| Objective: The study was conducted to explore the HPV infection status as well as the cognition of HPV and cervical cancer among community women aged 30-59 in Longgang District,Shenzhen and evaluate the health economics of the local cervical cancer screening program,which aims to provide reference for local cervical cancer screening and scientific basis for the development of cervical cancer prevention and treatment measures for women in the community.Methods: In this study,a cross-sectional survey was conducted in Longgang District of Shenzhen City from January to December 2021 and 7896 patients who participated in the HPV screening were selected from 6 community health service centers.28 kinds of HPV subtypes were detected by PCR-reverse hybridization.1008 people were randomly selected to fill in the HPV infection-related risk factors and cognitive assessment questionnaire.The data were statistically analyzed using univariate methods and multivariate unconditional logistic regression methods.The transfer probability determined by Markov model was used to calculate the relevant quality of life indicators in 10 years without screening,and the health economics evaluation and analysis of the cervical cancer screening program were carried out from three aspects of cost-effect,cost-benefit and cost-utility.Results: 1.Infection status: Among 7896 screened women,721 were HPV-positive,with an infection rate of 9.1%(95%CI: 8.5%-9.8%),and the infection rate of HPV-16/18,other high-risk,probable high-risk,and low-risk HPV subtypes was 1.4%(95%CI: 1.2%-1.7%),5.2%(95% CI: 4.7% 5.7%),0.9%(95% CI: 0.7% 1.1%)and 2.9%(95% CI: 2.6% 3.3%).HPV infection rate was different among different age groups,with the highest(14.9%,60/403)in 55-59 years old and the lowest(7.5%,148/1985)in 35-39 years old.HPV infection rate increased with age(P<0.001);Among the 28 HPV subtypes detected,HPV-52,16 and 58 were the most important,with infection rates of 2.1%,1.0% and 0.9%,respectively.The other top 10 genotypes were 44,53,42,51,68,81 and 39,respectively.Single infection,double infection and multiple infection were found in 568 cases(7.2%,95%CI: 6.6%-7.8%),126 case(1.6%,95%CI: 1.3%-1.9%)and 27 case(0.3%,95%CI:0.2%-0.5%),respectively.Single infection was dominant in HPV infection.2.Questionnaire survey results: a total of 1008 questionnaires were sent out,and 1000 valid questionnaires were recovered,with a qualified rate of 99.2%.In terms of risk factors: the mean age of the HPV positive group was higher than that of the negative group(t=2.171,P<0.05),the first sexual intercourse age of the HPV positive group was lower than that of the negative group(t=2.754,P<0.01);The HPV infection rate of the subjects with menopause,long-term use of contraceptives,family history of cervical cancer diseases,history of cervical erosion,cervicitis and genital mold infection was higher than that of the corresponding negative population groups(P<0.05);HPV infection rate of the subjects who used condoms frequently,cleaned their underwear separately,cleaned their vulva by the female before the sexual intercourse,cleaned their vulva by the male before the sexual intercourse,and had the habit of drinking tea were all lower than those of the corresponding negative population groups(P<0.05);Multivariate Logistic regression showed that a family history of cervical cancer increased the risk of HPV infection(OR=3.04,95%CI:1.32-7.01,P=0.009).The risk of HPV infection was increased in people with menopause(OR=1.99,95%CI:1.16-3.43,P=0.013).Long-term contraceptive use increased the risk of HPV infection(OR=2.70,95%CI:1.32-5.51,P=0.006);The later the age of first sexual intercourse,the lower the risk of HPV infection(OR=0.88,95%CI:0.81-0.96,P=0.005);The risk of HPV infection was decreased in the group that had the habit of drinking tea(OR=0.61,95%CI:0.38-0.97,P=0.040).In terms of cognition: more than 70% of the respondents knew "what is cervical cancer"(71.1%)and "sex life hygiene can prevent cervical cancer"(74.2%),and about half of the respondents knew about "what is early stage of cervical cancer"(49.9%),"survival status of early cervical cancer"(60.1%)and "cervical cancer can be cured in the early stage"(52.0%);but only about 30% of the respondents knew that "HPV infection is a necessary cause of cervical cancer"(35.4%)and "HPV is mainly transmitted through sexual behavior"(32.0%);the awareness rate of the 30-39year-old group was generally higher than that of the 40-49-year-old group and the 50-59year-old group(P<0.05);58.0% of people "voluntarily participated" in HPV screening,and only 11.5% of them participated in screening because of "persuasion from relatives and friends";82.6% of respondents believed that it was necessary to conduct HPV screening every year;about 80.5% of respondents were willing to pay a certain amount screening fee.More than half of the people(62.6%)were more willing to pay the screening fee of less than 200 yuan,and the willingness to pay of the respondents who knew "what is cervical cancer" and "cervical cancer can be cured in the early stage" was higher than that of the unknown group(P<0.05).3.Health economics evaluation results: In this study,a total of7175 patients were screened for Well,654 patients with HPV infection but no substantial lesions,27 patients with CIN I,2 patients with CIN II,37 patients with CIN III,1 patient with CC and 0 patients with Dead.The cost-effectiveness ratio of the screening program was 36,489.26(610100.50/16.72),and the ratio of cost-effectiveness ratio to local GDP was 0.46(less than 1).In 10 years,the net benefit of the screening program can reach10048249.96 yuan(more than 0);the ratio of cost-utility ratio to local GDP is called EDCI value and the value was 0.19(less than 5).Therefore,the screening program has cost-effect,cost-benefit and cost-utility values.Conclusion: 1.HPV infection in Longgang District of Shenzhen is characterized by single and high-risk subtype infection.HPV infection subtypes in this area are mainly HPV-52,16,58,44 and 53.2.Younger age at first sexual intercourse,family history of cervical cancer,long-term use of contraceptives and menopause are independent risk factors for HPV infection,and tea-drinking habit is a protective factor.3.The awareness rate of women in the local community about the knowledge on cervical cancer caused by HPV infection is still low.It is recommended to strengthen health education to improve the awareness rate of women’s related knowledge,and promote their concern for their own health,so as to promote the better development of the cervical cancer early diagnosis and early treatment projects.4.The cervical cancer screening program has good health economics value and can be used as an option for the continuation of local cervical cancer screening program. |
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