Richard Muwonge

Use of Thermal Ablation in Low-Resource Settings: Experience From Three Multicenter Noninferiority Randomized Clinical Trials

PURPOSE Thermal ablation (TA) is now a widely used treatment for cervical precancer in low- and middle-income countries. Over the past decade, TA devices have been redesigned to be more portable, user-friendly, and affordable. This analysis combines data from three large randomized clinical trials comparing the efficacy, safety, and acceptability of TA with those of the previous standard, gas-based cryotherapy. METHODS This analysis used Human Papillomavirus (HPV) test results at 1-year post-treatment as the primary outcome. Secondary outcomes included side effects and patient satisfaction. RESULTS Of the 2,948 participants treated with either TA or gas-based cryotherapy, 80.9% and 81.8% completed HPV testing at 1 year, respectively. Overall, 60.7% tested negative for HPV at follow-up, with slightly higher rates in the TA group (62.5%) compared with cryotherapy (58.7%), although the difference was not statistically significant ( P value = .14). Side effects were minimal for both treatments. Severe pain was slightly more common with TA (7.6% v 3.9% for cryotherapy), but vasovagal responses were less frequent (2.3% v 7.6%). Satisfaction with treatment was high (approximately 98%) across both groups. CONCLUSION Our findings support the efficacy of TA in treating cervical precancer, offering an effective and practical alternative in low-resource settings. However, future research is urgently needed to address critical questions, including the standardization of treatment protocols and tailored approaches for women living with HIV.

Analysis of time trends of prevalence of high-risk HPV infections, high grade cervical precancer and cervical cancer disease in women from Eastern India over 20 years − Pooled analysis from three studies

Cervical cancer remains a leading cause of cancer related morbidity and mortality among women worldwide, particularly in low-and middle- income countries (LMICs). The incidence of cervical cancer has declined in India over the last two decades despite the lack of any organised population-based screening programme or HPV vaccination. This study analyses the trends in high-risk human papilloma virus (hrHPV) prevalence and CIN 2 + detection and examines the influence of sociodemographic factors in West Bengal, India from over a span of two decades. Data from three cervical cancer screening studies conducted in rural West Bengal were analysed between 2001 and 2021. A total of 80,988 women aged 30-60 years were screened using Hybrid Capture II© (HC II) test. Detection rates of CIN 2 + were stratified by age, education and marriage. Logistic regression models were used to identify factors influencing high risk HPV positivity and CIN 2 + prevalence. The overall high risk HPV positivity rate remained relatively stable (5 %) across the study periods with no significant difference between self-collected and provider collected samples. However, CIN 2 + detection rates declined significantly from 5.7/1000 in 2001-2003 to 2/1000 in 2018-2021 (adjusted odds ratio [OR]:0.27; 95 % confidence interval [CI]:0.12-0.46). Higher education (OR: 0.64; 95 % CI: 0.45-0.88) and delayed age at marriage (OR: 0.62; 95 %CI: 0.31-1 for age>21) were associated with lower CIN 2 + risk. The findings of the study indicate that the observed decline in CIN 2 + prevalence in West Bengal can be attributed to improved education, delayed age at marriage, reduced fertility rate and women's empowerment, which can explain the gradual reduction in cervical cancer incidence in India. However, the cervical cancer incidence in India remains above WHO elimination targets. Expedited implementation of HPV vaccination and strengthening screening programmes are necessary to sustain and accelerate progress towards elimination of cervical cancer.

Agreement between Self- and Physician‑Sampling for Detection of High‑Risk Human Papillomavirus Infections in Women Attending Cervical Screening at National Cancer Institute, Thailand

We determined testing of self-sampling vagina swabs for Human Papilloma Virus (HPV) can be used to screen for cervical disease in outpatient clinics. In this study, women attending cervical cancer screening clinic and gynecology clinic of the National Cancer Institute were invited to take a vaginal self-sampling and physician-collected cervical sampling. Of 268 participants, 20 (7.5%) were HPV-positive on the physician-collected samples. Among these screen-positive women, only two (0.7%) had HPV 18 and/or 45 and none had HPV 16 infections. For the self-collected samples, 4 participants had invalid HPV test results. Of the remaining 264 women with valid test results on self-collected samples, 29 (11.0 %) were HPV-positive, of whom, two (0.8%) were infected with HPV 16 and one (0.4%) with HPV 18 and/or 45 infections. The agreement between self-sampling and physician-sampling HPV test results (when two HPV results categories were considered) was 92. 8% with a moderate Kappa value of 0.57. Overall, self-sampling seems to be a reliable alternative to health-provider collection. However, instructions on proper procedures for sample collection to the women are important step before general roll out.