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

15 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Cremer, M., Maza, M., Alfaro, K., Morales Velado, M., Felix, J., Castle, P. E., Kim, J., & Gage, J. C. (2017). Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador. Journal of Lower Genital Tract Disease, 21(1), 26-32. https://doi.org/10.1097/LGT.0000000000000280