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Huchko, Megan Justine

Positions:

Instructor, Temporary in the Department of Obstetrics and Gynecology

Community Outreach & Education Division
School of Medicine

Associate Research Professor of Global Health

Duke Global Health Institute
Institutes and Provost's Academic Units

Education:

B.A. 1997

B.A. — Duke University

M.D. 2002

M.D. — Albert Einstein College of Medicine of Yeshiva University

M.P.H. 2007

M.P.H. — University of California at Berkeley

News:

Grants:

Prevention and Detection of Cervical Cancer through Self-Administered Screening in the Community

Administered By
Duke Global Health Institute
AwardedBy
University of California - San Francisco
Role
Principal Investigator
Start Date
September 01, 2016
End Date
August 31, 2019

Evaluating a Community-Driven Cervical Cancer Prevention Strategy in Western Kenya

Administered By
Duke Global Health Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 19, 2014
End Date
August 31, 2019

Publications:

WOMEN'S EMPOWERMENT AND FAMILY PLANNING: A REVIEW OF THE LITERATURE.

This paper reviews the literature examining the relationship between women's empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women's empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women's empowerment and family planning use.

Authors
Prata, N; Fraser, A; Huchko, MJ; Gipson, JD; Withers, M; Lewis, S; Ciaraldi, EJ; Upadhyay, UD
MLA Citation
Prata, N, Fraser, A, Huchko, MJ, Gipson, JD, Withers, M, Lewis, S, Ciaraldi, EJ, and Upadhyay, UD. "WOMEN'S EMPOWERMENT AND FAMILY PLANNING: A REVIEW OF THE LITERATURE. (Accepted)" Journal of biosocial science 49.6 (November 2017): 713-743.
PMID
28069078
Source
epmc
Published In
Journal of Biosocial Science
Volume
49
Issue
6
Publish Date
2017
Start Page
713
End Page
743
DOI
10.1017/s0021932016000663

Performance of p16INK4a ELISA as a primary cervical cancer screening test among a large cohort of HIV-infected women in western Kenya: a 2-year cross-sectional study.

A biomarker with increased specificity for cervical dysplasia compared with human papillomavirus (HPV) testing would be an attractive option for cervical cancer screening among HIV-infected women in resource-limited settings. p16(INK4a) has been explored as a biomarker for screening in general populations.A 2-year cross-sectional study.2 large HIV primary care clinics in western Kenya.1054 HIV-infected women in western Kenya undergoing cervical cancer screening as part of routine HIV care from October 2010 to November 2012.Participants underwent p16(INK4a) specimen collection and colposcopy. Lesions with unsatisfactory colposcopy or suspicious for cervical intraepithelial neoplasia 2+ (CIN2+; including CIN2/3 or invasive cervical cancer) were biopsied. Following biopsy, disease status was determined by histopathological diagnosis.We measured the sensitivity, specificity and predictive values of p16(INK4a) ELISA for CIN2+ detection among HIV-infected women and compared them to the test characteristics of current screening methods used in general as well as HIV-infected populations.Average p16(INK4a) concentration in cervical samples was 37.4 U/mL. After colposcopically directed biopsy, 127 (12%) women were determined to have CIN2+. Receiver operating characteristic analysis showed an area under the curve of 0.664 for p16(INK4a) to detect biopsy-proven CIN2+. At a p16(INK4a) cut-off level of 9 U/mL, sensitivity, specificity, positive and negative predictive values were 89.0%, 22.9%, 13.6% and 93.8%, respectively. The overall p16(INK4a) positivity at a cut-off level of 9 U/mL was 828 (78.6%) women. There were 325 (30.8%) cases of correct p16(INK4a) prediction to detect or rule out CIN2+, and 729 (69.2%) cases of incorrect p16(INK4a) prediction.p16(INK4a) ELISA did not perform well as a screening test for CIN2+ detection among HIV-infected women due to low specificity. Our study contributes to the ongoing search for a more specific alternative to HPV testing for CIN2+ detection.

Authors
Wu, TJ; Smith-McCune, K; Reuschenbach, M; von Knebel Doeberitz, M; Maloba, M; Huchko, MJ
MLA Citation
Wu, TJ, Smith-McCune, K, Reuschenbach, M, von Knebel Doeberitz, M, Maloba, M, and Huchko, MJ. "Performance of p16INK4a ELISA as a primary cervical cancer screening test among a large cohort of HIV-infected women in western Kenya: a 2-year cross-sectional study." BMJ open 6.9 (September 13, 2016): e012547-.
PMID
27625065
Source
epmc
Published In
BMJ Open
Volume
6
Issue
9
Publish Date
2016
Start Page
e012547
DOI
10.1136/bmjopen-2016-012547

Cervical Cancer Stigma in Rural Kenya: What Does HIV Have to Do with It?

Cervical cancer is a leading cause of cancer-related death amongst women in sub-Saharan Africa, largely due to the lack of early screening and treatment. In addition to poor access to screening services, inadequate uptake of available services is a barrier to early identification of precancerous lesions. Given that cervical cancer is caused by a sexually transmitted virus and is associated with HIV positivity, stigma is one of the potential barriers to the utilization of cervical cancer programs in sub-Saharan Africa. We conducted a cross-sectional survey of 419 women attending health facilities in rural western Kenya to measure levels of cervical cancer and HIV stigma and to measure the associations between cervical cancer stigma, HIV stigma, and HIV status. Women who qualified for cervical cancer screening were asked to complete an oral questionnaire using a modified 9-point HIV stigma scale. Low cervical cancer stigma was reported in this study, with only 85/419 (20.3 %) of respondents answering yes to at least one cervical cancer stigma question. However, cervical cancer stigma was highly correlated with HIV stigma (correlation coefficient 0.72) and was significantly lower in HIV-positive women (p < 0.001). Reducing cervical cancer stigma in the general population is an important part of promoting screening in sub-Saharan Africa.

Authors
Rosser, JI; Njoroge, B; Huchko, MJ
MLA Citation
Rosser, JI, Njoroge, B, and Huchko, MJ. "Cervical Cancer Stigma in Rural Kenya: What Does HIV Have to Do with It?." Journal of cancer education : the official journal of the American Association for Cancer Education 31.2 (June 2016): 413-418.
PMID
25982550
Source
epmc
Published In
Journal of Cancer Education
Volume
31
Issue
2
Publish Date
2016
Start Page
413
End Page
418
DOI
10.1007/s13187-015-0843-y

Cervical Cancer Screening Knowledge and Behavior among Women Attending an Urban HIV Clinic in Western Kenya.

Cervical cancer is a highly preventable disease that disproportionately affects women in developing countries and women with HIV. As integrated HIV and cervical cancer screening programs in Sub-Saharan Africa mature, we have an opportunity to measure the impact of outreach and education efforts and identify areas for future improvement. We conducted a cross-sectional survey of 106 women enrolled in care at an integrated HIV clinic in the Nyanza Province of Kenya 5 years after the start of a cervical cancer screening program. Female clinic attendees who met clinic criteria for cervical cancer screening were asked to complete an oral questionnaire assessing their cervical cancer knowledge, attitudes, and screening history. Ninety-nine percent of women had heard of screening, 70 % felt at risk, and 84 % had been screened. Increased duration of HIV diagnosis was associated with feeling at risk and with a screening history. Nearly half (48 %) of women said they would not get screened if they had to pay for it.

Authors
Rosser, JI; Njoroge, B; Huchko, MJ
MLA Citation
Rosser, JI, Njoroge, B, and Huchko, MJ. "Cervical Cancer Screening Knowledge and Behavior among Women Attending an Urban HIV Clinic in Western Kenya." Journal of cancer education : the official journal of the American Association for Cancer Education 30.3 (September 2015): 567-572.
PMID
25595965
Source
epmc
Published In
Journal of Cancer Education
Volume
30
Issue
3
Publish Date
2015
Start Page
567
End Page
572
DOI
10.1007/s13187-014-0787-7

My Obstetrician Got Me Fired: How Work Notes Can Harm Pregnant Patients and What to Do About It.

Prenatal care providers are frequently asked to provide employment notes for their patients requesting medical leave or changes to work duties. Writing employment notes correctly can help patients negotiate for and obtain medically indicated workplace accommodations, allowing them to continue to work and earn an income. However, a poorly written or poorly timed note can jeopardize a patient's employment and salary. This commentary provides an overview of pregnancy-related employment laws and guidance in writing work accommodations letters that allow pregnant women to keep their jobs while maintaining a healthy pregnancy.

Authors
Jackson, RA; Gardner, S; Torres, LN; Huchko, MJ; Zlatnik, MG; Williams, JC
MLA Citation
Jackson, RA, Gardner, S, Torres, LN, Huchko, MJ, Zlatnik, MG, and Williams, JC. "My Obstetrician Got Me Fired: How Work Notes Can Harm Pregnant Patients and What to Do About It." Obstetrics and gynecology 126.2 (August 2015): 250-254.
PMID
26241411
Source
epmc
Published In
Obstetrics & Gynecology (Elsevier)
Volume
126
Issue
2
Publish Date
2015
Start Page
250
End Page
254
DOI
10.1097/aog.0000000000000971

Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey.

Although cervical cancer is highly preventable through screening, it remains the number one cause of cancer-related death in Kenyan women due to lack of funding and infrastructure for prevention programs. In 2012, Family AIDS Care and Education Services in partnership with the Kenya Ministry of Health began offering free screening at eleven rural health facilities. We sought to explore why screening coverage remains low at some sites. We examined the barriers to screening through a survey of 106 healthcare staff. The most frequently cited barriers to service delivery included staffing shortages, lack of trained staff, insufficient space, and supply issues. The patient barriers commonly perceived by the staff included inadequate knowledge, wait time, discomfort with male providers, and fear of pain with the speculum exam. Despite multilateral efforts to implement cervical cancer screening, staff face significant challenges to service provision and increased education is needed for both providers and patients.

Authors
Rosser, JI; Hamisi, S; Njoroge, B; Huchko, MJ
MLA Citation
Rosser, JI, Hamisi, S, Njoroge, B, and Huchko, MJ. "Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey." Journal of community health 40.4 (August 2015): 756-761.
PMID
25677728
Source
epmc
Published In
Journal of Community Health
Volume
40
Issue
4
Publish Date
2015
Start Page
756
End Page
761
DOI
10.1007/s10900-015-9996-1

Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: The effects of an educational intervention in rural Kenya.

Cervical cancer screening uptake may be influenced by inadequate knowledge in resource-limited settings. This randomized trial evaluated a health talk's impact on cervical cancer knowledge, attitudes, and screening rates in rural Kenya.419 women attending government clinics were randomized to an intervention (N=207) or control (N=212) group. The intervention was a brief health talk on cervical cancer. Participants completed surveys at enrollment (all), immediately after the talk (intervention arm), and at three-months follow-up (all). The primary outcomes were the change in knowledge scores and the final screening rates at three-months follow-up. Secondary outcomes were changes in awareness about cervical cancer screening, perception of personal cervical cancer risk, cervical cancer and HIV stigma, and screening acceptability.Mean Knowledge Scores increased by 26.4% (8.7 points increased to 11.0 points) in the intervention arm compared to only 17.6% (8.5 points increased to 10.0 points) in the control arm (p<0.01). Screening uptake was moderate in both the intervention (58.9%; N=122) and control (60.9%; N=129) arms, with no difference between the groups (p=0.60).A brief health talk increased cervical cancer knowledge, although it did not increase screening over simply informing women about free screening.Screening programs can increase patient understanding with just a brief educational intervention.

Authors
Rosser, JI; Njoroge, B; Huchko, MJ
MLA Citation
Rosser, JI, Njoroge, B, and Huchko, MJ. "Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: The effects of an educational intervention in rural Kenya." Patient education and counseling 98.7 (July 2015): 884-889.
PMID
25858634
Source
epmc
Published In
Patient Education and Counseling
Volume
98
Issue
7
Publish Date
2015
Start Page
884
End Page
889
DOI
10.1016/j.pec.2015.03.017

Outcomes Up to 12 Months After Treatment With Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Among HIV-Infected Women.

HIV-infected women may have higher rates of recurrent cervical precancer after treatment. Knowledge about rates and predictors of recurrence could impact guidelines and program planning, especially in low-resource settings.In this prospective cohort study in Western Kenya, we followed HIV-infected women at 6 and 12 months after treatment for cervical intraepithelial neoplasia 2 or greater (CIN2+) after treatment with loop electrosurgical excision procedure (LEEP). All women underwent follow-up colposcopy with biopsy as indicated for the diagnosis of CIN2+. We calculated the incidence and predictors of primary disease recurrence after treatment.Among the 284 women who underwent LEEP and had at least 1 follow-up visit, there were 37 (13%) cases of CIN2+ detected by 12-month follow-up. Four (10.8%) of the recurrences were invasive cancer, all stage IA1. The 6- and 12-month rates of recurrence were 13.7 and 12.8 cases per 100 person-years of follow-up, respectively. Antiretroviral therapy use did not significantly impact the rate of recurrence (hazard ratio: 1.24, 95% confidence interval: 0.59 to 2.79). The only significant predictor of recurrence in the multivariate analysis was CD4(+) nadir <200 cells per cubic millimeter (adjusted hazard ratio: 3.14, 95% confidence interval: 1.22 to 8.08).The overall rate of treatment failure within a year of LEEP was low in this cohort of HIV-infected women. Among the women with recurrence, there was a significant amount of invasive cancer. The relatively high rate of cancer after treatment suggests that HIV-infected women merit continued close follow-up after treatment.

Authors
Huchko, MJ; Leslie, H; Maloba, M; Zakaras, J; Bukusi, E; Cohen, CR
MLA Citation
Huchko, MJ, Leslie, H, Maloba, M, Zakaras, J, Bukusi, E, and Cohen, CR. "Outcomes Up to 12 Months After Treatment With Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Among HIV-Infected Women." Journal of acquired immune deficiency syndromes (1999) 69.2 (June 2015): 200-205.
PMID
25647529
Source
epmc
Published In
Journal of Acquired Immune Deficiency Syndromes
Volume
69
Issue
2
Publish Date
2015
Start Page
200
End Page
205
DOI
10.1097/qai.0000000000000565

Knowledge about cervical cancer screening and perception of risk among women attending outpatient clinics in rural Kenya.

To evaluate cervical cancer knowledge, risk perception, and screening intention among women attending outpatient clinics in rural Kenya.A cross-sectional oral survey was conducted among non-pregnant women aged 23-64 years who attended one of 11 western Kenyan health facilities for any reason between March 25 and April 26, 2013. Demographic and clinical predictors were identified using bivariate and multivariate regression analyses.Among 419 participants, 327 (78.0%) had heard of cervical cancer screening. Nevertheless, their specific knowledge was low (mean score 8.6±2.4 [out of 15.0]). Overall, 288 (68.7%) women felt at risk for cervical cancer, and 333 (79.5%) stated that they would undergo screening if offered. Women who intended to undergo screening were less likely to attend a district hospital (adjusted odds ratio [AOR] 0.4; 95% confidence interval [CI] 0.2-0.6) and more likely to have been diagnosed with HIV more than 4 years previously (AOR 0.4; 95% CI 0.2-0.6). Additionally, increased screening acceptance was associated with high knowledge scores (P=0.004).Educational interventions to increase knowledge about cervical cancer might increase screening uptake in low-income settings. Additionally, improvements in services at local health facilities could have a large effect.

Authors
Rosser, JI; Njoroge, B; Huchko, MJ
MLA Citation
Rosser, JI, Njoroge, B, and Huchko, MJ. "Knowledge about cervical cancer screening and perception of risk among women attending outpatient clinics in rural Kenya." International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 128.3 (March 2015): 211-215.
PMID
25467908
Source
epmc
Published In
International Journal of Gynecology & Obstetrics
Volume
128
Issue
3
Publish Date
2015
Start Page
211
End Page
215
DOI
10.1016/j.ijgo.2014.09.006

Acceptability and Accuracy of Cervical Cancer Screening Using a Self-Collected Tampon for HPV Messenger-RNA Testing among HIV-Infected Women in South Africa.

HIV increases women's risk for high-risk human papillomavirus (hrHPV) infection and invasive cervical cancer. South Africa has a high HIV prevalence but low cervical cancer screening coverage. Self-collection of cervical specimens and hrHPV testing, including hrHPV messenger-RNA (mRNA) testing, are methods aimed at increasing screening rates. However, data are limited on the acceptability and accuracy of tampon-based self-collection for hrHPV mRNA testing in HIV-infected women.We recruited 325 HIV-infected women seeking care at a government HIV clinic in Pretoria, South Africa. A clinician performed a pelvic examination and obtained an endocervical specimen. Study participants performed self-collection using a tampon. Both clinician- and self-collected specimens were tested for hrHPV mRNA. Acceptability of both collection methods was assessed, the prevalence of hrHPV mRNA in our study population was estimated, test positivity of the two collection methods were compared, and test agreement was assessed by calculating the κ-statistic, sensitivity, and specificity.Over 90% of women reported no difficulties self-collecting specimens and 82% were willing to perform the tampon-collection at home. Based on clinician-collection specimens, the prevalence of hrHPV mRNA in our study population was 36.7% (95% CI: 31.4%- 42.0%). There was no difference in test positivity between clinician-collection, 36.7%, and tampon-collection, 43.5% (p-value = 0.08). Using clinician-collection as the reference test, the sensitivity and specificity for hrHPV mRNA of tampon-collection were 77.4% (95% CI: 69.8-85.0%) and 77.8% (95% CI: 71.9-83.6%), respectively.Tampon-based self-collection is acceptable to women and has similar hrHPV mRNA positivity rates as clinician-collection, but has reduced sensitivity and specificity compared to clinician-collection. The hrHPV mRNA prevalence in our study population is high, but similar to other high-risk populations, and highlights the need for improved cervical cancer screening. Further research into the optimal use of tampon-based collection as a cervical cancer screening tool is warranted.

Authors
Adamson, PC; Huchko, MJ; Moss, AM; Kinkel, HF; Medina-Marino, A
MLA Citation
Adamson, PC, Huchko, MJ, Moss, AM, Kinkel, HF, and Medina-Marino, A. "Acceptability and Accuracy of Cervical Cancer Screening Using a Self-Collected Tampon for HPV Messenger-RNA Testing among HIV-Infected Women in South Africa." PloS one 10.9 (January 2015): e0137299-.
PMID
26332236
Source
epmc
Published In
PloS one
Volume
10
Issue
9
Publish Date
2015
Start Page
e0137299
DOI
10.1371/journal.pone.0137299

The time has come to make cervical cancer prevention an essential part of comprehensive sexual and reproductive health services for HIV-positive women in low-income countries.

HIV and cervical cancer are intersecting epidemics that disproportionately affect one of the most vulnerable populations in the world: women in low- and middle-income countries (LMICs). Historically, the disparity in cervical cancer risk for women in LMICs has been due to the lack of organized screening and prevention programmes. In recent years, this risk has been augmented by the severity of the HIV epidemic in LMICs. HIV-positive women are at increased risk for developing cervical precancer and cancer, and while the introduction of antiretroviral therapy has dramatically improved life expectancies among HIV-positive women it has not been shown to improve cancer-related outcomes. Therefore, an increasing number of HIV-positive women are living in LMICs with limited or no access to cervical cancer screening programmes. In this commentary, we describe the gaps in cervical cancer prevention, the state of evidence for integrating cervical cancer prevention into HIV programmes and future directions for programme implementation and research.Despite the biologic, behavioural and demographic overlap between HIV and cervical cancer, cervical cancer prevention has for the most part been left out of sexual and reproductive health (SRH) services for HIV-positive women. Lower cost primary and secondary prevention strategies for cervical cancer are becoming more widely available in LMICs, with increasing evidence for their efficacy and cost-effectiveness. Going forward, cervical cancer prevention must be considered a part of the essential package of SRH services for HIV-positive women. Effective cervical cancer prevention programmes will require a coordinated response from international policymakers and funders, national governments and community leaders. Leveraging the improvements in healthcare infrastructure created by the response to the global HIV epidemic through integration of services may be an effective way to make an impact to prevent cervical cancer among HIV-positive women, but more work remains to determine optimal approaches.Cervical cancer prevention is an essential part of comprehensive HIV care. In order to ensure maximal impact and cost-effectiveness, implementation strategies for screening programmes must be adapted and rigorously evaluated through a framework that includes equal participation with policymakers, programme planners and key stakeholders in the target communities.

Authors
Huchko, MJ; Maloba, M; Nakalembe, M; Cohen, CR
MLA Citation
Huchko, MJ, Maloba, M, Nakalembe, M, and Cohen, CR. "The time has come to make cervical cancer prevention an essential part of comprehensive sexual and reproductive health services for HIV-positive women in low-income countries." Journal of the International AIDS Society 18.Suppl 5 (January 2015): 20282-.
PMID
26643456
Source
epmc
Published In
Journal of the International AIDS Society
Volume
18
Issue
Suppl 5
Publish Date
2015
Start Page
20282
DOI
10.7448/ias.18.6.20282

A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women.

Visual inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI) are increasingly recommended in various cervical cancer screening protocols in low-resource settings. Although VIA is more widely used, VILI has been advocated as an easier and more specific screening test. VILI has not been well-validated as a stand-alone screening test, compared to VIA or validated for use in HIV-infected women. We carried out a randomized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women. Women attending the Family AIDS Care and Education Services (FACES) clinic in western Kenya were enrolled and randomized to undergo either VIA or VILI with colposcopy. Lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Between October 2011 and June 2012, 654 were randomized to undergo VIA or VILI. The test positivity rates were 26.2% for VIA and 30.6% for VILI (p = 0.22). The rate of detection of CIN2+ was 7.7% in the VIA arm and 11.5% in the VILI arm (p = 0.10). There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2+. Sensitivity and specificity were 84.0% and 78.6%, respectively, for VIA and 84.2% and 76.4% for VILI. The positive and negative predictive values were 24.7% and 98.3% for VIA, and 31.7% and 97.4% for VILI. Among women with CD4+ count < 350, VILI had a significantly decreased specificity (66.2%) compared to VIA in the same group (83.9%, p = 0.02) and compared to VILI performed among women with CD4+ count ≥ 350 (79.7%, p = 0.02). VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women.

Authors
Huchko, MJ; Sneden, J; Zakaras, JM; Smith-McCune, K; Sawaya, G; Maloba, M; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Sneden, J, Zakaras, JM, Smith-McCune, K, Sawaya, G, Maloba, M, Bukusi, EA, and Cohen, CR. "A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women." PloS one 10.4 (January 2015): e0118568-.
Website
http://hdl.handle.net/10161/12715
PMID
25849627
Source
epmc
Published In
PloS one
Volume
10
Issue
4
Publish Date
2015
Start Page
e0118568
DOI
10.1371/journal.pone.0118568

Accuracy of visual inspection with acetic acid to detect cervical cancer precursors among HIV-infected women in Kenya.

Visual inspection with acetic acid (VIA) is becoming a more widely recommended and implemented screening tool for cervical cancer prevention programs in low-resource settings. Many of these settings have a high prevalence of HIV-infected women. We carried out a cross-sectional validation study to define the sensitivity, specificity and predictive values of VIA among HIV-infected women. Women enrolled in HIV care at the Family AIDS Care and Education Services clinic in Kisumu, Kenya, were recruited for participation. All participants underwent VIA followed by colposcopy performed by a second blinded clinician. At colposcopy, lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Disease status was determined by final histopathologic diagnosis in women who underwent biopsies. A satisfactory colposcopy with no lesions was considered a negative result. From October 2010 to June 2012, 1,432 women underwent VIA and colposcopy. A total of 514 (35.7%) women had a positive VIA, and 179 (12.2%) had CIN2+ confirmed by colposcopically directed biopsy. Sensitivity, specificity, positive and negative predictive values of VIA for CIN2+ were 86.6, 71.6, 30.3 and 97.4%, respectively. Specificity, but not sensitivity, increased with older age. Among older women, sensitivity was affected by CD4+ count and use of antiretroviral therapy. Although they are impacted by age and immune status, test characteristics for VIA among HIV-infected women are similar to what has been reported for general populations. Recommendations to use VIA as a screening tool should not vary by HIV status.

Authors
Huchko, MJ; Sneden, J; Sawaya, G; Smith-McCune, K; Maloba, M; Abdulrahim, N; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Sneden, J, Sawaya, G, Smith-McCune, K, Maloba, M, Abdulrahim, N, Bukusi, EA, and Cohen, CR. "Accuracy of visual inspection with acetic acid to detect cervical cancer precursors among HIV-infected women in Kenya." International journal of cancer 136.2 (January 2015): 392-398.
PMID
24889387
Source
epmc
Published In
International Journal of Cancer
Volume
136
Issue
2
Publish Date
2015
Start Page
392
End Page
398
DOI
10.1002/ijc.28996

Men's knowledge and attitudes about cervical cancer screening in Kenya.

A number of studies have identified male involvement as an important factor affecting reproductive health outcomes, particularly in the areas of family planning, antenatal care, and HIV care. As access to cervical cancer screening programs improves in resource-poor settings, particularly through the integration of HIV and cervical cancer services, it is important to understand the role of male partner support in women's utilization of screening and treatment.We administered an oral survey to 110 men in Western Kenya about their knowledge and attitudes regarding cervical cancer and cervical cancer screening. Men who had female partners eligible for cervical cancer screening were recruited from government health facilities where screening was offered free of charge.Specific knowledge about cervical cancer risk factors, prevention, and treatment was low. Only half of the men perceived their partners to be at risk for cervical cancer, and many reported that a positive screen would be emotionally upsetting. Nevertheless, all participants said they would encourage their partners to get screened.Future interventions should tailor cervical cancer educational opportunities towards men. Further research is needed among both men and couples to better understand barriers to male support for screening and treatment and to determine how to best involve men in cervical cancer prevention efforts.

Authors
Rosser, JI; Zakaras, JM; Hamisi, S; Huchko, MJ
MLA Citation
Rosser, JI, Zakaras, JM, Hamisi, S, and Huchko, MJ. "Men's knowledge and attitudes about cervical cancer screening in Kenya." BMC women's health 14 (November 22, 2014): 138-.
Website
http://hdl.handle.net/10161/12716
PMID
25416335
Source
epmc
Published In
BMC Women's Health
Volume
14
Publish Date
2014
Start Page
138
DOI
10.1186/s12905-014-0138-1

Women's empowerment and fertility: a review of the literature.

Women's empowerment has become a focal point for development efforts worldwide and there is a need for an updated, critical assessment of the existing evidence on women's empowerment and fertility. We conducted a literature review on studies examining the relationships between women's empowerment and several fertility-related topics. Among the 60 studies identified for this review, the majority were conducted in South Asia (n = 35) and used household decision-making as a measure of empowerment (n = 37). Overall, the vast majority of studies found some positive associations between women's empowerment and lower fertility, longer birth intervals, and lower rates of unintended pregnancy, but there was some variation in results. In many studies, results differed based on the measure of empowerment used, sociopolitical or gender environment, or sub-population studied. This article is one of the first evaluations of the literature assessing the relationships between women's empowerment and fertility. We identify several key issues that merit further investigation.

Authors
Upadhyay, UD; Gipson, JD; Withers, M; Lewis, S; Ciaraldi, EJ; Fraser, A; Huchko, MJ; Prata, N
MLA Citation
Upadhyay, UD, Gipson, JD, Withers, M, Lewis, S, Ciaraldi, EJ, Fraser, A, Huchko, MJ, and Prata, N. "Women's empowerment and fertility: a review of the literature." Social science & medicine (1982) 115 (August 2014): 111-120. (Review)
PMID
24955875
Source
epmc
Published In
Social Science & Medicine
Volume
115
Publish Date
2014
Start Page
111
End Page
120
DOI
10.1016/j.socscimed.2014.06.014

Factors associated with recurrence of cervical intraepithelial neoplasia 2+ after treatment among HIV-infected women in Western Kenya.

HIV-infected women are at increased risk for recurrence of cervical dysplasia after treatment. Short-term recurrence rates may reflect treatment efficacy and therefore impact screening protocols and follow-up planning. We conducted a prospective study of 297 HIV-infected women undergoing loop electrosurgical excision procedure for cervical intraepithelial neoplasia 2+ (CIN2+) in an HIV clinic in Kisumu, Kenya. By 6 months after the procedure, 20 (7.1%) of women had recurrent CIN2+. Recurrence was significantly associated with CD4 nadir but not with highly active antiretroviral therapy use. Longer-term follow-up of this cohort will illustrate the potential impact of highly active antiretroviral therapy and immune status on CIN2/3 disease recurrence.

Authors
Huchko, MJ; Leslie, H; Maloba, M; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Leslie, H, Maloba, M, Bukusi, EA, and Cohen, CR. "Factors associated with recurrence of cervical intraepithelial neoplasia 2+ after treatment among HIV-infected women in Western Kenya." Journal of acquired immune deficiency syndromes (1999) 66.2 (June 2014): 188-192.
PMID
24662299
Source
epmc
Published In
Journal of Acquired Immune Deficiency Syndromes
Volume
66
Issue
2
Publish Date
2014
Start Page
188
End Page
192
DOI
10.1097/qai.0000000000000130

A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya.

To determine the optimal strategy for cervical cancer screening in women with human immunodeficiency virus (HIV) infection by comparing two strategies: visual inspection of the cervix with acetic acid (VIA) and VIA followed immediately by visual inspection with Lugol's iodine (VIA/VILI) in women with a positive VIA result.Data from a cervical cancer screening programme embedded in two HIV clinic sites in western Kenya were evaluated. Women at a central site underwent VIA, while women at a peripheral site underwent VIA/VILI. All women positive for cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) on VIA and/or VILI had a confirmatory colposcopy, with a biopsy if necessary. Overall test positivity, positive predictive value (PPV) and the CIN 2+ detection rate were calculated for the two screening methods, with biopsy being the gold standard.Between October 2007 and October 2010, 2338 women were screened with VIA and 1124 with VIA/VILI. In the VIA group, 26.4% of the women tested positive for CIN 2+; in the VIA/VILI group, 21.7% tested positive (P < 0.01). Histologically confirmed CIN 2+ was detected in 8.9% and 7.8% (P = 0.27) of women in the VIA and VIA/VILI groups, respectively. The PPV of VIA for biopsy-confirmed CIN 2+ in a single round of screening was 35.2%, compared with 38.2% for VIA/VILI (P = 0.41).The absence of any differences between VIA and VIA/VILI in detection rates or PPV for CIN 2+ suggests that VIA, an easy testing procedure, can be used alone as a cervical cancer screening strategy in low-income settings.

Authors
Huchko, MJ; Sneden, J; Leslie, HH; Abdulrahim, N; Maloba, M; Bukusi, E; Cohen, CR
MLA Citation
Huchko, MJ, Sneden, J, Leslie, HH, Abdulrahim, N, Maloba, M, Bukusi, E, and Cohen, CR. "A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya." Bulletin of the World Health Organization 92.3 (March 2014): 195-203.
PMID
24700979
Source
epmc
Published In
Bulletin of the World Health Organization
Volume
92
Issue
3
Publish Date
2014
Start Page
195
End Page
203
DOI
10.2471/blt.13.122051

Authors' reply: Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV-1 genital shedding: a prospective cohort study: population and statistical queries.

Authors
Huchko, MJ; Leslie, HH; Smith-McCune, K
MLA Citation
Huchko, MJ, Leslie, HH, and Smith-McCune, K. "Authors' reply: Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV-1 genital shedding: a prospective cohort study: population and statistical queries." BJOG : an international journal of obstetrics and gynaecology 121.3 (February 2014): 372-. (Letter)
PMID
24428454
Source
epmc
Published In
Bjog : An International Journal of Obstetrics & Gynaecology
Volume
121
Issue
3
Publish Date
2014
Start Page
372
DOI
10.1111/1471-0528.12520

Risk factors for cervical precancer detection among previously unscreened HIV-infected women in Western Kenya.

HIV and cervical cancer are intersecting epidemics in many low-resource settings, yet there are few accurate estimates of the scope of this public health challenge. To understand disease prevalence and risk factors for cervical intraepithelial neoplasia 2 or greater (CIN2+), we conducted a cross-sectional study of women undergoing cervical cancer screening as part of routine HIV care in Kisumu, Kenya. Women were offered screening with visual inspection with acetic acid, followed by confirmation with colposcopy and biopsy as needed. Univariable and multivariable analyses were carried out to determine clinical and demographic predictors of prevalent CIN2+. Among 3,241 women screened, 287 (9%) had an initial diagnosis of biopsy-confirmed CIN2+. On multivariable analysis, combined oral contraceptives remained significantly associated with detection of CIN2+ among women on HAART (AOR 1.84, CI 1.20-2.82), and not on HAART (AOR 1.72, 95% CI 1.08-2.73), while use of a progesterone implant was associated with increased detection of CIN2+ (AOR 9.43, 95% CI 2.85-31.20) only among women not on HAART. CD4+ nadir over 500 cells/mm(3) was associated with reduced detection of CIN2+ (AOR 0.61, CI 0.38, 0.97) in the overall group, but current CD4+ was only associated with reduced detection of CIN2+ among women not on HAART (AOR 0.42, CI 0.22, 0.80). In conclusion, a history of less severe immunosuppression appeared to reduce the risk of CIN2+ detection, but current CD4+ count was significant only in non-HAART users. The association of CIN2+ with hormonal contraception should be explored more in prospective studies designed to better control for confounding factors.

Authors
Huchko, MJ; Leslie, H; Sneden, J; Maloba, M; Abdulrahim, N; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Leslie, H, Sneden, J, Maloba, M, Abdulrahim, N, Bukusi, EA, and Cohen, CR. "Risk factors for cervical precancer detection among previously unscreened HIV-infected women in Western Kenya." International journal of cancer 134.3 (February 2014): 740-745.
PMID
23900762
Source
epmc
Published In
International Journal of Cancer
Volume
134
Issue
3
Publish Date
2014
Start Page
740
End Page
745
DOI
10.1002/ijc.28401

Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods.

To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation.Human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries.We developed a causal model of the factors related to combined oral contraceptive (COC) use and cervical intraepithelial neoplasia 2 or greater (CIN2+) and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation.We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7%) were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9%) increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification.Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an increased prevalence of CIN2+ associated with COC, evidence is insufficient to conclude causality. Priority areas for future studies to better satisfy causal criteria are identified.

Authors
Leslie, HH; Karasek, DA; Harris, LF; Chang, E; Abdulrahim, N; Maloba, M; Huchko, MJ
MLA Citation
Leslie, HH, Karasek, DA, Harris, LF, Chang, E, Abdulrahim, N, Maloba, M, and Huchko, MJ. "Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods." PloS one 9.6 (January 2014): e101090-.
Website
http://hdl.handle.net/10161/12717
PMID
24979709
Source
epmc
Published In
PloS one
Volume
9
Issue
6
Publish Date
2014
Start Page
e101090
DOI
10.1371/journal.pone.0101090

Prevalence, characteristics, and outcomes of HIV-positive women diagnosed with invasive cancer of the cervix in Kenya.

To determine the prevalence of invasive cervical cancer (ICC) and assess access to, and outcomes of, treatment for ICC among HIV-infected women in Kisumu, Kenya.We performed a retrospective chart review to identify women diagnosed with ICC between October 2007 and June 2012, and to examine the impact of a change in the referral protocol. Prior to June 2009, all women with ICC were referred to a regional hospital. After this date, women with stage IA1 disease were offered treatment with loop electrosurgical excision procedure (LEEP) in-clinic.Of 4308 women screened, 58 (1.3%) were diagnosed with ICC. The mean age at diagnosis was 34years (range, 22-50years). Fifty-four (93.1%) women had stage IA1 disease, of whom 36 (66.7%) underwent LEEP, 7 (12.9%) had a total abdominal hysterectomy, and 11 (20.4%) had unknown or no treatment. At 6, 12, and 24months after LEEP, 8.0% (2/25), 25.0% (6/24), and 41.2% (7/17) of women had a recurrence of cervical intraepithelial neoplasia 2 or worse, respectively.Most HIV-positive women diagnosed with ICC through screening had early-stage disease. The introduction of LEEP in-clinic increased access to treatment; however, recurrence was high, indicating the need for continued surveillance.

Authors
Mungo, C; Cohen, CR; Maloba, M; Bukusi, EA; Huchko, MJ
MLA Citation
Mungo, C, Cohen, CR, Maloba, M, Bukusi, EA, and Huchko, MJ. "Prevalence, characteristics, and outcomes of HIV-positive women diagnosed with invasive cancer of the cervix in Kenya." International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 123.3 (December 2013): 231-235.
PMID
24095308
Source
epmc
Published In
International Journal of Gynecology & Obstetrics
Volume
123
Issue
3
Publish Date
2013
Start Page
231
End Page
235
DOI
10.1016/j.ijgo.2013.07.010

Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV-1 genital shedding: a prospective cohort study.

We sought to examine the impact of the loop electrosurgical excision procedure (LEEP) on the rate and magnitude of HIV-1 genital shedding among women undergoing treatment for cervical intraepithelial neoplasia 2/3 (CIN2/3).Prospective cohort study.Women infected with HIV-1 undergoing LEEP for CIN2/3 in Kisumu, Kenya.Participants underwent specimen collection for HIV-1 RNA prior to LEEP and at 1, 2, 4, 6, 10, and 14 weeks post-LEEP. HIV-1 viral load was measured in cervical and plasma specimens using commercial real-time polymerase chain reaction (PCR) assays, to a lower limit of detection of 40 copies per specimen.Presence and magnitude of HIV-1 RNA (copies per specimen or cps) in post-LEEP specimens, compared with baseline.Among women on highly active antiretroviral therapy (HAART), we found a statistically significant increase in cervical HIV-1 RNA concentration at week 2, with a mean increase of 0.43 log10 cps (95% CI 0.03-0.82) from baseline. Similarly, among women not receiving HAART, we found a statistically significant increase in HIV-1 shedding at week 2 (1.26 log10 cps, 95% CI 0.79-1.74). No other statistically significant increase in concentration or detection of cervical HIV-1 RNA at any of the remaining study visits were noted.In women infected with HIV undergoing LEEP, an increase in genital HIV shedding was observed at 2 but not at 4 weeks post-procedure. The current recommendation for women to abstain from vaginal intercourse for 4 weeks seems adequate to reduce the theoretical increased risk of HIV transmission following LEEP.

Authors
Huchko, MJ; Woo, VG; Liegler, T; Leslie, H; Smith-McCune, K; Sawaya, GF; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Woo, VG, Liegler, T, Leslie, H, Smith-McCune, K, Sawaya, GF, Bukusi, EA, and Cohen, CR. "Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV-1 genital shedding: a prospective cohort study." BJOG : an international journal of obstetrics and gynaecology 120.10 (September 2013): 1233-1239.
PMID
23647852
Source
epmc
Published In
Bjog : An International Journal of Obstetrics & Gynaecology
Volume
120
Issue
10
Publish Date
2013
Start Page
1233
End Page
1239
DOI
10.1111/1471-0528.12258

Association of cervical biopsy with HIV type 1 genital shedding among women on highly active antiretroviral therapy.

HIV-1 genital shedding is associated with increased HIV-1 transmission risk. Inflammation and ulceration are associated with increased shedding, while highly active antiretroviral therapy (HAART) has been shown to have a protective effect. We sought to examine the impact of cervical biopsies, a routine component of cervical cancer screening, on HIV-1 genital RNA levels in HIV-infected women on HAART. We enrolled HIV-1-infected women undergoing cervical biopsy for diagnosis of cervical intraepithelial neoplasia (CIN) 2/3 in this prospective cohort study. All were stable on HAART for at least 3 months. Clinical and demographic information as well as plasma HIV-1 viral load were collected at the baseline visit. Specimens for cervical HIV-1 RNA were collected immediately prior to biopsy, and 2 and 7 days afterward. Quantitative PCR determined HIV-1 concentration in cervical specimens at each time point to a lower limit of detection of 40 copies/specimen. Among the 30 participants, five (16.6%) women had detectable cervical HIV-1 RNA at baseline, of whom four (80%) had detectable HIV-1 RNA after cervical biopsy, with no significant increase in viral load in the follow-up specimens. Only one woman (3.3%) with undetectable baseline cervical HIV-1 RNA had detection postbiopsy. Detectable plasma HIV-1 RNA was the only factor associated with baseline cervical HIV-1 RNA. In women on HAART, an increase in cervical HIV-1 RNA detection or concentration was not associated with cervical biopsy. These findings help provide safety data regarding cervical cancer screening and diagnosis in HIV-infected women and inform postprocedure counseling.

Authors
Woo, VG; Liegler, T; Cohen, CR; Sawaya, GF; Smith-McCune, K; Bukusi, EA; Huchko, MJ
MLA Citation
Woo, VG, Liegler, T, Cohen, CR, Sawaya, GF, Smith-McCune, K, Bukusi, EA, and Huchko, MJ. "Association of cervical biopsy with HIV type 1 genital shedding among women on highly active antiretroviral therapy." AIDS research and human retroviruses 29.7 (July 2013): 1000-1005.
PMID
23594240
Source
epmc
Published In
AIDS Research and Human Retroviruses
Volume
29
Issue
7
Publish Date
2013
Start Page
1000
End Page
1005
DOI
10.1089/aid.2012.0341

Is there an association between HIV-1 genital shedding and cervical intraepithelial neoplasia 2/3 among women on antiretroviral therapy?

Given the high prevalence of cervical intraepithelial neoplasia (CIN) grade 2/3 among HIV-infected women, we sought to examine the relationship between CIN 2/3 and HIV-1 genital shedding among women on highly active antiretroviral therapy (HAART).Paired plasma and cervical wick specimens for HIV-1 RNA measurements were obtained from 44 HIV-infected women with biopsy-confirmed CIN 2/3 (cases) and 44 age-matched HIV-infected women with normal cervical findings on colposcopy (controls). All subjects tested negative for sexually transmitted infections and had been stable on HAART for at least 3 months. HIV-1 viral load was measured in both blood and cervical specimens using commercial real-time polymerase chain reaction assays.Cervical intraepithelial neoplasia 2/3 was not significantly associated with the detection or magnitude of plasma or cervical HIV-1 RNA shedding. HIV was detected in the plasma in 10 cases (23%) and 10 controls (25%) (odds ratio = 1.0; 95% confidence interval = 0.33-3.1). Cervical HIV-1 was detected in 6 cases (13.6%) and 9 controls (20.4%) (odds ratio = 0.61; 95% confidence interval = 0.20-1.90). Mean HIV-1 concentration in cervical secretions among women with CIN 2/3 who shed was 2.93 log10 copies versus 2.72 among controls (p = .65).Among women on HAART, we found no relationship between CIN 2/3 and HIV-1 genital shedding.

Authors
Huchko, MJ; Woo, V; Liegler, T; Leddy, A; Smith-McCune, K; Sawaya, GF; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Woo, V, Liegler, T, Leddy, A, Smith-McCune, K, Sawaya, GF, Bukusi, EA, and Cohen, CR. "Is there an association between HIV-1 genital shedding and cervical intraepithelial neoplasia 2/3 among women on antiretroviral therapy?." Journal of lower genital tract disease 17.3 (July 2013): 354-360.
PMID
23486070
Source
epmc
Published In
Journal of Lower Genital Tract Disease
Volume
17
Issue
3
Publish Date
2013
Start Page
354
End Page
360
DOI
10.1097/lgt.0b013e3182712286

A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening.

Our objective was to assess the sensitivity and specificity of human papillomavirus (HPV) testing for cervical cancer screening in randomized trials. We conducted a systematic literature search of the following databases: MEDLINE, CINAHL, EMBASE, and Cochrane. Eligible studies were randomized trials comparing HPV-based to cytology-based screening strategies, with disease status determined by colposcopy/biopsy for participants with positive results. Disease rates (cervical intraepithelial neoplasia [CIN]2 or greater and CIN3 or greater), sensitivity, and positive predictive value were abstracted or calculated from the articles. Six studies met inclusion criteria. Relative sensitivities for detecting CIN3 or greater of HPV testing-based strategies vs cytology ranged from 0.8 to 2.1. The main limitation of our study was that testing methodologies and screening/management protocols were highly variable across studies. Screening strategies in which a single initial HPV-positive test led to colposcopy were more sensitive than cytology but resulted in higher colposcopy rates. These results have implications for cotesting with HPV and cytology as recommended in the United States.

Authors
Patanwala, IY; Bauer, HM; Miyamoto, J; Park, IU; Huchko, MJ; Smith-McCune, KK
MLA Citation
Patanwala, IY, Bauer, HM, Miyamoto, J, Park, IU, Huchko, MJ, and Smith-McCune, KK. "A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening." American journal of obstetrics and gynecology 208.5 (May 2013): 343-353. (Review)
PMID
23159693
Source
epmc
Published In
American Journal of Obstetrics & Gynecology
Volume
208
Issue
5
Publish Date
2013
Start Page
343
End Page
353
DOI
10.1016/j.ajog.2012.11.013

Direct questioning is more effective than patient-initiated report for the detection of sexually transmitted infections in a primary care HIV clinic in Western Kenya.

In resource-limited settings, detection of sexually transmitted infections (STIs) often relies on self-reported symptoms to initiate management. We found self-report demonstrated poor sensitivity for STI detection. Adding clinician-initiated questions about symptoms improved detection rates. Vaginal examination further increased sensitivity. Including clinician-initiated screening in resource-limited settings would improve management of treatable STIs.

Authors
Woo, VGH; Cohen, CR; Bukusi, EA; Huchko, MJ
MLA Citation
Woo, VGH, Cohen, CR, Bukusi, EA, and Huchko, MJ. "Direct questioning is more effective than patient-initiated report for the detection of sexually transmitted infections in a primary care HIV clinic in Western Kenya." Sexually transmitted diseases 40.2 (February 2013): 158-161.
PMID
23324978
Source
epmc
Published In
Sexually Transmitted Diseases
Volume
40
Issue
2
Publish Date
2013
Start Page
158
End Page
161
DOI
10.1097/olq.0b013e318278bf97

Loop electrosurgical excision procedure: safety and tolerability among human immunodeficiency virus-positive Kenyan women.

To estimate the safety, tolerability, and acceptability of loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2 or 3) in human immunodeficiency virus (HIV)-positive women performed by nonphysician health care providers in an HIV care and treatment clinic.We performed a prospective cohort study among women undergoing LEEP for biopsy-confirmed CIN 2 or 3 at the Family Acquired Immunodeficiency Syndrome Care and Education Services Clinic in Kisumu, Kenya. Women were followed-up 4 weeks after the procedure and questioned for abstinence as well as presence and severity of side effects after the procedure. The results were analyzed using descriptive statistics and univariable and multivariable analysis.Among the 180 (91%) women who returned for a 4-week follow up after LEEP, 52% reported at least one postprocedure symptom, including bleeding, discharge, or pain. Using a Likert scale for severity of symptoms, 179 (99%) reported very mild to mild symptoms, whereas one (1%) participant described the symptoms as moderate. No participants reported severe symptoms. Mean CD4 count was significantly higher among women who reported any symptoms compared with women who reported no symptoms after LEEP (419 cells/mm compared with 349 cells/mm, P<.05), an association that remained significant after adjustment for antiretroviral treatment. The presence or severity of postprocedure symptoms did not differ among women who reported sexual activity (16%) less than 4 weeks after the procedure.LEEP performed by clinical officers was well-accepted by HIV-positive women and appears safe, resulting in minimal side effects, even among women with early resumption of intercourse.II.

Authors
Woo, VG; Cohen, CR; Bukusi, EA; Huchko, MJ
MLA Citation
Woo, VG, Cohen, CR, Bukusi, EA, and Huchko, MJ. "Loop electrosurgical excision procedure: safety and tolerability among human immunodeficiency virus-positive Kenyan women." Obstetrics and gynecology 118.3 (September 2011): 554-559.
PMID
21860283
Source
epmc
Published In
Obstetrics & Gynecology (Elsevier)
Volume
118
Issue
3
Publish Date
2011
Start Page
554
End Page
559
DOI
10.1097/aog.0b013e31822b0991

Building capacity for cervical cancer screening in outpatient HIV clinics in the Nyanza province of western Kenya.

To evaluate outcomes of cervical cancer screening within HIV care and treatment clinics in Kenya.Beginning in October 2007, visual inspection with acetic acid (VIA), colposcopy, and loop electrosurgical excision procedure (LEEP) were added to the clinical services offered at Family AIDS Care and Education Services (FACES) clinics in Kisumu, Kenya, after a systematic campaign to build capacity and community awareness.From October 2007 to October 2010, 3642 women underwent VIA as part of routine HIV care. Cervical intraepithelial neoplasia 2/3 was identified in 259 (7.1%) women, who were offered excisional treatment by LEEP in the clinic. Among those women offered screening, uptake was 87%. Clinical staff reported a high level of satisfaction with training for and implementation of cervical cancer screening strategies.Cervical cancer screening and prevention are feasible, acceptable, and effective within HIV care and treatment clinics. Screening test performance characteristics need to be defined for an HIV-positive population to determine the cost/benefit ratio of lower cost strategies that will ultimately be necessary to provide universal access to cervical cancer screening in low-resource settings.

Authors
Huchko, MJ; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Bukusi, EA, and Cohen, CR. "Building capacity for cervical cancer screening in outpatient HIV clinics in the Nyanza province of western Kenya." International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 114.2 (August 2011): 106-110.
PMID
21620403
Source
epmc
Published In
International Journal of Gynecology & Obstetrics
Volume
114
Issue
2
Publish Date
2011
Start Page
106
End Page
110
DOI
10.1016/j.ijgo.2011.02.009

P3-S1.08 Are there acceptable alternatives to syndromic management for the diagnosis of sexually transmitted infections in HIV positive Kenyan women?

Authors
Woo, V; Cohen, CR; Bukusi, EA; Huchko, MJ
MLA Citation
Woo, V, Cohen, CR, Bukusi, EA, and Huchko, MJ. "P3-S1.08 Are there acceptable alternatives to syndromic management for the diagnosis of sexually transmitted infections in HIV positive Kenyan women?." Sexually Transmitted Infections 87.Suppl 1 (July 1, 2011): A269-A269.
Source
crossref
Published In
Sexually transmitted infections
Volume
87
Issue
Suppl 1
Publish Date
2011
Start Page
A269
End Page
A269
DOI
10.1136/sextrans-2011-050108.408

The association of HIV counseling and testing with HIV risk behaviors in a random population-based survey in Kisumu, Kenya.

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population.

Authors
Huchko, MJ; Montandon, M; Nguti, R; Bukusi, EA; Cohen, CR
MLA Citation
Huchko, MJ, Montandon, M, Nguti, R, Bukusi, EA, and Cohen, CR. "The association of HIV counseling and testing with HIV risk behaviors in a random population-based survey in Kisumu, Kenya." AIDS and behavior 15.4 (May 2011): 718-724.
Website
http://hdl.handle.net/10161/12718
PMID
20012479
Source
epmc
Published In
AIDS and Behavior
Volume
15
Issue
4
Publish Date
2011
Start Page
718
End Page
724
DOI
10.1007/s10461-009-9649-4

Safety of the loop electrosurgical excision procedure performed by clinical officers in an HIV primary care setting.

Authors
Huchko, MJ; Maloba, M; Bukusi, EA
MLA Citation
Huchko, MJ, Maloba, M, and Bukusi, EA. "Safety of the loop electrosurgical excision procedure performed by clinical officers in an HIV primary care setting." International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 111.1 (October 2010): 89-90.
PMID
20630528
Source
epmc
Published In
International Journal of Gynecology & Obstetrics
Volume
111
Issue
1
Publish Date
2010
Start Page
89
End Page
90
DOI
10.1016/j.ijgo.2010.05.014

Antenatal steroid use and predictors of preterm labor

Authors
Huchko, MJ; Sharma, G; Healy, A
MLA Citation
Huchko, MJ, Sharma, G, and Healy, A. "Antenatal steroid use and predictors of preterm labor." April 2007.
Source
wos-lite
Published In
Obstetrics & Gynecology (Elsevier)
Volume
109
Issue
4
Publish Date
2007
Start Page
92S
End Page
92S

Rectus sheath hematoma after transvaginal follicle aspiration: a rare complication of in vitro fertilization.

OBJECTIVE: To discuss the diagnosis and management of rectus sheath hematomas after transvaginal follicle aspiration. DESIGN: Case report. SETTING: A single healthy patient in an academic IVF center. PATIENT(S): A healthy patient undergoing routine transvaginal follicle aspiration for IVF. INTERVENTION(S): CT scan, serial phlebotomy, IV fluid, in-patient observation. MAIN OUTCOME MEASURE(S): Condition at discharge. RESULT(S): Patient was successfully managed with conservative measures. After the initial decline, serial hematocrits were stable over 24 hours without any operative interventions. CONCLUSION(S): Rectus sheath hematomas are rare complications of IVF and can be managed conservatively.

Authors
Wang, JG; Huchko, MJ; Kavic, S; Sauer, MV
MLA Citation
Wang, JG, Huchko, MJ, Kavic, S, and Sauer, MV. "Rectus sheath hematoma after transvaginal follicle aspiration: a rare complication of in vitro fertilization." Fertility and sterility 84.1 (July 2005): 217-.
PMID
16009182
Source
epmc
Published In
Fertility and Sterility
Volume
84
Issue
1
Publish Date
2005
Start Page
217
DOI
10.1016/j.fertnstert.2005.01.116
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