A experiência da auto coleta para rastreio de infecções sexualmente transmissíveis em mulheres acompanhadas em serviço terciário de referência em Ginecologia
Data
2024-08-29
Autores
Marques, Miriane Borges 
Orientadores
Speck, Neila Maria de Goís
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a experiência da auto coleta para rastreio de infecções sexualmente transmissíveis (IST) em mulheres acompanhadas em serviço referência em ginecologia. Métodos: Foram realizados dois estudos, ambos prospectivos, descritivos, qualitativos e quantitativos. O primeiro estudo obteve de forma oportuna 47 participantes do sexo feminino, com colo uterino, sexualmente ativas e acima dos 25 anos de idade com diagnóstico ou risco de IST acompanhadas em serviço de referência em ginecologia. Foram divididas em Grupo 1: diagnóstico de lesão intraepitelial de alto grau do colo uterino (n=18); Grupo 2: pessoas que vivem com o vírus da imunodeficiência humana - PVHIV (n=17) e Grupo 3: risco de IST (n=12). Dados sociodemográficos foram aplicados, seguido da auto coleta e coleta realizada por um clínico, para rastreio de Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) através da técnica de Reação de polimerase em cadeia (PCR). A prevalência, adequabilidade das amostras e concordância entre os resultados foram analisados e comparou-se os grupos quanto ao desconforto. No segundo estudo, as mesmas 47 participantes foram convidadas por mensagens eletrônicas via telefone celular para irem até o serviço e realizar o teste de identificação do ácido desoxirribonucleico do papilomavírus humano de alto risco (DNA-HPVar), pela auto coleta vaginal e coleta realizada por um clínico, sendo avaliado a adesão ao teste. A prevalência de DNA-HPVar, a adequabilidade das amostras e a concordância entre os resultados das duas formas de coleta foram analisados. Comparou-se preferência, confiabilidade e conforto entre os dois métodos de coleta, além de avaliar o conhecimento da auto coleta como forma de rastreio de câncer de colo. Os resultados com valores de p<0,05 foram considerados significativos. Resultados: No primeiro estudo foi observado que PVHIV tinham menor média etária para o início da atividade sexual e que mulheres em risco de IST tiveram o maior número de parcerias sexuais em um ano. A prevalência de CT foi 2,1% e NG: 0%. Nenhuma das amostras foi considerada indeterminada. A concordância dos resultados entre os métodos de coleta foi absoluta. A auto coleta foi menos desconfortável em relação à coleta feita por um clínico. No segundo estudo, das 47 participantes, 17 (39,5%) tiveram adesão, não sendo possível estabelecer contato com 4. As participantes mais jovens e com maior escolaridade preferiram a auto coleta e tinham conhecimento dessa estratégia de rastreio. A confiança no resultado dos dois métodos de coleta foi absoluta. A prevalência de DNA-HPVar foi 29% e não houve resultado indeterminado, sendo 94,7% a concordância positiva dos resultados e 100%, negativa. Conclusões: A experiência da auto coleta para rastreio de IST em serviço terciário de referência em ginecologia foi positiva. A auto coleta pode não ser suficiente para otimizar o rastreamento de IST. A associação de outras estratégias, como educação, informação, organização do sistema de saúde, de forma tecnológica, facilitando o acesso aos kits de coletas e sua devolução bem como orientar seguimento, podem otimizar a adesão à prevenção de IST e influenciar a experiência da auto coleta em serviços de referência.
Objective: To evaluate the experience of self-collection for the screening of sexually transmitted infections (STI) in women followed up at a specialist gynecology service. Methods: Two studies were carried out. They both were prospective, descriptive, qualitative and quantitative. They were approved by the ethics committee and the informed consent was acquired. In the first study, 47 female participants, over 25 years of age, sexually active, with a cervix and with a diagnosis or risk of STI followed at a gynecology reference service, were analyzed timely. They were divided into Group 1: diagnosis of high-grade intraepithelial lesion of the cervix - HSIL (n=18); Group 2: people living with the human immunodeficiency virus - PLHIV (n=17) and Group 3: risk of STI (n=12). Sociodemographic data were requested, followed by urinary self-collection and cervico-vaginal clinician collected samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening tests using the Polymerase Chain Reaction (PCR) technique. The prevalence, the suitability of the samples and the agreement between results were analyzed. The discomfort between the two methods was compared. In the second study, the same 47 participants were invited by electronic messages via cell phone to go to the service and to perform the high-risk human papillomavirus deoxyribonucleic acid (HPVhr DNA) test through vaginal self-collection and cervical clinician collect sample. The adherence to the invitation for testing was assessed. The prevalence of DNA-HPVhr was evaluated, as well as the suitability of the samples and the agreement between the results of the two collection methods. The preference, reliability and comfort between the two methods were compared. In addition it was also evaluated the knowledge of self-collection as a screening method for cervical cancer. The results of the two studies with a p value < 0.05 were considered significant. Results: In the first study, it was observed that PLHIV had a lower mean age for the beginning of sexual activity and participants at risk for STI had the highest number of sexual partners in one year. The prevalence of CT was 2.1% and NG, 0%. None of the samples were considered indeterminate. The positive and negative agreement of the results between the collection methods was absolute. Self-collection was more comfortable compared to clinician collection samples. In the second study, 17 (39.5%) of the 47 participants were adherent, and it was not possible to establish contact with 4 participants. Younger and higher level degree participants preferred self-collection and they were aware of this screening method for cervical cancer screening. All participants trusted in the results of the two collection methods. The prevalence of DNA-HPVhr was 29% and there was no indeterminate result, with 94.7% positive agreement and 100% negative agreement. Conclusions: The experience of self-collection for STI screening in a tertiary specialist service in gynecology was positive. To offer self-collection methods may not be sufficient. The association with other strategies, such as education, information, organization of an efficient and technological health service can optimize adherence to STI prevention. These strategies might guarantee accessibility to collection methods and provide an adequate follow up. Sexually transmitted disease,
Objective: To evaluate the experience of self-collection for the screening of sexually transmitted infections (STI) in women followed up at a specialist gynecology service. Methods: Two studies were carried out. They both were prospective, descriptive, qualitative and quantitative. They were approved by the ethics committee and the informed consent was acquired. In the first study, 47 female participants, over 25 years of age, sexually active, with a cervix and with a diagnosis or risk of STI followed at a gynecology reference service, were analyzed timely. They were divided into Group 1: diagnosis of high-grade intraepithelial lesion of the cervix - HSIL (n=18); Group 2: people living with the human immunodeficiency virus - PLHIV (n=17) and Group 3: risk of STI (n=12). Sociodemographic data were requested, followed by urinary self-collection and cervico-vaginal clinician collected samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening tests using the Polymerase Chain Reaction (PCR) technique. The prevalence, the suitability of the samples and the agreement between results were analyzed. The discomfort between the two methods was compared. In the second study, the same 47 participants were invited by electronic messages via cell phone to go to the service and to perform the high-risk human papillomavirus deoxyribonucleic acid (HPVhr DNA) test through vaginal self-collection and cervical clinician collect sample. The adherence to the invitation for testing was assessed. The prevalence of DNA-HPVhr was evaluated, as well as the suitability of the samples and the agreement between the results of the two collection methods. The preference, reliability and comfort between the two methods were compared. In addition it was also evaluated the knowledge of self-collection as a screening method for cervical cancer. The results of the two studies with a p value < 0.05 were considered significant. Results: In the first study, it was observed that PLHIV had a lower mean age for the beginning of sexual activity and participants at risk for STI had the highest number of sexual partners in one year. The prevalence of CT was 2.1% and NG, 0%. None of the samples were considered indeterminate. The positive and negative agreement of the results between the collection methods was absolute. Self-collection was more comfortable compared to clinician collection samples. In the second study, 17 (39.5%) of the 47 participants were adherent, and it was not possible to establish contact with 4 participants. Younger and higher level degree participants preferred self-collection and they were aware of this screening method for cervical cancer screening. All participants trusted in the results of the two collection methods. The prevalence of DNA-HPVhr was 29% and there was no indeterminate result, with 94.7% positive agreement and 100% negative agreement. Conclusions: The experience of self-collection for STI screening in a tertiary specialist service in gynecology was positive. To offer self-collection methods may not be sufficient. The association with other strategies, such as education, information, organization of an efficient and technological health service can optimize adherence to STI prevention. These strategies might guarantee accessibility to collection methods and provide an adequate follow up. Sexually transmitted disease,
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Citação
MARQUES, Miriane Borges. A experiência da auto coleta para rastreio de infecções sexualmente transmissíveis em mulheres acompanhadas em serviço terciário de referência em Ginecologia. 2024. 101 f. Dissertação (Mestrado em Ginecologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.