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Introducing a High-Risk HPV DNA Test Into a Public Sector Screening Program in El Salvador
Miriam L Cremer1, Mauricio Maza, Karla M Alfaro
11Basic Health International, San Salvador, El Salvador; 2Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH; 3Center for Health Decision Science, Harvard School of Public Health, Boston, MA; 4Ministry of Health of El Salvador, San Salvador, El Salvador; 5Department of Preventive Medicine, University of Southern California, Children' s Oncology Group, Arcadia, CA; 6Department of Pathology, University of Southern California, Los Angeles, CA; 7Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; and 8Division of Cancer Epidemiology and Genetic, National Cancer Institute, Rockville, MD.
Objective:
In a primary human papillomavirus (HPV) screening program, we compared the 6-month follow-up among colposcopy and noncolposcopy-based management strategies for screen-positive women.
Materials And Methods:
Women aged 30 to 49 years were screened with HPV DNA tests using both self-collection and provider collection of samples. Women testing positive received either (1) colposcopy management (CM) consisting of colposcopy and management per local guidelines or (2) screen-and-treat (ST) management using visual inspection with acetic acid to determine cryotherapy eligibility, with eligible women undergoing immediate cryotherapy. One thousand women were recruited in each cohort. Of these, 368 (18.4%) of 2000 women were recruited using a more intensive outreach strategy. Demographics, HPV positivity, and treatment compliance were compared across recruitment and management strategies.
Results:
More women in the ST cohort received treatment within 6 months compared with those in the CM cohort (117/119 [98.3%] vs 64/93 [68.8%]; p < .001). Women recruited through more intensive outreach were more likely to be HPV positive, lived in urban areas, were more educated, and had higher numbers of lifetime sexual partners and fewer children.
Conclusions:
Women in the CM arm were less likely to complete care than women in the ST arm. Targeted outreach to underscreened women successfully identified women with higher prevalence of HPV and possibly higher disease burden.
