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. 2020 Jun:135:106076.
doi: 10.1016/j.ypmed.2020.106076. Epub 2020 Apr 2.

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

Francesca Holme  1 , Jose Jeronimo  2 , Francisco Maldonado  3 , Claudia Camel  4 , Manuel Sandoval  5 , Benito Martinez-Granera  6 , Mirna Montenegro  7 , Jacqueline Figueroa  8 , Rose Slavkovsky  9 , Kerry A Thomson  10 , Silvia de Sanjose  11 ; Scale-Up project team
Affiliations

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

Francesca Holme et al. Prev Med. 2020 Jun.

Abstract

The Scale-Up project introduced vaginal self-sampling and low-cost human papillomavirus (HPV) testing as the primary approach for cervical cancer screening in selected public health centers in Guatemala, Honduras, and Nicaragua. We evaluate the country-specific accomplishments in screening: target-coverage, triage, and treatment. Between 2015 and 2018, cervical cancer screening was offered to women at least 30 years of age. Triage of HPV-positive women was based on visual inspection with acetic acid or Pap. Aggregated data included total women screened, use of self-sampling, age, time elapsed since last screening, HPV results, triage tests, triage results, and treatment. A total of 231,741 women were screened for HPV, representing 85.8% of the target populations within the project. HPV positivity was lower in Guatemala (12.4%) compared to Honduras and Nicaragua (14.5% and 14.2%, respectively, p < 0.05). A follow-up triage test was completed for 84.2%, 85.8%, and 50.1% of HPV-positive women in Guatemala, Nicaragua, and Honduras, respectively. Of those with a positive triage test, 84.7%, 67.1%, and 58.8% were treated in Guatemala, Nicaragua, and Honduras, respectively. First-time screening was highest in Nicaragua (55.8%) where self-sampling was also widely used (97.1%). The Scale-Up project demonstrated that large-scale cervical cancer screening and treatment intervention in a high-burden, low-resource setting can be achieved. Self-sampling and ablative treatment were key to the project's achievements. Data monitoring, loss to follow-up, and triage methods of screen- positive women remain critical to full success.

Keywords: Cervical cancer; HPV; Health information system; Screening; Thermal ablation.

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Conflict of interest statement

Declaration of competing interest Francesca Holme, Francisco Maldonado; Claudia Camel; Manuel Sandoval; Benito Martinez-Granera, Mirna Montenegro, Jacqueline Figueroa, Rose Slavkovsky, Kerry A. Thomson and Silvia de Sanjose declare no competing interests. Jose Jeronimo was the co-owner and Deputy Manager of Onco Prev International, a Peruvian company, from 2012 through March 2017. Onco Prev offers cervical cancer screening services and in 2016 also began positioning for distribution of medical devices including colposcopes and the Liger thermo-coagulator. Onco Prev International did not commercialize any medical instrument during the time JJ was part of that company. JJ declares that he has never received an honorarium, travel money, or compensation from any company manufacturing thermal ablation equipment.

Figures

Fig. 1
Fig. 1
Map of countries and target areas in the Scale-Up Project.
Fig. 2
Fig. 2
General algorithm for the screening intervention using HPV as primary screening test under the Scale-project in Guatemala, Honduras and Nicaragua.
Fig. 3
Fig. 3
Cumulative number of HPV tests run in three regions in Honduras between 2015 and 18. Self-sampling was only implemented in Region Metropolitana de Francisco Morazan.
See this image and copyright information in PMC

References

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