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This Week in PLOS Medicine: Flexible sigmoidoscopy screening & Home-based HIV testing in Africa

For December 4 and 11, visit the Speaking of Medicine blog for updates on the latest articles from PLOS Medicine. Two new research articles published this week:

Flexible sigmoidoscopy screening cuts large bowel cancer death rate in half

Image Credit: Ano Lobb

Screening for bowel cancer using flexible sigmoidoscopy (a flexible tube with a camera and light at the end, which allows doctors to look into the lower part of the large bowel) can cut in half the rate of deaths from cancer of the large bowel (colorectal cancer) and can reduce by one third the number of new cases of this cancer, according to a study by US researchers published in this week’s PLOS Medicine.

As these findings came from the best available evidence to date, the authors of the study recommend that screening for colorectal cancer using flexible sigmoidoscopy should be included in guidelines for colorectal screening.

The authors, led by Joseph Elmunzer from the University of Michigan Medical Center, systematically reviewed all relevant studies and included five randomized controlled trials in their combined analysis: a total of 166,049 patients were randomized to be screened by flexible sigmoidoscopy and 250,100 people were randomized to the control group (no recommended intervention).

The authors found that screening using flexible sigmoidoscopy reduced the number of new cases of colorectal cancer by 18%, and the number of new cases of left sided colorectal cancer by 33%. In their combined analysis, the authors also found that 361 people would need to undergo screening with flexible sigmoidoscopy to prevent 1 new case of colorectal cancer but that the number of new cancers in those actually screened would fall by 32%.

Home-based HIV testing is highly acceptable in Africa

Image Credit: Jon Gos

Voluntary counselling and testing for HIV at home is highly acceptable in sub Saharan Africa, highlighting the importance of this approach in diagnosing HIV, according to a study by international researchers published in this week’s PLOS Medicine.

The authors, led by Kalpana Sabapathy, from the London School of Hygiene and Tropical Medicine, Imperial College London and the medical humanitarian organization Médecins Sans Frontières (Doctors Without Borders), reviewed relevant studies from Africa that described interventions to provide HIV testing at home and that reported the proportions of participants accepting HIV testing out of all individuals offered a home-based HIV test.

In their analysis, the authors included 21 studies from five African countries—Kenya, Malawi, South Africa, Uganda, and Zambia—comprising a total of 524,867 people. Overall, the proportion of people who accepted voluntary counselling and testing for HIV at home ranged from 58.1% to 99.7%, with a combined average of 83.3% in the pooled analysis. Men were as likely as women to accept home based testing (78.5% vs 81.5%). Combined with the finding that 40-70%  of those diagnosed as HIV-positive were previously undiagnosed, these results suggests that this approach may reach individuals who would otherwise not discover their HIV status. Furthermore, none of the included studies found any negative consequences of voluntary counselling and testing for HIV at home.

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