The present study evaluates the quality of life of 1,139 surviving victims of the Colombian armed conflict benefited from some actions of reparation, through a brief sociodemographic and ...victimological survey and the WHO quality of life (WHOQOL-BREF) questionnaire, which takes into account perceived physical and mental health, social relations, and environmental factors. The results show that the quality of life of the victims of the armed conflict, once peace agreements had been reached, remained low or medium-low. The number of victimizing events suffered and the time elapsed have little effect on the quality of life, with type of trauma being more relevant. Land-related experiences, such as expropriation, had fundamentally an influence on environmental factors. Kidnappings, sexual assaults, and events where minors were involved affected mental health. Victims of sexual assault were those whose quality of life was most affected and torture victims were those with a lower index of global quality of life. Simple passing of time did not mean quality of life increase with specific interventions being needed to repair damage. To repair the damage caused, special attention should be paid to the sociodemographic characteristics of each victim, the type of aggression suffered, and their needs in the areas of physical and mental health, and economic resources.
In the context of opportunistic cervical cancer screening settings of low‐and‐middle‐income countries, little is known about the benefits of high‐risk human papillomavirus (hrHPV) testing on ...high‐grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC‐US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC‐US) (RC) and hrHPV testing (colposcopy if hrHPV‐positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20 to 69 years with ASC‐US in routine care. Participants (n = 2661) were evenly randomized into three arms (n = 882 IC, n = 890 RC, n = 889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality‐control external panel (QC). The primary endpoint was the first QC‐diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow‐up (between enrolment and exit visit) and exit visit. The trial is completed. Colposcopy was done on 88%, 42% and 52% of participants in IC, RC and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (P = .821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2‐year routine follow‐up (relative proportion 0.35, 95% CI 0.09‐0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC‐US cytology.
What's new?
Guidelines for high‐risk human papillomavirus (hrHPV) testing in cervical cancer screening were introduced in Colombia in 2014 but have yet to be adopted in clinical practice. Moreover, follow‐up for screen‐positive women, including those with atypical squamous cells of undetermined significance (ASC‐US) cytology is limited. Here, hrHPV testing for follow‐up of women with ASC‐US cytology was compared with two approaches currently available in Colombia, immediate colposcopy and repeat cytology at two‐year routine follow‐up. Compared to immediate colposcopy, hrHPV testing reduced the burden of high‐grade cervical abnormalities by 65 percent and colposcopy referral by 41 percent.
The S5‐methylation test, an alternative to cytology and HPV16/18 genotyping to triage high‐risk HPV‐positive (hrHPV+) women, has not been widely validated in low‐middle‐income countries (LMICs). We ...compared S5 to HPV16/18 and cytology to detect cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) and CIN3+ in hrHPV+ women selected from a randomized pragmatic trial of 2661 Colombian women with an earlier‐borderline abnormal cytology. We included all hrHPV+ CIN2 and CIN3+ cases (n = 183) age matched to 183 <CIN2 hrHPV+. Baseline specimens were HPV‐genotyped and tested by S5‐methylation, blinded to cytology, histology and initial HPV results. We evaluated the test performance of predefined S5‐classifier (cut‐point 0.8) and a post hoc classifier at a different cut‐point (3.1). S5 sensitivity for CIN2+ was 82% (95% confidence interval CI 76.4‐87.5) and for CIN3+ 77.08% (95% CI 65.19‐88.97). S5 sensitivity was higher than HPV16/18 sensitivity (48.1%, 95% CI 40.85‐55.33) or cytology (31.21%, 95% CI 24.50‐37.93) but with lower specificity (35%, 95% CI 28.1‐42). At cut‐point 3.1, S5 sensitivity for CIN2+ (55.2%, 95% CI 48‐62.4) or CIN3+ (64.6%, 95% CI 51.0‐78.1) was also superior to HPV16/18 (P < .05) or cytology (P < .0001). At this cut‐point S5 specificity (76%, 95% CI 69.8‐82.1 for <CIN2) was higher than HPV16/18 (67.21%, 95% CI 60.41‐74.01, P = .0062) and similar to cytology (75.57%, 95% CI 69.34‐81.79, P = 1). HPV16/18 plus cytology sensitivity was similar to S5 for CIN3+, however, false‐positive rate was higher (50.27% vs. 24.04%). High sensitivity is crucial in LMICs, S5‐methylation exceeded HPV16/18 or cytology sensitivity with comparable specificity for CIN2+ and CIN3+ in hrHPV‐positive Colombian women. Furthermore, S5 triage had comparable sensitivity and significantly fewer false positives than cytology and HPV16/18 combination.
What's new?
For cervical cancer screening, testing HPV16/18 types has lower specificity than cytology, but a high false positive rate. Here, the authors evaluated the S5 classifier test, which is based on DNA methylation. They found that for triaging women who test positive for high risk HPV, S5 had better sensitivity and fewer false positives than cytology plus HPV16/18. This paper represents the first time that S5 methylation has been tested head‐to‐head with cytology and HPV16/18 testing in a LMIC. As affordable methylation tests become available, this strategy may prove useful for triage in low resource settings.
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