Browsing by Author "Steinberg, Malcolm"

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    Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda
    (International Journal of Gynecology and Obstetrics, 2013) Ogilvie, Gina S.; Mitchell, Sheona; Sekikubo, Musa; Biryabarema, Christine; Jeronimo, Jose; Miller, Dianne; Steinberg, Malcolm; Money, Deborah M.
    Objective: To examine the feasibility of a community-based screening program using human papillomavirus (HPV) self-sampling in a low-income country with a high burden of cervical cancer. Methods: A pilot study was conducted among 205 women aged 30–69 years in the Kisenyi district of Kampala, Uganda, from September 5 to October 30, 2011. Women were invited to provide a self-collected specimen for high-risk oncogenic HPV testing by outreach workers at their homes and places of gathering in their community. Specimens were tested for HPV, Neisseria gonorrhoeae and Chlamydia trachomatis. Women who tested posi tive for HPV were referred for colposcopy, biopsy, and treatment at a regional hospital. Results: Of the 199 women who provided a specimen, 35 (17.6%) tested positive for HPV. The outreach workers were able to provide results to 30 women (85.7%). In all, 26 (74.3%) of the women infected with HPV attended their colposcopy appointments and 4 (11.4%) women were diagnosed with grade 3 cervical intraepithelial neoplasia. Conclusion: Self-collection of samples for community-based HPV testing was an acceptable option; most women who tested positive attended for definitive treatment. Self-sampling could potentially allow for effective recruitment to screening programs in limited-resource settings. © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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    Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda
    (BMJ Open, 2014) Teng, Flora F; Mitchell, Sheona M; Sekikubo, Musa; Biryabarema, Christine; Byamugisha, Josaphat K; Steinberg, Malcolm; Money, Deborah M; Ogilvie, Gina S
    Objective: To define embarrassment and develop an understanding of the role of embarrassment in relation to cervical cancer screening and self-collected human papillomavirus (HPV) DNA testing in Uganda. Design: Cross-sectional, qualitative study using semi structured one-to-one interviews and focus groups. Participants: 6 key-informant health workers and 16 local women, purposively sampled. Key informant inclusion criteria: Ugandan members of the project team. Focus group inclusion criteria: woman age 30–69 years, Luganda or Swahili speaking, living or working in the target Ugandan community. Exclusion criteria: unwillingness to sign informed consent. Setting: Primary and tertiary low-resource setting in Kampala, Uganda. Results: In Luganda, embarrassment relating to cervical cancer is described in two forms. ‘Community embarrassment’ describes discomfort based on how a person may be perceived by others. ‘Personal embarrassment’ relates to shyness or discomfort with her own genitalia. Community embarrassment was described in themes relating to place of study recruitment, amount of privacy in dwellings, personal relationship with health workers, handling of the vaginal swab and misunderstanding of HPV self collection as HIV testing. Themes of personal embarrassment related to lack of knowledge, age and novelty of the self-collection swab. Overall, embarrassment was a barrier to screening at the outset and diminished over time through education and knowledge. Fatalism regarding cervical cancer diagnosis, worry about results and stigma associated with a cervical cancer diagnosis were other psychosocial barriers described. Overcoming psychosocial barriers to screening can include peer-to peer education, drama and media campaigns. Conclusions: Embarrassment and other psychosocial barriers may play a large role at the onset of a screening programme, but over time as education and knowledge increase, and the social norms around screening evolve, its role diminishes. The role of peer to-peer education and community authorities on healthcare cannot be overlooked and can have a major impact in overcoming psychosocial and social barriers to screening.