背景: 随着延长人类免疫缺陷病毒（HIV+）女性生存期的药物可用性的增加，预计印度尼西亚与人类乳头瘤病毒（HPV）相关的癌症负担将会增加。迫切需要进行宫颈癌（CC）筛查以应对这一问题。
目的: 本研究的主要目的是确定高风险女性中HPV感染和宫颈前病变的负担，并评估教育计划的有效性，以提高印度尼西亚巴厘岛HIV诊所就诊妇女对HPV和CC知识的理解。
方法: 在教育项目前后（预教育和后教育），为200名HIV+女性分发了一份关于HPV和CC的问卷。使用宫颈细胞进行Papanicolaou (Pap) 检查并检测13种高风险（HR）HPV基因型。被诊断出有大于不典型鳞状细胞意义未定（≥ASCUS+）的妇女被认为是异常Pap。
结果: 54% 的女性被诊断为 ASCUS+, 其中81% 的女性至少有一种高风险HPV基因型呈阳性，而71%的女性对九价（9V）HPV疫苗所包含的所有HPV类型均呈阳性。在预教育面试时，正确回答问题的比例是3-25%，而在后教育面试时，同样的问题则有97-100% 的正确答案（P
结论: 我们的研究首次记录了巴厘岛HIV诊所就诊的女性中ASCUS+和高风险HPV阳性率显著，这使她们患宫颈癌的风险很高。如果这些女性能够接种九价（9V）HPV疫苗，则至少70% 的女性可以预防ASCUS+的发展。由于我们的教育项目中的所有200名妇女都同意接受筛查，因此我们明确表明HIV+女性可以被成功地教育参与CC筛查。
关键词: 宫颈癌；教育；筛查。
简易摘要
当由于抗逆转录病毒药物的可用性，人类免疫缺陷病毒（HIV）感染女性能活得更长时，更多女性可能因另一种常见于HIV感染女性中的病毒感染——人乳头瘤病毒（HPV），而患宫颈癌（CC）。因此，迫切需要进行CC筛查以解决这一问题。在发展中国家如印度尼西亚，参与CC筛查的比例很低。由于多个研究表明教育项目可以提高高风险国家中CC筛查率，我们在巴厘岛HIV诊所进行了这项研究，旨在测试HPV感染和宫颈前病变的负担，并评估教育计划的有效性，以便改善妇女对HPV和CC的理解。我们观察到超过50% 的女性有宫颈癌前病变，其中81% 患者也感染了致癌型HPVs。我们也注意到在预教育面试时正确回答问题的比例为3-25%，而在后教育面试时则上升到了97-100%。由于我们的项目中的所有200名女性都同意参与筛查，我们明确表明可以通过成功教育HIV诊所的妇女来参加CC筛查，这是降低HIV感染女性患宫颈癌风险的重要一步。
© 2024 Lestari et al.
