Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador

Miriam Cremer, Mauricio Maza, Karla Alfaro, Mario Morales Velado, Juan Felix, Philip E. Castle, Jane Kim, Julia C. Gage

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalJournal of Lower Genital Tract Disease
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

El Salvador
Colposcopy
Uterine Cervical Neoplasms
Human Papillomavirus DNA Tests
Cryotherapy
Public Sector
Costs and Cost Analysis

Keywords

  • cervical cancer
  • human papillomavirus
  • screening and care of human papillomavirus

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador. / Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Morales Velado, Mario; Felix, Juan; Castle, Philip E.; Kim, Jane; Gage, Julia C.

In: Journal of Lower Genital Tract Disease, Vol. 21, No. 1, 01.01.2017, p. 26-32.

Research output: Contribution to journalArticle

Cremer, M, Maza, M, Alfaro, K, Morales Velado, M, Felix, J, Castle, PE, Kim, J & Gage, JC 2017, 'Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador', Journal of Lower Genital Tract Disease, vol. 21, no. 1, pp. 26-32. https://doi.org/10.1097/LGT.0000000000000280
Cremer, Miriam ; Maza, Mauricio ; Alfaro, Karla ; Morales Velado, Mario ; Felix, Juan ; Castle, Philip E. ; Kim, Jane ; Gage, Julia C. / Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador. In: Journal of Lower Genital Tract Disease. 2017 ; Vol. 21, No. 1. pp. 26-32.
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abstract = "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.",
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