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Cepheid
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Leitura de 5 m
7 de Novembro de 2024
SAÚDE COMUNITÁRIA E GLOBAL
Artigo
HPV Testing in South African Clinic May Prevent Cervical Cancer
O cancro do colo do útero é o segundo cancro mais comum diagnosticado em mulheres sul-africanas, mas é um dos cancros mais evitáveis. A doença é causada por infeção do colo do útero (abertura do útero) por um vírus muito comum, conhecido por vírus do papiloma humano (HPV). Embora a maioria das mulheres infetadas pelo HPV consiga eliminar a infeção através da sua própria imunidade, algumas mulheres irão desenvolver cancro devido a esta infeção.
A community clinic for disadvantaged women in South Africa, demonstrated HPV testing and treatment in one visit was feasible using Cepheid GeneXpert® point-of-care testing, helping patients reduce their risk of developing cancer.
As mulheres que vivem em comunidades desfavorecidas na África do Sul enfrentam muitas barreiras para aceder a serviços de saúde de qualidade, incluindo o teste do HPV. Historically, prevention of cervical cancer required women to undergo a Pap smear. However, for many women, the Pap smear was neither available nor accessible and could often take as long as 6 weeks to get a result. During this waiting period, positive individuals may be lost to follow-up and be a risk for transmission to others through skin-to-skin contact, including sexual activity.
O município de Khayelitsha, na Cidade do Cabo, é uma área desprivilegiada onde existem taxas relativamente elevadas de infeção por HPV não diagnosticada. Anteriormente, para uma mulher fazer o teste do HPV na clínica comunitária de Khayelitsha, as amostras de doentes (esfregaços de Papanicolau) tinham de ser enviadas para um laboratório. It took about six weeks for the results to come back to the clinic. Quanto mais tempo passava, mais difícil se tornava para a clínica entrar em contacto com as mulheres para lhes dar os seus resultados. Many patients never returned to the clinic after their initial visit, meaning they didn't get the treatment they may have needed.
No entanto, uma vez detetadas e adequadamente tratadas, é extremamente improvável que as mulheres com teste positivo para HPV desenvolvam cancro do colo do útero.
The new point-of-care model of testing has condensed the test-and-treat pathway at the South African clinic from two appointments six weeks apart to a single visit.
It is now possible to take a sample from the cervix and immediately run the Xpert HPV test* on the GeneXpert system, located on-site, eliminating the need to transport the specimens to an off-site lab. Instead, within an hour, the system provides a result, enabling healthcare workers at the clinic to determine the best treatment for the patient the same day they are tested.
"The rates of HPV are quite high in this community,” explained Dr. Rakiya Saidu, University of Cape Town, doctor in obstetrics and gynaecology.
According to Saidu, the rapid HPV test takes away two of the main obstacles to preventing cervical cancer in low-income countries.
“One is women lost to follow-up. If we take a sample and the woman has to come back, she may never come back. It has also taken away the waiting to get treatment. Now a woman comes and gets the test done, gets the results and she gets treated if she needs it. That is very important," said Saidu.
Mais de 3000 mulheres receberam resultados no mesmo dia para o HPV na clínica, o que potencialmente as terá protegido de desenvolverem cancro do colo do útero no futuro. Mais de 95% das mulheres ficaram contentes por esperar uma hora para receber os seus resultados e plano de tratamento.
Esteja atento para saber como os testes no "point of care" estão a acelerar a via de diagnóstico do HPV em clínicas de saúde comunitárias na África do Sul.
Transcritos
Ncumisa Sonwabo: “My name is Ncumisa Sonwabo. I'm 41 years old and I have four lovely boys—three biological and one adopted. I live in Khayelitsha, one of the biggest townships in Cape Town.”
Rakiya Saidu, M.D.: “Khayelitsha is a diverse community with many health challenges, especially in semi-urban areas like this. The high rate of unemployment and violence, particularly against women, makes it difficult for women to negotiate condom use, putting them at risk for infections like HPV and HIV. These infections are prevalent and very real in this community.”
Lynette Denny, M.D, Ph.D: “These community health clinics were a brilliant idea. They offer diverse services to any woman who comes in seeking help. We also invite them to join our research projects focused on preventing cervical cancer. That's our main work.”
Ncumisa Sonwabo: “I never knew anything about cervical cancer until the clinic taught us about it and asked us to participate in the study. I was interested in doing it.”
Rakiya Saidu, M.D.: “This particular study started in 2015, and we have been recruiting patients through word of mouth. Women tell their neighbors and daughters, so we get a lot of patients. Over the last 1,5 years, we recruited over 3000 women.”
Ncumisa Sonwabo: “When I go there, everything is fine. The staff is friendly and welcoming, and everything is easy. They have a playground for the kids, and they are welcome because they also give the kids some juices and stuff. It’s very nice to take your kids there.”
Dixy Zweni: “When a woman walks in, she goes to the waiting room where we provide health education about what is going to happen.”
Ncumisa Sonwabo: “I was scared but willing to test because I just wanted to stay safe. They say it's better to know beforehand.”
Dixy Zweni: “After placing the woman on the examination bed, we take a sample from the cervix and put it in a thin prep, which we take upstairs to the technician to test for HPV.”
Vathiswa Kamkam: “We use the GeneXpert® machine to determine which HPV type the patient has. When we get the specimens from the nurse, we prepare them and then put them in the GeneXpert machine, which takes an hour to prepare and get results.
Lynette Denny, M.D, Ph.D: “It's incredibly brilliant technology. You screen a woman and treat her during the same visit.”
Dixy Zweni: “Previously, we had to do a Pap smear and wait six weeks for the results, which was challenging because patients often didn't come back for their results, requiring us to trace and track them.”
Rakiya Saidu, M.D.: “The Rapid HPV Test removes two main obstacles in preventing cervical cancer in low-income countries: loss to follow-up and waiting for treatment. If a woman has to come back for results, she may never return. This test eliminates that issue and allows for treatment on the same day. The woman gets tested, receives her results, and gets treated if needed—all in one visit. This is very important.”
Dixy Zweni: “Patients are excited to be treated on the same day because they know a problem was detected and addressed immediately. This is beneficial for both us and the patients.”
Ncumisa Sonwabo: “Being in this small clinic has helped me a lot. I get to know the doctors and learn more about HPV. They teach us everything we need to know to take care of and protect ourselves. I like visiting there.”
Lynette Denny, M.D, Ph.D: “We've shown that screen and treat works. It prevents conditions that can lead to cancer. Now we need to implement it outside the comfort of this kind of building.”
Rakiya Saidu, M.D.: “It's a blessing to be a woman. Women face many issues, but somehow we cope with them all. As a doctor, I feel very honored to help other women.”
Referências:
- OMS. Cervical cancer health topics. Accessed 9/16/2024. https://www.who.int/health-topics/cervical-cancer#tab=tab_1
- Cancer Research U.K. About Cancer. Access 9/16/2-24. https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/infections-eg-hpv-and-cancer/does-hpv-cause-cancer
- WHO Factsheet; Human papillomavirus (HPV) and cervical cancer https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer
CE-IVD. Dispositivo médico para diagnóstico in vitro. Poderá não estar disponível em todos os países. Não está disponível nos Estados Unidos da América.
*Xpert HPV ENGLISH Package Insert 301-2585 Rev E Intended Use states that the Xpert HPV Assay is a qualitative in vitro test for the detection of the E6/E7 region of the viral DNA genome from high-risk Human Papillomavirus (HPV) in patient specimens. As indicações para o teste Xpert HPV incluem: The Xpert HPV Assay can be used with a Pap specimen to assess the presence or absence of high-risk HPV types. Esta informação, em conjunto com a avaliação que o médico faz da história clínica da paciente, outros fatores de risco e orientações profissionais, pode ser utilizada para orientar o controlo da paciente. • O ensaio Xpert HPV pode ser utilizado com amostras para teste de Papanicolaou (esfregaço) para avaliar a presença ou a ausência dos genótipos 16 e 18/45 do HPV. Esta informação, em conjunto com a avaliação que o médico faz da história clínica da paciente, outros fatores de risco e orientações profissionais, pode ser utilizada para orientar o controlo da paciente.
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