INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Cervical Inspection With AAVI and Cryotherapy on HPV-Diagnosed Women in Windhoek, Namibia

In 2018, the Ministry of Health and Social Services (MoHSS) introduced acetic acid visual inspection (AAVI) screening program and treatment of cervical precancers with cryotherapy in replacement of Pap smear intervention in Namibia. The study examines the effective use of AAVI-and-cryotherapy treatment on HPV-diagnosed women. Female patients of the reproductive age (20-49 years) group visiting 2 Namibian healthcare facilities for AAVI and cryotherapy treatment were investigated using a cross-sectional approach. The SPSS and coding themes were used to analyze data received through questionnaires and face-to-face interviews from a total of 265 participants. Written informed consent was obtained from participants for treatment and for publication. Among the women that participated in the study, 151 (62%) tested HPV positive, of which 132 (53%) were referred for cryotherapy and 19 (8%) for colposcopy treatments due to Cervical Intraepithelial Neoplasia (CIN I-III) detected. Regardless of the age groups, there was significant evidence of an association between para gravida and HPV positive (χ2(6) = 24.518; P < .001) and HPV negative (χ2(18) = 137.098; P < .001). About 80% of all participants experienced unpleasant pelvic sensations during the examination, with slight abdominal pain during and after the procedure. Ten percent experienced brownish discharges from their pelvis, of which was treated during the cryotherapy treatment. These findings suggest that MoHSS should actively re-evaluate the existing policies to promote AAVI and cryotherapy treatment.

Social Determinants of Human Papillomavirus Vaccine Uptake Among Adolescent Girls in Low-Middle-Income Countries: A Systematic Review & Meta-Analysis

Cervical cancer remains the fourth most common cancer among women globally, despite being preventable with the human papillomavirus (HPV) vaccine. However, HPV vaccine uptake remains a challenge in low- and middle-income countries (LMICs), where cervical cancer elimination faces significant delays. The present study aims to identify the social determinants impacting HPV vaccine uptake in LMICs. This systematic review and meta-analysis included studies published between 2010 and 2025, identified through PubMed, Google Scholar, and ScienceDirect. Eligible studies reported HPV vaccine uptake (initiation, completion, or both) among adolescent girls aged 9 to 19 and examined at least 1 individual- or household-level social determinant. Data were thematically synthesized, and a meta-analysis was conducted using the random-effects model, with results expressed as odds ratios (ORs), with 95% confidence intervals (CIs). Eight studies, conducted in Ethiopia, Tanzania, and Uganda, were included. Key determinants assessed included age, religion, residence, parental education, occupation, wealth index, marital status, and household factors. Meta-analyses revealed wealth index (OR = 1.34; 95% CI: 1.05-1.70; P  = .02) and parental marital status (OR = 0.86; 95% CI: 0.78-0.95; P  < .01) as significant predictors of HPV vaccine uptake among adolescent girls in LMICs. Other factors, such as age, residence, parental education, etc., showed inconsistent effects or no significant association, with high heterogeneity across studies limiting the generalizability of some findings. This review highlights the complex, context-specific individual and household factors influencing HPV vaccine uptake among adolescent girls in LMICs. While wealth index and parental marital status showed consistent associations, other factors varied across studies. Community-based, culturally sensitive, tailored interventions are critical to improve the vaccine uptake. Continued research with standardized mixed-methods is vital to address multilevel factors and ensure equitable HPV vaccine uptake in LMICs.

Estimating Out-of-Pocket Savings From Medicare Site-Neutral Payments on Colon, Lung, Ovarian, and Prostate Cancer Patients

Site-neutral payment reforms seek to align Medicare reimbursement rates for common outpatient services across care sites. Recent reports have assessed the composite impact of site-neutral payment policies on beneficiaries, federal savings, and the commercial market. This analysis builds on such work, focusing on the potential patient-level savings of site-neutral reform for high-utilizing Medicare beneficiaries facing common chronic cancers. We compiled the outpatient services of standard treatment regimens for a typical lung, ovarian, prostate, and colon cancer patient over their first year of treatment. By simulating scenarios for these patients in which hospital outpatient rates were and were not aligned with those of independent physician offices for the 57 service classifications recommended by the Medicare Payment Advisory Commission (MedPAC), we were able to estimate the effect of site-neutral payments on patient out-of-pocket cancer costs. We found that expanding site-neutral payments for MedPAC’s recommended services would greatly reduce Medicare cancer patients’ outpatient out-of-pocket share, with certain beneficiaries saving over $1000 in out-of-pocket spending in their first year of cancer treatment. Along with patient savings, site-neutral payment expansion would produce larger Medicare fee-for-service savings that average over $5500 per cancer patient for the 4 standard cancer treatments analyzed. The largest portions of Medicare and patient savings with site-neutral payments for these 4 cancers came in the form of drug administration costs, particularly when chemotherapy was included as a part of treatment. The findings of this analysis suggest that existing regulatory and legislative site-neutral proposals have the ability to save Medicare and its higher-need beneficiaries thousands of dollars per patient when treating typical lung, ovarian, prostate, and colon cancer cases.