Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador. J Low Genit Tract Dis 2017 Jan;21(1):26-32
Date
12/07/2016Pubmed ID
27922905Pubmed Central ID
PMC5201413DOI
10.1097/LGT.0000000000000280Scopus ID
2-s2.0-85002292065 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
OBJECTIVE: The Cervical Cancer Prevention in El Salvador is a demonstration project to introduce a lower-cost human papillomavirus (HPV)-DNA test into a public sector project. Started in October 2012, The Cervical Cancer Prevention in El Salvador consists of 3 phases and will ultimately screen 30,000 women. Results of phase 2 of the project are presented. The objective of this project was to compare colposcopy and noncolposcopy-based management for HPV-positive women.
MATERIAL AND METHODS: In phase 2, a total of 8,050 women, aged 30 to 49 years, were screened; 6,761 provided both self- and provider-collected specimens and 1,289 provided only provider-testing specimens. HPV results from self-collected specimens were not used in clinical management decisions. Women with provider-collected HPV-positive results were treated based on the strategy assigned to their community; the strategy was colposcopy management (CM) or screen-and-treat (ST) management if they were cryotherapy eligible or colposcopy if not eligible. Outcomes were assessed 6 months after screening.
RESULTS: Overall, 489 (12.3%) of 3,963 women receiving CM and 465 (11.4%) of 4,087 women receiving ST tested HPV positive. In the CM cohort, 216 (44.2%) of 489 completed their intervention (203 treated, 11 diagnosed negative, 2 pregnant). In the ST cohort, 411 (88.4%) of 465 completed their intervention (407 treated, 2 diagnosed negative, 1 pregnant). Overall agreement between HPV test results from self-collected and provider-collected specimens was 93.7%, with a κ value of 0.70 (95% CI = 0.68-0.73).
CONCLUSIONS: Human papillomavirus testing with ST management resulted in an approximately twice completion rate compared with CM management. Agreement between self- and provider-based sampling was good and might be used to extend screening to women in areas that are more difficult to reach.
Author List
Cremer M, Maza M, Alfaro K, Morales Velado M, Felix J, Castle PE, Kim J, Gage JCAuthor
Juan Felix MD Vice Chair, Director, Professor in the Pathology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultCohort Studies
Early Detection of Cancer
El Salvador
Female
Health Services Administration
Humans
Middle Aged
Papillomavirus Infections
Uterine Cervical Neoplasms
