Spatial Epidemiology of Human Papillomavirus Screening Coverage in Mexico, 2013-2019

Area of Science:

• Public Health
• Epidemiology
• Oncology

Background:

• Cervical cancer remains a significant global health concern, with Human Papillomavirus (HPV) infection being the primary causative agent.
• Effective screening programs are crucial for early detection and prevention of cervical cancer.
• Understanding the spatial distribution and trends of HPV infections is vital for targeted public health interventions.

Purpose of the Study:

• To evaluate the coverage of the national HPV screening program across Mexico's 32 federal states from 2013 to 2019.
• To analyze the spatial patterns and trends of HPV infections within Mexico during the same period.
• To identify geographic disparities in HPV screening coverage and infection rates.

Main Methods:

• An exploratory, ecological study design was employed using national health program data from 2013-2019.
• Adjusted rates per 100,000 females (aged 25-64) were calculated and georeferenced to assess screening coverage and HPV positivity.
• Spatial cluster analysis was utilized to identify significant geographic patterns and trends in HPV detection.

Main Results:

• Over 2.5 million HPV screening tests were analyzed, revealing an overall HPV positivity prevalence of 11.1%.
• A substantial decrease in HPV screening test coverage was observed, dropping from 2,835.4 to 0.8 per 100,000 females between 2013 and 2019.
• A spatial cluster of states with a higher probability of HPV detection was identified, indicating geographic variations in infection prevalence.

Conclusions:

• The study identified a significant decline in HPV screening program coverage and notable geographic differences in HPV infections across Mexico.
• These findings suggest that current strategies for HPV prevention and detection may be insufficient to accelerate cervical cancer elimination.
• A critical reconsideration of public health strategies is recommended to address the identified coverage gaps and spatial inequalities.