Introduction of HPV testing for cervical cancer screening in Central America: The Scale-Up project

Holme, Francesca; Jerónimo, José; Galindo, Francisco; Camel, Claudia; Sandoval, Manuel; Martinez-Granera, Benito; Montenegro, Mirna; Figueroa, Jacqueline; Slavkovsky, Rose; Thomson, Kerry A.; Sanjosé, Sílvia de

doi:10.1016/j.ypmed.2020.106076

Cited by 41 publications

(64 citation statements)

References 28 publications

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“…This estimate relies on several assumptions, including that women were truly lost in the triage step rather than receiving treatment elsewhere. In Guatemala and Honduras, where similar HPV testing strategies were implemented under the Scale-Up project, the percentages of triage-positive women treated between 2015 and 2018 were 84.7 and 58.8%, respectively [11]; and estimated percentages of women treated, accounting for those lost in the triage step, were reduced to 71.2 and 30.2%, respectively. Findings from an HPVbased screening program in Argentina, where the screening algorithm uses Pap and colposcopy for triage, 85.2% of women with confirmed CIN2+ lesions were treated; this represents just 27.7% of women with an abnormal Pap in triage [16].…”

Section: Discussionmentioning

confidence: 99%

“…Of note, in 2018 MINSA invested time and resources in finding and following up women who screened positive for HPV in previous years, including 2017. This effort led to additional women in the target provinces receiving treatment, for a total of 67.1% of HPV-positive, triagepositive women receiving treatment from 2015 to 2018 [11], and suggests that there is potential for LMICs to address the problem of loss to follow-up within a longer timeframe, given sufficient resources and prioritization.…”

Section: Discussionmentioning

confidence: 99%

“…Details of the overall Scale-Up project methods have been described elsewhere [11]. This report is a secondary analysis, using data from the public sector health system in Nicaragua.…”

Section: Methodsmentioning

confidence: 99%

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HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Holme

Galindo²,

Martinez-Granera³

et al. 2020

BMC Public Health

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Background: In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. Methods: We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self-vs. provider-collected sampling. Results: Forty-four thousand six hundred thirty-five women were screened with HPV testing; 96.6% of women used self-sampling. Six thousand seven hundred seventy-six women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04-0.08, p < 0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29. Conclusions: Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of selfsampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Holme

Galindo²,

Martinez-Granera³

et al. 2020

BMC Public Health

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“…Study sites consisted of four government health facilities in the metropolitan region of Francisco Morazán in Honduras, one of four regions in the country where the Secretary of Health recently implemented HPV testing for cervical cancer screening. 18 As described previously, the study enrolled 319 women. 15 Briefly, participants with a positive result for both HPV and visual inspection with acetic acid (VIA) were invited and assessed for eligibility.…”

Section: Methodsmentioning

confidence: 99%

Health Outcomes at 1 Year After Thermal Ablation for Cervical Precancer Among Human Papillomavirus– and Visual Inspection With Acetic Acid–Positive Women in Honduras

Slavkovsky

Bansil

Sandoval

et al. 2020

JCO Global Oncology

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PURPOSE This study aims to assess the detection of cervical intraepithelial lesions grades 2 and 3 (CIN2-3) at 1 year after treatment with thermal ablation among human papillomavirus (HPV)–positive and visual inspection with acetic acid (VIA)–positive women. METHODS All women screened and triaged for cervical cancer at four government health facilities in Honduras who were eligible for ablative treatment were enrolled and treated with thermal ablation. Women with confirmed CIN2-3 and a subset of women with CIN1/normal diagnoses at baseline were evaluated at 12 months. Follow-up procedures included HPV testing ( careHPV), VIA, directed biopsy (if VIA-positive), and Papanicolaou test (if HPV positive, VIA negative). Outcomes at 1 year included histologic or cytologic assessment of CIN lesions among those with any abnormal test. RESULTS Among the 319 women treated with thermal ablation, baseline histologic diagnoses were available for 317. Two (0.6%) had invasive cancer, 36 (11.4%) had CIN3, 40 (12.6%) had CIN2, and 239 (75.4%) had CIN1/normal histology. Among the 127 women eligible for follow-up, 118 (92.9%) completed all study procedures at 1 year. Overall, 98 (83.1%) had no evidence of CIN2-3 or persistent low-grade infection, 13 (11.2%) had CIN1/atypical squamous cells of undetermined significance, six (5.1%) had CIN2/high-grade squamous intraepithelial lesion, and 1 (0.8%) had a persistent CIN3. No adverse events associated with thermal ablation at 1 year were registered. CONCLUSION A high proportion of women had no evidence of CIN2-3 at 1 year after thermal ablation treatment. Thermal ablation is an alternative to cryotherapy that may facilitate greater treatment coverage and prevent unnecessary deaths from cervical cancer.

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“…Details of the overall Scale-Up project methods have been described elsewhere. 11 This report is a secondary analysis, using data from the public sector health system in Nicaragua. MINSA defined the target population for screening with HPV tests as all women aged 30 to 59 years living in the provinces of Chinandega, Chontales, and Carazo (141,637 women).…”

Section: Methodsmentioning

confidence: 99%

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Holme¹,

Galindo²,

Martinez-Granera³

et al. 2020

Preprint

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Background: In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. Methods: We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self- vs. provider-collected sampling.Results: 44,635 women were screened with HPV testing; 96.6% of women used self-sampling. 6,776 women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04–0.08, p<0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29.. Conclusions: Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of self-sampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.Trial registration :Not applicable.

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Introduction of HPV testing for cervical cancer screening in Central America: The Scale-Up project

Cited by 41 publications

References 28 publications

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Health Outcomes at 1 Year After Thermal Ablation for Cervical Precancer Among Human Papillomavirus– and Visual Inspection With Acetic Acid–Positive Women in Honduras

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

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