BACKGROUND: Cervical cancer is one of the most common forms of gynecologic malignancies worldwide with increased incidence in lower income countries. Bolivia, a lower-income country, experiences high rates of morbidity and mortality related to cervical cancer. The increased incidence is a multifactorial issue that includes low cervical cancer literacy, barriers to healthcare access, and poor follow-up rates. LITERATURE REVIEW FINDINGS: The current research finds that Bolivia's fragmented healthcare system has significantly influenced the country’s high cervical cancer burden. Women often receive inadequate sexual and reproductive health services that has led to a higher incidence of preventable morbidity and mortality. Previous research, however, has shown that the implementation of HPV self-screening and use of point of care testing are effective interventions in rural areas of Bolivia to increase screening. In addition, studies have shown that vaccination of school aged children utilizing a school-based model is another promising intervention in hopes of lowering the country’s burden of disease. Lack of cervical health knowledge in rural areas of Bolivia is another finding. Previous research has proposed that community education and optimization of cervical cancer knowledge can have a great impact on screening. METHODS: The study proposes to conduct an interventional study. The study will initially seek to implement an education intervention to improve the knowledge and understanding of cervical health for school aged and adult women in a single school district of rural Cochabamba, Bolivia. Phase I and II of the study will then aim to implement a vaccination campaign and an HPV self-screening program with point of care testing in the same school district. CONCLUSION: This study will seek to implement an HPV- self screening program and a vaccination campaign in rural Cochabamba, Bolivia through a multidisciplinary approach which involves vaccination, screening, and community education. Limitations of the proposed study includes lack of generalizability, time constraints, and financial constraints. SIGNIFICANCE: Cervical cancer is highly preventable through adequate screening and prophylaxis with vaccination. The goals of the study will seek to implement affordable and easily accessible screening methods and vaccination for a population in rural Bolivia to ultimately improve screening rates and follow up care. Efforts to increase screening in this population can lead to decreased rates of mortality and morbidity from cervical cancer in vulnerable, resource limited countries.

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Gimdos kaklelio vėžys pasaulyje yra antroji, o Lietuvoje ketvirtoji pagal dažnumą moterų onkologinė liga. Pagrindinė gimdos kaklelio vėžio priežastis yra žmogaus papilomos viruso (ŽPV) infekcija gimdos kaklelyje. Vakarų šalyse ikivėžiniams pokyčiams ar vėžinėms ląstelės nustatyti yra naudojamas citologija paremtas Papanicolaou testas (Pap) ir ŽPV DNR testas. Šiuo metu naudojami ŽPV diagnostiniai testai remiasi molekulinės biologijos tyrimo metodais. Tyrimui buvo pasirinktas polimerazės grandininės reakcijos (PGR) metodas, o ne plačiai naudojamas JAV bei Europos kokybės sertifikatus turintis Hybrid Capture 2 (HC2) metodas. PGR yra ypač jautrus, greitas, komerciškai prieinamas metodas, kuriam reikalingas nedidelis tiriamosios medžiagos kiekis, ir kuriuo galima tiksliai identifikuoti ŽPV tipus. HC2 metodas nenustato ŽPV genotipų, galimi klaidingai neigiami rezultatai, nes nėra vidinės kontrolės, o dėl kryžminių reakcijų galimi klaidingai teigiami rezultatai. Naujausi literatūros šaltiniai teigia, kad PGR turi daug perspektyvų ateityje ir manoma, kad ŽPV nustatymo standartas bus 14 DR-ŽPV tyrimas sujungtas su ŽPV-16 ir ŽPV-18 tipų nustatymu. Todėl siekiant ŽPV tyrimams pasirinkti optimaliausią iš Lietuvoje siūlomų komercinių rinkinių Valstybiniame patologijos centre buvo atliekamas šis tyrimas. Įvertinus tyrimų rezultatus, tolesniems tyrimams pasirinktas „Seeplex® HPV4A ACE Screening“ ŽPV nustatymo rinkinys. / Cervical cancer is the second oncological disease in women in the world, and the fourth one in Lithuania. The main cause of the cervical cancer is Human papillomavirus (HPV) infection in the cervix uteri. In order to detect precancerous changes or cancer cells, a Papanicolaou (Pap) test based on cytology and HPV DNA test are used in the Western world. Currently used HPV diagnostic tests are based on molecular biology testing methods. The polymerase chain reaction (PCR) method, not the extensively used Hybrid Capture 2 (HC2) method awarded the certificate of quality by both the USA and Europe, was chosen. PCR is a particularly sensitive, fast, and commercially available method that needs a small quantity of research material and can identify the types of HPV. HC2 method does not detect HPV genotypes, false-negative results are possible because there is no internal control, and due to cross reactions, false-positive results are possible. The newest written sources state that PCR will have much potential in the future and it is thought that HPV detection standard will become 14 HR-HPV test combined with the detection of the types of HPV-16 and HPV-18. Therefore, in order to chose the optimum one for HPV tests from the commercial kits offered in Lithuania, this investigation was carried out in the National Centre of Pathology. Four different HPV diagnostic kits were used for the research. Having evaluated the research results, „Seeplex® HPV4A ACE Screening“ HPV diagnostic kit was... [to full text]