HPV vaccination impact on a cervical cancer screening program: methods of the FASTER-Tlalpan Study in Mexico

Salmerón, Jorge; Torres‐Ibarra, Leticia; Bosch, F. Xavier; Cuzick, Jack; Lörincz, Attila T.; Wheeler, Cosette M.; Castle, Philip E.; Robles, Claudia; Lazcano‐Ponce, Eduardo

doi:10.21149/spm.v58i2.7790

Cited by 17 publications

(15 citation statements)

References 17 publications

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“…Nevertheless, effective structures to guarantee adequate supplies, transport of samples, communication of results and in general the triage and follow-up system for women with positive results must be in place [ 13 , 43 , 49 , 51 ]. In addition, innovative triage strategies as well as the combination of vaccination and screening for adult women (in addition to vaccinating girls) should be explored through studies to confirm cost-effectiveness and safety issues [ 51 , 52 ]. In addition, culturally appropriate health education and counseling will remain important.…”

Section: Discussionmentioning

confidence: 99%

Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study

Allen‐Leigh¹,

Uribe-Zúñiga²,

León‐Maldonado

et al. 2017

BMC Cancer

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BackgroundData is needed about barriers to self-collection of Human Papillomavirus (HPV) samples and cytology among low-income, disadvantaged women living in rural areas of lower-income countries as these women are at increased risk of cervical cancer mortality.MethodsIndividual interviews (n = 29), focus groups (n = 7, 5–11 participants) and discussion groups (n = 2, 18–25 participants) were organized with women from three indigenous ethnic groups residing in rural areas in Mexico, after they were provided with free, self-sampled HPV tests. These groups are low-income, underserved by healthcare and have historically been on the receiving end of racism and social exclusion. Descriptive, qualitative content analysis was done, including two cycles of coding.ResultsInterview and focus/discussion group data indicate women had limited understanding of HPV’s role in cervical cancer etiology. They identified HPV’s existence, that cytology detects cervical cancer, the need for regular testing and that cervical cancer is sexually transmitted. Organizational barriers to clinic-based cytology included irregular supplies of disposable speculums, distance to clinics and lack of clear communication by healthcare personnel. Women considered self-collected HPV-testing easy, less embarrassing and less painful than cytology, an opportunity for self-care and most felt they understood how to take a self-sample after a 20-min explanation. Some women feared hurting themselves when taking the self-sample or that they would take the sample incorrectly, which they worried would make the test useless. Attending HPV-testing in groups facilitated use by allowing women to discuss their doubts and fears before doing self-collection of the sample or to ask other women who were the first to do the self-sampling what the experience had been like (whether it hurt and how easy it was). Lack of indoor bathrooms was a barrier to doing HPV self-sampling at home, when those homes were resource-poor (one-room dwellings).ConclusionsLow-income, indigenous Mexican women residing in rural, underserved areas identified their need for cervical cancer screening but encountered multiple barriers to cytology-based screening. They found a number of advantages of HPV self-sampled tests. Employing self-collected HPV-testing instead of cytology could resolve some but not all gender-related, organizational or technical quality-of-care issues within cervical cancer detection and control programs.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3723-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study

Allen‐Leigh¹,

Uribe-Zúñiga²,

León‐Maldonado

et al. 2017

BMC Cancer

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“…Skinner et al in 2016 studied the progression of HPV infection to detectable CIN in 2838 women and followed the persistent infections, finding that women infected with types 16, 31, 33, and 45 had a higher risk to develop CIN 2 32 . Salmeron et al are performing a study in Mexico that will allow a more objective estimate of the efficacy of cervical cancer prevention programs and to establish the number of doses required for an effective protection 33 .…”

Section: Concurrent Infectionsmentioning

confidence: 99%

Prevalence of Human Papillomavirus in Women from the State of Michoacan, Mexico, Showed High Frequency of Unusual Virus Genotypes

Jácome-Galarza¹,

Ito-Nakashimada

Figueroa-Aguilar

et al. 2017

RIC

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Background: Human papillomaviruses (HPVs), the leading cause of cervical cancer, are distributed worldwide, with high prevalence in developing countries. Objective: The objective of the study is to know the prevalence and genotypes of HPV in women from the state of Michoacán and the Women's Hospital in Morelia, Michoacán. Materials and Methods: Cervical smear samples (159,288) were subjected to HPV detection by hybrid capture 2. A subsample of 484 patients from the Women's Hospital was studied by Papanicolaou test and linear array HPV genotyping, and when positive, patients were also examined by colposcopy and histopathology. Results: The overall prevalence for HPV in Michoacán State was 7.74%; 7.11% in 2009, 6.46% in 2010, 9.58% in 2011, and 8.43% in 2012. The highest prevalence was found in the age groups < 25 and 25-34 years. The prevalence at the Women's Hospital was 8.51%. Cytological examination revealed normal cytology in 64.44% of samples, 26.66 % with low-grade and 8.88 % with high-grade squamous intraepithelial lesion (HSIL). However, by colposcopy, normal tissue appearance was found only in 26.66%; 51% were reclassified as low-grade squamous intraepithelial lesion, 17.77% as HSIL, and in 4.4% atrophy was observed. The most prevalent genotype in single infections was HPV59, followed by HPV51 and HPV45. Double infections occurred with the following genotypes:

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“…The FASTER-Tlalpan study is currently assessing the efficacy of a combined strategy of HPV screening with one or two doses of the bivalent or quadrivalent vaccine in women aged 25-45. 47 Its results will provide valuable data for the HPV-FASTER strategy, 48 that aims to accelerate the reduction in cervical cancer burden, if demonstrated, in a single screen-andvaccine visit.…”

Section: Conclusion and Further Research Needsmentioning

confidence: 99%

Alternative HPV vaccination schedules in Latin America

2018

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In 2008, the first HPV vaccination program in Latin America started in Panama, targeting girls aged 10-11 years with a 3-dose vaccine schedule, an initiative that was to be followed by other Latin American countries after local feasibility and population acceptability evaluations were completed. A 3-dose vaccine regimen over six months was originally chosen for HPV vaccines, copying the Hepatitis B vaccine schedule (0, 1-2, 6 months). Alternative vaccine schedules have been proposed afterwards based on: i) noninferior immunogenicity or immune response levels compared to those at which clinical efficacy has been proven (i.e., those observed in a 3-dose HPV vaccine schedule in women aged 15-26), and, ii) proven efficacy in clinical trials and/or effectiveness among women who were provided less than three doses due to a lack of adherence to a 3-dose vaccine schedule. In 2014, based on the available evidence and the potential increase in coverage by expansion of vaccination target groups, particularly in low and middle income countries (LMIC), the World Health Organization recommended a 2-dose schedule with at least a 6-month interval between doses for females up to 15 years of age and a 3-dose schedule for older women. More recently, it has been suggested that 1-dose HPV vaccination schemes may provide enough protection against HPV infection and may speed up the introduction of HPV vaccination in LMIC, where most needed.

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HPV vaccination impact on a cervical cancer screening program: methods of the FASTER-Tlalpan Study in Mexico

Cited by 17 publications

References 17 publications

Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study

Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study

Prevalence of Human Papillomavirus in Women from the State of Michoacan, Mexico, Showed High Frequency of Unusual Virus Genotypes

Alternative HPV vaccination schedules in Latin America

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