Browsing by Author "De Souza, Michelle"

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    The costs of reducing loss to follow-up in South African cervical cancer screening
    (BioMed Central Ltd, 2005) Goldhaber-Fiebert, Jeremy; Denny, Lynette; De Souza, Michelle; Wright, Thomas; Kuhn, Louise; Goldie, Sue
    BACKGROUND:This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. METHODS: Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW) time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s), and those who never returned despite attempted contact(s) were determined. The number of CHW visits per woman was also estimated. RESULTS: 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5%) occurred without CHW contact, 918 (24.8%) occurred after contact(s), and 472 (12.7%) did not occur despite contact(s). Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand) for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. CONCLUSION: CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.
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    Program spending to increase adherence: South African cervical cancer screening
    (Public Library of Science, 2009) Goldhaber-Fiebert, Jeremy D; Denny, Lynette A; De Souza, Michelle; Kuhn, Louise; Goldie, Sue J
    Background: Adherence is crucial for public health program effectiveness, though the benefits of increasing adherence must ultimately be weighed against the associated costs. We sought to determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa. M ethodology/Principal Findings: We conducted an observational study of 5,258 CHW home visits made in 2003-4 as part of a community-based screening program. We estimated the functional relationship between spending on these visits and increased appointment attendance (adherence). Increased adherence was noted after each subsequent CHW visit. The costs of making the CHW visits was based on resource use including both personnel time and vehicle-related expenses valued in 2004 Rand. The CHW program cost R194,018, with 1,576 additional appointments attended. Adherence increased from 74% to 90%; 55% to 87%; 48% to 77%; and 56% to 80% for 6-, 12-, 24-, and 36-month appointments. Average per-woman costs increased by R14-R47. The majority of this increase occurred with the first 2 CHW visits (90%, 83%, 74%, and 77%; additional cost: R12-R26). Conclusions/Significance: We found that study data can be used for program planning, identifying spending levels that achieve adherence targets given budgetary constraints. The results, derived from a single disease program, are retrospective, and should be prospectively replicated.
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    Risk factors for high risk Human Papillomavirus (HR-HPV) infection among unscreened African women aged thirty-five to sixty-five years
    (2008) De Souza, Michelle; Moodley, J
    Introduction: Persistent infection with high risk types of Human Papillomavirus (HRHPV) is a known necessary cause of cervical cancer which is the second most common cancer in women around the world. Genital HPV infection is one of the commonest sexually transmitted infections in the world. This study was designed to evaluate the prevalence of HR-HPV in previously unscreened African women aged thirty-five to sixty-five years and to determine the socio-demographic, behavioural, contraceptive use and biological risk factors for HR-HPV infection among these women. Methods: This was a cross-sectional analytic study design using data derived from a randomized control trial (SAT study) evaluating screen and treat modalities, which was located in an area called Khayelitsha in the Western Cape. At enrolment, all women underwent a clinical examination, completed a questionnaire on demographic characteristics and sexual behaviors, and provided blood samples for HIV testing. Samples for Neisseria gonhorreae and Chlamydia trachomatis were collected using endocervical cone-brushes and tested using the Hybrid Capture GC/CT DNA Assay Endocervical cone-brush samples were tested for Human Papilloma Virus (HPV) DNA using the Hybrid Capture II HPV DNA Assay. Wet mount exams were performed on-site during the clinical examination by trained study nurses to identify Trichomonas vagina/is and Bacterial vaginosis was assessed during the clinical examination using Amsel criteria. Data from the enrollment visit was analyzed for 6645 participants and a multiple logistic regression analysis was performed to evaluate the risk factors for HR-HPV infection. - 14 - Results: In total, 6645 participants were included in the analysis. Of these women, 1416 (21.3%, 95% confidence interval (CI); 20.3; 22.3) tested positive for HR-HPV infection. The multivariate logistic regression analysis showed that a positive Human immunodeficiency virus (HIV) status (odds ratio (OR); 4.08, 95% CI; 3.47; 4.80), previous sterilization (OR; 0.72, 95% CI; 0.61; 0.85), current use of condoms (OR; 2.15, 95% CI; 1.22; 3.80), current use of Depot medroxyprogesterone acetate (DMPA) (OR; .. 1.37, 95% CI; 1.13; 1.65), current use ofNorethindrone enanthate (Net-EN) (OR; 1.39, 95% CI; 1.02; 1.88), currently married (OR; 0.71, 95% CI; 0.62; 0.81), mean number of live births (OR; 1.10, 95% CI; 1.06; 1.14), mean age in years (OR; 0.99, 95% CI; 0.98; 0.997) and currently employed (OR; 0.86, 95% CI; 0.74; 0.99) were significant in a model predicting the odds of infection with HR-HPV when adjusted for other sociodemographic, behavioural and biological variables and use of contraception. Conclusions: In conclusion, this study shows that there is a very high prevalence of HRHPV infection in African women aged thirty-five to sixty-five years living in Khayelitsha. The overwhelming association between HIV infection and HR-HPV infection in this study has very important clinical and policy implications in the communities where HIV infection, Acquired immunodeficiency disease syndrome (AIDS) and cervical cancer are major health problems. This study also adds onto the knowledge of risk factors for HR-HPV infection, but introduces the possibility of longacting injectable progesterones (LAIP) having a significant effect on the prevalence of HR-HPV infection and highlights the need for further research into the risks ofHR-HPV infection