Attendance for diagnostic colposcopy among high‐risk human papillomavirus positive women in a Brazilian feasibility study

Abstract

Objective To investigate factors associated with colposcopy attendance in HPV‐positive women in São Paulo, Brazil. Methods We analyzed data from a prospective cohort of women positive for high‐risk HPV (hr‐HPV) undergoing cervical cancer screening in primary care services in São Paulo, Brazil. Non‐pregnant women attending routine screening between December 2014 and March 2016 were offered an hr‐HPV test, and those testing positive and aged 25 years or older were invited for colposcopy. Sociodemographic information was recorded at study enrollment. We compared variables between women who did and did not attend colposcopy within a logistic regression framework. Results Of 1537 hr‐HPV‐positive women, 1235 (80.4%) attended for colposcopy, with a median time from primary test to colposcopy of 132 days. Younger age (P<0.001) and concurrent negative cytology results (P=0.025) were associated with lower attendance. Women registered at units providing both the primary test and colposcopy were more likely to attend than those at units making external referrals (788/862 [91.4%] versus 447/675 [66.2%], P<0.001). Conclusion Non‐attendance for colposcopy may limit the success of future screening programs based on hr‐HPV testing in Brazil. Transfer of colposcopy services to primary care is a simple and effective facilitator of attendance.

Access to colposcopy in the State of São Paulo, Brazil: probabilistic linkage study of administrative data

“…A feasibility study of HPV primary testing in São Paulo previously estimated colposcopy attendance 16 . In this study, we offered a single HPV test to women attending routine screening services.…”

“…The greater density of health services in these cities may help explain this. We considered the proximity to screening services an important factor influencing access to colposcopy 16 .…”

Health outcomes in women attending with clinical guideline PROGYNE to a primary care center for cervical cancer prevention

“…34,35 Non-attendance for colposcopy of women positive for high-risk HPV negatively affects CC screening in Brazil; therefore, bringing colposcopy to primary care would facilitate attendance. 36 Making use of evidence-based strategies aimed at the detection and control of CC is paramount, as well as the qualification and training of professionals. 3 Research on alternative methods for CC screening in low resource settings such as VILI 24,25,28,29,37,38 and digital cervicography 11,26,[39][40][41] is notable.…”

“…Although colposcopy is a resource intensive diagnostic method, it requires provider training, specialized equipment, bringing it closer to the population increases the chance of attendance, consequently decreasing the delay in performance and loss to follow-up, which provides an early diagnosis of pre-cancerous lesions. [34][35][36]42 Therefore, investing in methods such as digital cervicography, VILI, and colposcopy can be an advantageous alternative to the Papanicolaou test for CC prevention in primary health care.…”

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city—Lessons learned from the Amazon city of Manaus, Brazil

“…While follow-up visits should have been completed during this time, some delays might have been further observed due to the shutdown and distractions in the health system. Regardless, follow-up is a great challenge for women, local health clinic teams and Women's Health departments [32][33][34][35]. The newer SISCAN data system, released by SUS in 2013, is currently being introduced in the Manaus public health system and, especially if linked with other local SUS information systems will help alleviate this problem.…”