Jennifer L. Winkler

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Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect(More)
Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing,(More)
OBJECTIVE AND METHOD Cervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008(More)
Cervical cancer is often the most common cancer among women in developing countries, yet current screening efforts have not been effective in reducing incidence and mortality rates in these settings. In an effort to increase knowledge about screening participation in low-resource settings, this study sought to identify key factors affecting women's(More)
Operational research using a mixed method, cross-sectional, case-study approach assessed the feasibility and health system impact of large-scale implementation of human papillomavirus (HPV) vaccination into routine vaccine delivery by the Ministry of Health in Peru. The strategy was school-based vaccination of fifth grade girls in 527 primary schools in(More)
OBJECTIVE To understand the sociocultural environment, health systems' capacities, and policy processes related to cervical cancer and HPV vaccines in order to inform HPV vaccine introduction. MATERIAL AND METHODS Mixed-method formative research using qualitative and quantitative data collection techniques. Participants included girls, parents, community(More)
OBJECTIVE To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru. MATERIALS AND METHODS Participants completed a risk factor questionnaire before screening. High-risk(More)
Japanese encephalitis (JE) virus is a major cause of neurologic infection in Asia, but surveillance has been limited. Three JE immunoglobulin M (IgM) antibody capture enzyme-linked immunosorbent assay kits have recently been developed. The aim of this study was to evaluate their sensitivity, specificity, and usability using 360 acute-phase serum samples(More)
Prophylactic human papillomavirus (HPV) vaccines provide promise as a key component of future cervical cancer prevention programs in the Latin America and the Caribbean region. The successful introduction and acceptance of these vaccines will depend on a range of factors including awareness of cervical cancer as a problem, affordability of the vaccine,(More)
BACKGROUND Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown. METHODS In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative(More)