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Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador
Miriam Cremer1, Mauricio Maza, Karla Alfaro
11Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH; 2Basic Health International, San Salvador, El Salvador; 3National Unit of Control and Prevention of Cancer, Ministry of Health, San Salvador, El Salvador; 4Department of Pathology, University of Southern California, Los Angeles, CA; 5Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; 6Albert Einstein College of Medicine, Bronx, NY; 7Global Coalition Against Cervical Cancer, Arlington VA; and 8Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA.
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.
