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Background Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact. Materials and Methods This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers. Results Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support. Conclusions Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.

Objectives This study investigated anal high-risk HPV (HR-HPV) prevalence in HIV-infected women using the Cepheid Xpert HPV assay and compares its performance with that of Hybrid Capture-2 (hc2). Methods A total of 199 HIV-infected women were recruited from Helen Joseph Hospital, Johannesburg. Stored ThinPrep anal swabs that had previously been tested using hc2 were tested for HPV using Xpert. Results The HR-HPV prevalence by Xpert was 40.8% and similar to hc2 (41.8%) with overall agreement of 86.7%; Cohen's kappa 0.73 (95% CI 0.63-0.82). High grade squamous intraepithelial lesions (HSIL) was associated with increasing number of multiple HPV infection (P < .001). Xpert and hc2 were similarly sensitive (77.4% and 77.4%, respectively) and specific (66.1% and 64.8% respectively) for HSIL detection. HPV16 (OR: 14.0, 95% CI: 3.9-48.0, P < .0001), HPV39/68/56/66 (OR: 4.1, 95% CI: 1.4-12, P = .01) and HPV51/59 (OR: 2.8, 95% CI: 1.1-7.6, P = .04) were independently associated with anal HSIL. Conclusions Xpert HPV typing is a promising anal screening test in HIV-infected women that performs similarly to hc2.

For decades reproductive tract infections (RTIs) have been hypothesized to play a role in uterine fibroid development. The few previous studies conducted used self-reported history of RTIs and had inconsistent findings. We investigated this hypothesis further using serological analysis, an immunological measure of past exposure. We focused on herpes simplex virus type 2 (HSV-2) because prior published data have suggested a possible association with fibroids, and serology for HSV-2 is much more sensitive than self-report. We used cross-sectional enrollment data from African-American women enrolled in a prospective study of fibroid incidence and growth (recruited 2010–2012) in the Detroit, Michigan, area. The women were aged 23–34 years and were screened for fibroids using a standardized ultrasound examination at their enrollment. Age- and multivariable-adjusted logistic regression models were used to estimate odds ratios. Of 1,696 participants, 1,658 had blood samples and HSV-2 serology results; 22% of participants with serology results had fibroids. There was no significant association between HSV-2 seropositivity and the presence of fibroids (multivariable-adjusted odds ratio = 0.94, 95% confidence interval: 0.73, 1.20), nor were there any associations with size of the largest fibroid, number of fibroids, or total fibroid volume. Our data provide no evidence for an influence of HSV-2 exposure on fibroid risk in young African-American women. Further study of other serologically measured RTIs is warranted.

BACKGROUND: In April 2014 we investigated the association of migration of a womans husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. METHODS: Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husbands migration status with HR-HPV infection and cervical cytology status. RESULTS: In 265 women the prevalence of HR-HPV was 7.5% (20/265) while the prevalence of abnormal cervical cytology defined using the Bethesda system as atypical glandular cells of undetermined significance or worse was 7.6% (19/251). Half of the study participants (50.8% 130/256) had husbands who had reported migrating for work at least once. Women aged 34 years (OR 0.22 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husbands migration. CONCLUSION: Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husbands migration for work could be delaying HR-HPV infections in married women until an older age. (c) The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions please e-mail: journals.permissions@oup.com.

Studies have suggested that exposure to ultraviolet (UV) light may increase risk of herpes simplex virus (HSV) recurrence. Between 1993 and 1997, the Herpetic Eye Disease Study (HEDS) randomized 703 participants with ocular HSV to receipt of acyclovir or placebo for prevention of ocular HSV recurrence. Of these, 308 HEDS participants (48% female and 85% white; median age, 49 years) were included in a nested study of exposures thought to cause recurrence and were followed for up to 15 months. We matched weekly UV index values from the National Oceanic and Atmospheric Administration to each participant's study center and used marginal structural Cox models to account for time-varying psychological stress and contact lens use and selection bias from dropout. There were 44 recurrences of ocular HSV, yielding an incidence of 4.3 events per 1,000 person-weeks. Weighted hazard ratios comparing persons with ≥8 hours of time outdoors to those with less exposure were 0.84 (95% confidence interval (CI): 0.27, 2.63) and 3.10 (95% CI: 1.14, 8.48) for weeks with a UV index of

Worldwide, one-seventh of cervical cancers occur in China, which lacks a national screening program. By evaluating the diagnostic accuracy of self-collected cervicovaginal specimens tested for human papillomavirus (HPV) DNA (Self-HPV testing) in China, we sought to determine whether Self-HPV testing may serve as a primary cervical cancer screening method in low-resource settings.We compiled individual patient data from five population-based cervical cancer-screening studies in China. Participants (n = 13 140) received Self-HPV testing, physician-collected cervical specimens for HPV testing (Physician-HPV testing), liquid-based cytology (LBC), and visual inspection with acetic acid (VIA). Screen-positive women underwent colposcopy and confirmatory biopsy. We analyzed the accuracies of pooled Self-HPV testing, Physician-HPV testing, VIA, and LBC to detect biopsy-confirmed cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) and CIN3+. All statistical tests were two-sided.Of 13 004 women included in the analysis, 507 (3.9%) were diagnosed as CIN2+, 273 (2.1%) as CIN3+, and 37 (0.3%) with cervical cancer. Self-HPV testing had 86.2% sensitivity and 80.7% specificity for detecting CIN2+ and 86.1% sensitivity and 79.5% specificity for detecting CIN3+. VIA had statistically significantly lower sensitivity for detecting CIN2+ (50.3%) and CIN3+ (55.7%) and higher specificity for detecting CIN2+ (87.4%) and CIN3+ (86.9%) (all P values.001) than Self-HPV testing, LBC had lower sensitivity for detecting CIN2+ (80.7%, P = .015), similar sensitivity for detecting CIN3+ (89.0%, P = .341), and higher specificity for detecting CIN2+ (94.0%, P.001) and CIN3+ (92.8%, P.001) than Self-HPV testing. Physician-HPV testing was more sensitive for detecting CIN2+ (97.0%) and CIN3+ (97.8%) but similarly specific for detecting CIN2+ (82.7%) and CIN3+ (81.3%) (all P values.001) than Self-HPV testing.The sensitivity of Self-HPV testing compared favorably with that of LBC and was superior to the sensitivity of VIA. Self-HPV testing may complement current screening programs by increasing population coverage in settings that do not have easy access to comprehensive cytology-based screening.

Purpose. The feasibility of contracting for medication therapy management (MTM) services in a physician’s office was studied. Methods. Patient records from January to June 2007 were reviewed at a university-based family medicine clinic to identify patients eligible for MTM services. Inclusion criteria included a minimum of six long-term medications and three chronic diseases. If eligible for MTM services, the patient’s primary pharmacy was contacted to determine in which Medicare prescription drug plan (MPDP) the patient was enrolled. Each MPDP was then contacted to establish a contract for compensation for face-to-face encounters by a pharmacist. Data were analyzed using descriptive statistics. Results. A total of 832 patients with Medicare Part B coverage were identified, and 404 charts were randomly selected for review. Of the 404 charts reviewed, 208 patients met the inclusion criteria. MPDP information was obtained for 185 patients. Patients were taking a mean ± S.D. of 8.6 ± 2.4 medications. Patients’ most common diseases included hypertension, hyperlipidemia, diabetes, gastroesophageal reflux disease, and arthritis. A total of 185 patients were enrolled in 20 MPDPs. Of those plans, 6 (30%) provided MTM services through internal drug plan staff to 80 (43%) of the patients reviewed. No information regarding MTM services was available from 13 (65%) of the 20 MPDPs. One MPDP (5%) provided MTM through face-to-face encounters; however, this MPDP contracted with only the dispensing pharmacy, not individual pharmacists. Conclusion. Over a six-month time period, pharmacists in a family medicine practice were unable to receive compensation by Medicare for providing MTM services.

We thank Dr. Castle for his constructive and contributory commentary (1) on our meta-analysis of human papillomavirus (HPV) persistence and cervical neoplasia. We agree that ascertaining HPV persistence may have clinical utility and that several issues must be addressed before persistence can be effectively implemented in cervical screening programs. As Dr. Castle mentioned a single HPV test is more sensitive but less specific than a single Papanicolaou test for the detection of cervical precancer and cancer. In fact HPV testing at a single time point has approximately 20-40 percent higher sensitivity than Papanicolaou testing and 5-10 percent lower specificity. Incorporating HPV persistence into routine cervical cancer screening may help to improve specificity without unduly reducing sensitivity by distinguishing women with short-term infections and therefore lower risk of cervical precancer and cancer from women with long-term infections and therefore higher risk. (excerpt)

The Centers for Medicare and Medicaid Services (CMS) has established local coverage determinations (LCDs) and national coverage determinations (NCDs) to define covered outpatient services.[1][1] LCDs and NCDs are typically developed for high-dollar or high-volume items and services and outline the

Nordic countries or elsewhere where similar registry linkage studies may be possible—such an analysis would indeed be relevant and informative in considering the total number of administered doses. HPV vaccination coverage rates in Sweden from 2006 to 2010 (approximately 4 years after introduction) were approximately 30% for both the youngest cohorts of girls and women aged 13 to 17 and 18 to 19 years, with relatively high completion rates of the three-dose series among those who initiated vaccination (approximately 80%). Sweden has an HPV vaccination registration system (SVEVAC) overseen by the Swedish Institute for Communicable Disease Control, as well as a national registry for drug prescriptions at the National Board of Health and Welfare. Because HPV vaccines must be prescribed by a health-care professional to be subsidized before implementation of a school-based program, Leval and colleagues likely captured close to 100% of the administered HPV vaccinations (at least in the group aged 13–17 years) through registry linkages when combining these two databases. Given these estimates of HPV vaccination initiation and that coverage rates were higher among residents whose parent(s) had higher education status, further efforts are needed to ensure broader HPV vaccination coverage of the entire Swedish female population, particularly for young girls at the highest future risk of cervical cancer—daughters of parents of relatively low educational