Eradicating Human Diseases: Opportunities and Risks

Eradicating Human Diseases: Opportunities and Risks

The Director of the Center for Global Reproductive Health, Dr. Megan Huchko, participated in a panel on November 28th entitled "Eradicating Human Diseases: Opportunities and Risks." Dr. Gavin Yamey (Director for the Center for Policy Impact in Global Health) moderated the event, which featured Dr. Christopher Plowe (Director of the Duke Global Health Institute), Dr. Lavanya Vasudevan (Assistant Professor in Community and Family Medicine) and Dr. Osondu Ogbuoji (Deputy Director of the Center for Policy Impact in Global Health) as additional panelists. While the panelists disagreed on the definition of eradication, they all commented upon 'donor fatigue' and the economic and political difficulty of completing eradication as cases dwindle. The panel discussed the difficulty global health programs face in second-world countries, which don't benefit from the same economic resources as first-world countries or as many donations as third-world countries. The panelists stressed the importance of continued screenings, especially in the case of cervical cancer, and emphasized the necessity of childhood vaccinations....
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One Man, His Wife’s Legacy, and the “Monarch of Dreams”: Cervical Cancer Prevention in Zambia

One Man, His Wife’s Legacy, and the “Monarch of Dreams”: Cervical Cancer Prevention in Zambia

The women of Zambia have the world’s fourth highest rate of cervical cancer; yet, Zambia’s government provides free cervical cancer screening services. This begs the question: why does such a high incidence of cervical cancer persist? The answer is due, in part, to a lack of awareness amongst the female population regarding this disease, particularly in rural areas. Robert Zulu, in upholding the legacy of his late wife whom he lost to cervical cancer, aims to inform and empower Zambia’s women by encouraging regular cervical cancer screenings. These preventative measures are especially important for HIV, which disproportionately affects Zambia’s women, as this disease increases the likelihood of cervical cancer diagnosis by three times. Zulu’s non-profit, Rakellz Dream Initiative, takes an incredibly unique approach to this end of raising awareness, producing plays and movies about cervical cancer. Zulu’s latest film, “Monarch of Dreams,” which is based on his wife’s battle with cancer, premiered on October 31st in Lusaka, Zambia’s capital. The...
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Embracing My Role as a Researcher – Sharing My Small Slice of the HPV Research Pie

Embracing My Role as a Researcher – Sharing My Small Slice of the HPV Research Pie

Guest Blog: Carissa Novak Throughout my recently completed Masters in Global Health Science, Duke’s Global Health Institute faculty regularly stressed the importance and potential impact of disseminating research findings. Therefore, I felt presenting the research findings from my thesis at the 32nd International Papillomavirus Conference inSydney, Australia, this fall was not only appropriate but necessary. Due to ongoing conversations regarding HPV vaccination coverage and HPV screening for cervical cancer communities are witnessing a tremendous increase in screening rates, especially in low-resource settings, where cervical cancer is most common. However, most programs still face significant challenges in addressing HPV positive women’s low rates of follow-up and treatment. My attendance at the conference was an opportunity to share the findings of my thesis work, in which we found that in western Kenya, a setting where resources were limited for all HPV positive women, stigma and isolation were the main differentiating features between women who accessed follow-up and those who did not. Interestingly, I presented...
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US Preventive Services Task Force recommends primary cervical HPV testing as an effective cervical cancer screening method

US Preventive Services Task Force recommends primary cervical HPV testing as an effective cervical cancer screening method

Cervical cancer is the fourth most common cancer in women worldwide. In the US, deaths from cervical cancer have decreased by more than 50 percent over the past 60 years, since the introduction of regular screening tests that detect high-grade precancerous cervical lesions and cervical cancer. However, over 13,000 women are diagnosed with cervical cancer annually and about 4,200 women die from it, even with screening and treatment. Recommendations continue to evolve, reflecting the latest screening technology and evidence. The new USPSTF recommendations for screening have been recently published in the latest issue of JAMA. Women over 30 now have three options for screening, including HPV testing alone; the other two options are pap smear and a combination of pap smear and HPV testing. HPV testing has been shown to be more effective than a pap test as it is able to detect precancerous cells earlier and more accurately than cytology. These screening guidelines update the previous guidelines; now, for...
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Health Systems Barriers to Cervical Cancer Prevention in Kenya

Health Systems Barriers to Cervical Cancer Prevention in Kenya

Blog by Charlotte Page, Ob/Gyn Resident: This is a follow-up post to “Patient Barriers to Cervical Cancer Prevention in Kenya”. I’ve realized while in Kenya that there are a lot of things I take for granted in bathrooms in the US: running water, a toilet that flushes, toilet paper, soap, and electricity. If you’re missing one of these things, the restroom is that much more uncomfortable – or perhaps even unfunctional. Similarly, small systems issues here in Kenya can inhibit women from receiving the healthcare they need. For the HPV-positive women in the study I’m working on, such problems can significantly increase the amount of time and effort required to get treated with cryotherapy, to the point that some women don’t obtain treatment at all. To paint a picture: yesterday I was at Migori County Referral Hospital (MCRH), one of the sites where cryotherapy is provided in our study. This procedure uses compressed gas to freeze precancerous cells on the cervix, thereby preventing them...
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Legislation Promoting HPV Vaccine Use Does NOT Increase Risky Sexual Behavior

Legislation Promoting HPV Vaccine Use Does NOT Increase Risky Sexual Behavior

  The relatively low HPV vaccine uptake in the US has been attributed in part to fears that vaccinating against the sexually transmitted virus would encourage early or risky sexual behavior in adolescents. To look at the potential impact of pro-vaccine legislation on behaviors, researchers compared CDC surveillance data on teen sexual activity in states in the US with policies promoting or mandating HPV vaccination among adolescents to states without any specific vaccination policies in a study published in Pediatrics this month. They found no difference in reported sexual activity or risk behavior in states with vaccine legislation. These results support a prior study in which researchers looked at diagnosis of sexually transmitted infection as a marker for sexual activity or increased risk behavior, and found that there was no difference between vaccinated and unvaccinated adolescents over the five year study period. Despite this consistent, reassuring evidence that vaccinating for HPV will not increase sexual activity among adolescents, the US has...
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Community Health Campaign: Thoughts Station by Station

Community Health Campaign: Thoughts Station by Station

Not much changes yet everything seems different whenever I return to my home country of Kenya. I was reminded of my first time in Kisumu last year with Dr. Megan Huchko & Katelyn Bryant-Comstock and how anxious I was, even though I was in Kenya, I was completely unfamiliar with this region, the local language, and the culture. Last year, I was a rising junior filled with high hopes, yet naïve of the intricacies of proposing a project and carrying it out. This year, I have returned with much more practical expectations as well as a greater capacity to carry out my project: using GIS spatial mapping to enumerate the risk of loss-to-follow up for treatment of HPV. My project is taking place in Migori, Kenya as a part of the ongoing Cervical Cancer Screening & Prevention Study. The use of geographic information systems will help us create correlations between women’s sociodemographic variables as risk-factors and treatment loss-to-follow up rates....
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Patient Barriers to Cervical Cancer Prevention in Kenya

Patient Barriers to Cervical Cancer Prevention in Kenya

Starting at age 21, you get regular pap smears. You get in your car, drive on a paved road to an Ob/Gyn or primary care clinic, and have the pap done, with relatively little effort on your part. That’s how cervical cancer screening works for most women in the United States and most other developed countries. In these countries, pap smears have significantly reduced rates of cervical cancer and resulting deaths. It’s a different story in developing countries like Kenya. In East Africa, cervical cancer is the most common cancer in women, even surpassing breast cancer. In Kenya, only 3.5%[1] of eligible women ever get screened for cervical cancer, and it’s difficult for those that screen positive for precancer or cancer to access treatment. Some barriers relate to infrastructure, as cervical cancer prevention and treatment requires resources including skilled providers, supplies, and transportation of specimens. To try to overcome some of these systems issues, Dr. Megan Huchko (director of the Center for...
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Thailand honored for Cervical Cancer Prevention Program

Thailand honored for Cervical Cancer Prevention Program

For years, Thailand had a high incidence of cervical cancer and had seen little success from their pap smear based screening approach. In 2000, Jhpiego, the government of Thailand, the Provincial Health Office of Roi Et, and the Royal Thai College of Obstetricians and Gynecologists implemented a pilot study using a screen-and-treat approach for cervical cancer prevention. This method allows women to attend a single visit with a health care provider and services can be provided by a nurse, allowing for task-sharing within the health system. Based on results from this study, the WHO adopted the screen-and-treat strategy as part of their comprehensive cervical cancer guidelines. These services are now offered in 32 Thai provinces and the government has recently introduced a HPV vaccination campaign to further efforts in cervical cancer prevention. This week, the Roi Et Provincial Health Office was awarded a United Nations Public Service Award honoring their pioneering efforts in cervical cancer prevention....
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New study shows low, declining HPV vaccine follow-through in U.S.

New study shows low, declining HPV vaccine follow-through in U.S.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections, and causes about 31,500 cancers in the United States each year. It also has a vaccine--but many Americans aren't being vaccinated. The HPV vaccine is already underutilized in the United States, and a new study by researchers at the University of North Carolina found that HPV vaccine follow-through is declining over time. The vaccine, which is highly effective at preventing the development of abnormal cells that can progress to cervical cancer, is delivered in a series of doses. The Centers for Disease Control and Prevention (CDC) recommends that all children ages 11-12 should get two doses of the vaccine six to twelve months apart; adolescents older than 14 should get three shots over four months. Yet the survey of more than a million privately-insured Americans showed that vaccine follow-through declined from 2006 to 2014. The decrease was especially prominent among female patients, from 67% in 2006 to 38%...
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