Lições aprendidas com a comparação de esfregaços vaginais autocoletados e colhidos por médicos para o diagnóstico de infecções em ambientes com recursos limitados: uma revisão de 24 anos
DOI:
https://doi.org/10.5327/DST-2177-8264-2024361410Palavras-chave:
Diagnóstico, Saúde reprodutiva, Saúde da mulherResumo
Introdução: A saúde reprodutiva é essencial para o bem-estar geral das mulheres, mas infecções vaginais, como vaginose bacteriana (VB), candidíase
e tricomoníase, são prevalentes e podem levar a complicações graves, se não forem tratadas. Em países de alta renda, os sistemas de saúde geralmente estão equipados para lidar com essas infecções, no entanto, em ambientes com recursos limitados, barreiras, como isolamento geográfico, restrições financeiras e estigmas sociais, dificultam o acesso a cuidados eficazes. Os esfregaços vaginais autocoletados apresentam uma alternativa promissora às amostras tradicionais coletadas por médicos, oferecendo benefícios potenciais em regiões carentes. Objetivos: Este estudo tem como objetivo avaliar a viabilidade, a precisão do diagnóstico e a aceitação da comunidade de amostras vaginais coletadas pela própria mulher em comparação com amostras coletadas por médicos para o diagnóstico de vaginose bacteriana, candidíase e tricomoníase em ambientes com recursos limitados e explorar estratégias
para ampliar essa abordagem a fim de melhorar a saúde reprodutiva das mulheres. Métodos: Esta revisão narrativa sintetiza a literatura sobre a eficácia,
a viabilidade e a aceitação da comunidade de swabs vaginais autocoletados em comparação com amostras coletadas por médicos para o diagnóstico de VB, candidíase e tricomoníase. Uma busca sistemática foi conduzida no PubMed, Google Scholar e repositórios institucionais para estudos de janeiro de 2000 a maio de 2024. A revisão abrangeu várias seções, incluindo o histórico sobre a importância do diagnóstico oportuno, iniciativas que empoderam as mulheres por meio da autocoleta, desafios e sucessos dessas iniciativas e estratégias para garantia de qualidade e defesa de políticas. Resultados: Os esfregaços vaginais autocoletados foram tão precisos quanto as amostras coletadas pelo médico no diagnóstico de VB, candidíase e tricomoníase. O método melhora a acessibilidade e reduz o estigma, mostrando potencial para uma aplicação mais ampla em ambientes de saúde comunitários. Conclusão: Os esfregaços vaginais autocoletados representam uma solução viável para os desafios da saúde reprodutiva em cenários com recursos limitados. Eles oferecem precisão diagnóstica comparável à dos materiais obtidos por médicos, melhoram a acessibilidade e reduzem as barreiras culturais para a busca de cuidados.
Os esforços futuros devem se concentrar na educação da comunidade, em inovações tecnológicas e reformas de políticas para maximizar a eficácia e a
sustentabilidade dessa abordagem, visando à melhoria da saúde global das mulheres.
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Referências
World Health Organization. Reproductive health. Reproductive health
in the South-East Asia Region [Internet]. 2021 [cited on 2024 Jan 03].
Available from: https://www.who.int/southeastasia/health-topics/
reproductive-health#:~:text=Reproductive%20health%20implies%20
that%20people,how%20often%20to%20do%20so.
Mohankumar B, Shandil RK, Narayanan S, Krishnan UM. Vaginosis:
advances in new therapeutic development and microbiome restoration. Microb
Pathog. 2022;168:105606. https://doi.org/10.1016/j.micpath.2022.105606
Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369(9577):1961-71.
https://doi.org/10.1016/S0140-6736(07)60917-9
Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician.
;62(5):1095-104. PMID: 10997533.
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S,
et al. High-quality health systems in the sustainable development goals
era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196-e1252.
https://doi.org/10.1016/S2214-109X(18)30386-3
Habib SS, Jamal WZ, Zaidi SMA, Siddiqui JU, Khan HM, Creswell J, et al.
Barriers to access of healthcare services for rural women-applying a gender
lens on TB in a rural district of Sindh, Pakistan. Int J Environ Res Public
Health. 2021;18(19):10102. https://doi.org/10.3390/ijerph181910102
Mohammadi F, Kohan S, Mostafavi F, Gholami A. The stigma of
reproductive health services utilization by unmarried women. Iran Red
Crescent Med J. 2016;18(3):e24231. https://doi.org/10.5812/ircmj.24231
Hariprasad R, John A, Abdulkader RS. Challenges in the implementation
of human papillomavirus self-sampling for cervical cancer screening in
India: a systematic review. JCO Glob Oncol. 2023;9:e2200401. https://
doi.org/10.1200/GO.22.00401
Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of
samples as an additional approach to deliver testing services for sexually
transmitted infections: a systematic review and meta-analysis. BMJ Glob
Health. 2019;4(2):e001349. https://doi.org/10.1136/bmjgh-2018-001349
Khan Z, Bhargava A, Mittal P, Bharti R, Puri P, Khunger N, et al.
Evaluation of reliability of self-collected vaginal swabs over physiciancollected
samples for diagnosis of bacterial vaginosis, candidiasis and
trichomoniasis, in a resource-limited setting: a cross-sectional study
in India. BMJ Open. 2019;9(8):e025013. https://doi.org/10.1136/
bmjopen-2018-025013
Jaya ZN, Mapanga W, Dlangalala T, Thembane N, Kgarosi K, Dzinamarira
T, et al. Accuracy of self-collected versus healthcare worker collected
specimens for diagnosing sexually transmitted infections in females: an
updated systematic review and meta-analysis. Sci Rep. 2024;14(1):10496.
https://doi.org/10.1038/s41598-024-61358-y
Lozar T, Nagvekar R, Rohrer C, Mandishora RSD, Ivanus U, Fitzpatrick
MB. Cervical cancer screening postpandemic: self-sampling opportunities
to accelerate the elimination of cervical cancer. Int J Womens Health.
;13:841-59. https://doi.org/10.2147/IJWH.S288376
Lwamba E, Shisler S, Ridlehoover W, Kupfer M, Tshabalala N, Nduku P,
et al. Strengthening women’s empowerment and gender equality in fragile
contexts towards peaceful and inclusive societies: a systematic review
and meta-analysis. Campbell Syst Rev. 2022;18(1):e1214. https://doi.
org/10.1002/cl2.1214
Kumar S, Preetha G. Health promotion: an effective tool for global health.
Indian J Community Med. 2012;37(1):5-12. https://doi.org/10.4103/0970-
94009
Matin BK, Williamson HJ, Karyani AK, Rezaei S, Soofi M, Soltani S.
Barriers in access to healthcare for women with disabilities: a systematic
review in qualitative studies. BMC Womens Health. 2021;21(1):44.
https://doi.org/10.1186/s12905-021-01189-5
Hussein J, Ferguson L. Eliminating stigma and discrimination in sexual
and reproductive health care: a public health imperative. Sex Reprod
Health Matters. 2019;27(3):1-5. https://doi.org/10.1080/26410397.2019.
Stangl AL, Earnshaw VA, Logie CH, van Brakel W, Simbayi LC, Barré
I, et al. The health stigma and discrimination framework: a global,
crosscutting framework to inform research, intervention development, and
policy on health-related stigmas. BMC Med. 2019;17(1):31. https://doi.
org/10.1186/s12916-019-1271-3
Nielsen M, D’Agostino D, Gregory P. Addressing rural health challenges
head on. Mo Med. 2017;114(5):363-6. PMID: 30228634.
Parsons LM, Somoskövi A, Gutierrez C, Lee E, Paramasivan CN, Abimiku
A, et al. Laboratory diagnosis of tuberculosis in resource-poor countries:
challenges and opportunities. Clin Microbiol Rev. 2011;24(2):314-50.
https://doi.org/10.1128/CMR.00059-10
World Health Organization. WHO guideline for screening and treatment
of cervical pre-cancer lesions for cervical cancer prevention: use of
dual-stain cytology to triage women after a positive test for human
papillomavirus (HPV). 2nd ed. Geneva: World Health Organization; 2024.
Semrau M, Gronholm PC, Eaton J, Maulik PK, Ayele B, Bakolis I, et al.
Reducing stigma and improving access to care for people with mental
health conditions in the community: protocol for a multi-site feasibility
intervention study (Indigo-Local). Res Sq [Preprint]. 2023:rs.3.rs-3237562.
https://doi.org/10.21203/rs.3.rs-3237562/v1
Nickel S, von dem Knesebeck O. Effectiveness of community-based
health promotion interventions in urban areas: a systematic review. J
Community Health.
Tolley A, Grewal K, Weiler A, Papameletiou AM, Hassan R, Basu S.
Factors influencing adherence to non-communicable disease medication
in India: secondary analysis of cross-sectional data from WHO –
SAGE2. Front Pharmacol. 2023;14:1183818. https://doi.org/10.3389/
fphar.2023.1183818
Ignoffo S, Gu S, Ellyin A, Benjamins MR. A review of community
health worker integration in health departments. J Community Health.
;49(2):366-76. https://doi.org/10.1007/s10900-023-01286-6
Yadav R, Zaman K, Mishra A, Reddy MM, Shankar P, Yadav P, et al.
Health seeking behaviour and healthcare utilization in a rural cohort of
North India. Healthcare (Basel). 2022;10(5):757. https://doi:.org/10.3390/
healthcare10050757
Frost D, Mahmud M, Kaiser MS, Musoke D, Henry P, Islam S. Innovative
approaches to strengthening health systems in low- and middle-income
countries: Current models, developments, and challenges. Health Policy
Technol. 2021;10(4):100567. https://doi.org/10.1016/j.hlpt.2021.100567
Iqbal A, Anil G, Bhandari P, Crockett ED, Hanson VM, Pendse BS,
et al. A digitally capable mobile health clinic to improve rural health
care in America: a pilot quality improvement study. Mayo Clin Proc
Innov Qual Outcomes. 2022;6(5):475-83. https://doi.org/10.1016/j.
mayocpiqo.2022.08.002
Ezike TC, Okpala US, Onoja UL, Nwike CP, Ezeako EC, Okpara OJ,
et al. Advances in drug delivery systems, challenges and future directions.
Heliyon. 2023;9(6):e17488. https://doi.org/10.1016/j.heliyon.2023.e17488
Zhang Y. Access to healthcare facilities and women’s healthcare
requirements in urban areas: a case study of Beijing. Int J Environ Res
Public Health. 2022;19(6):3709. https://doi.org/10.3390/ijerph19063709
Morales-Garzón S, Parker LA, Hernández-Aguado I, Tolosana MGM,
Pastor-Valero M, Chilet-Rosell E. Addressing health disparities through
community participation: a scoping review of co-creation in public
health. Healthcare (Basel). 2023;11(7):1034. https://doi.org/10.3390/
healthcare11071034
Gizaw Z, Astale T, Kassie GM. What improves access to primary
healthcare services in rural communities? A systematic review. BMC Prim
Care. 2022;23(1):313. https://doi.org/10.1186/s12875-022-01919-0
Grady PA, Gough LL. Self-management: a comprehensive approach to
management of chronic conditions. Am J Public Health. 2014;104(8):e25-
https://doi.org/10.2105/AJPH.2014.302041
Wakjira DB, Habedi D. Barriers to access and utilisation of sexual and
reproductive health services among adolescents in Ethiopia: a sequential
mixed-methods study. BMJ Open. 2022;12(11):e063294. https://doi.
org/10.1136/bmjopen-2022-063294
Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A,
Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health
workers and health equity in low- and middle-income countries: systematic
review and recommendations for policy and practice. Int J Equity Health.
;21(1):49. https://doi.org/10.1186/s12939-021-01615-y
Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C.
The effects of public health policies on health inequalities in high-income
countries: an umbrella review. BMC Public Health. 2018;18(1):869.
https://doi.org/10.1186/s12889-018-5677-1
Lassi ZS, Kumar R, Bhutta ZA. Community-based care to improve maternal,
newborn, and child health. In: Black RE, Laxminarayan R, Temmerman
M, Walker PN, Bustreo F, Jamison DT, et al., eds. Reproductive, maternal,
newborn, and child health: disease control priorities. 3rd ed. Washington:
The International Bank for Reconstruction and Development; 2016. https://
doi.org/10.1596/978-1-4648-0348-2_ch14
Ameyaw EK, Amoah PA, Ezezika O. Effectiveness of mHealth apps for
maternal health care delivery: systematic review of systematic reviews. J
Med Internet Res. 2024;26:e49510. https://doi.org/10.2196/49510
Anawade PA, Sharma D, Gahane S. A comprehensive review on
exploring the impact of telemedicine on healthcare accessibility. Cureus.
;16(3):e55996. https://doi.org/10.7759/cureus.55996
Ajuebor O, Boniol M, McIsaac M, Onyedike C, Akl EA. Increasing access
to health workers in rural and remote areas: what do stakeholders’ value
and find feasible and acceptable? Hum Resour Health. 2020;18(1):77.
https://doi.org/10.1186/s12960-020-00519-2
Stover J, Hardee K, Ganatra B, et al. Interventions to improve reproductive
health. In: Black RE, Laxminarayan R, Temmerman M, Walker PN,
Bustreo F, Jamison DT, et al., eds. Reproductive, maternal, newborn,
and child health: disease control priorities. 3rd ed. Washington: The
International Bank for Reconstruction and Development; 2016. https://
doi.org/10.1596/978-1-4648-0348-2_ch6
Ssetaala A, Ssempiira J, Wambuzi M, Nanyonjo G, Okech B, Chinyenze
K, et al. Improving access to maternal health services among rural hardto-
reach fishing communities in Uganda, the role of community health
workers. Womens Health (Lond). 2022;18:17455057221103993. https://
doi.org/10.1177/17455057221103993
Desai S, Misra M, Das A, Singh RJ, Sehgal M, Gram L, et al. Community
interventions with women’s groups to improve women’s and children’s
health in India: a mixed-methods systematic review of effects, enablers and
barriers. BMJ Glob Health. 2020;5(12):e003304. https://doi.org/10.1136/
bmjgh-2020-003304
Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M,
et al. Interventions to improve primary healthcare in rural settings: a
scoping review. PLoS One. 2024;19(7):e0305516. https://doi.org/10.1371/
journal.pone.0305516
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