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Recall Efforts Successfully Increase Follow-Up for Cervical Cancer Screening Among Women With Human Papillomavirus in Honduras

Kerry A. Thomson, Manuel Sandoval, Carolyn Bain, Francesca Holme, Pooja Bansil, Jacqueline Figueroa and Silvia de Sanjosé
Global Health: Science and Practice June 2020, 8(2):290-299; https://doi.org/10.9745/GHSP-D-19-00404

Figures & Tables

Figures

  • FIGURE 1.
    FIGURE 1.

    Cervical Cancer Screening Algorithm Followed in the Scale-Up Project, Honduras

    Abbreviations: HPV, human papillomavirus; VIA, visual inspection with acetic acid.

    a The current evaluation focuses on HPV-positive, VIA-negative women due for repeat HPV testing at 1 year.

  • FIGURE 2.
    FIGURE 2.

    Overview of Recall Efforts to Encourage HPV-Positive VIA-Negative Women to Return for Clinic-Based HPV Testing ≥1 Year After Their First HPV-Positive Test Result

    Abbreviations: HPV, human papillomavirus; VIA, visual inspection with acetic acid.

Tables

  • TABLE 1.

    Demographic Characteristics of Women Who Were HPV-Positive VIA-Negative and Indicated for HPV Retesting After 1 Year, Honduras

    Characteristics
    All women, No. (%)558 (100)
    Clinic Location
        Carrizal, No. (%)77 (13.8)
        Las Crucitas, No. (%)48 (8.6)
        San Benito, No. (%)33 (5.9)
        San Miguel, No. (%)98 (17.6)
        Alonzo Suazo, No. (%)110 (19.7)
        Villadela, No. (%)59 (10.6)
        Monterey, No. (%)77 (13.8)
        Pedregal, No. (%)56 (10.0)
    Parity
        No children, No. (%)4 (0.7)
        1 child, No. (%)22 (3.9)
        2 or more children , No. (%)96 (17.2)
        Not documented, No. (%)436 (78.1)
    Age Category, years
        < 30, No. (%)4 (0.7)
        30–39, No. (%)162 (29.0)
        40–49, No. (%)122 (21.9)
        50–59, No. (%)90 (16.1)
        ≥ 60, No. (%)23 (4.1)
        Not documented, No. (%)157 (28.1)
    Age, mean (standard deviation)43.2 (9.6)
  • TABLE 2.

    Recall Methods Used To Encourage Repeat HPV Testing Among Women With Initial HPV-Positive VIA-Negative Screening Results, Honduras

    Total
    N = 558
    Contacts received per woman, mean (SD) [range]2.3 (1.5) [1–8]
    Contacts received per woman who returned for 1-year follow-up (n=419a), mean (SD) [range]2.1 (1.5) [0–8]
    Phone calls/voicemails placed per woman, No. (%)
        1211 (42.5)
        2118 (23.8)
        386 (17.3)
        4 or more76 (15.3)
        Missing5 (1.0)
        Days between first outreach and returning for 1-year follow-up (n=344b) , mean (SD) [range]10.7 (14.7) [0–104)
    Self-reported recall method that motivated clinic attendance (n=419) , No. (%)
        Telephone contact (phone call or text/SMS)364 (86.9)
        Home visit25 (6.0)
        None (presented spontaneously)19 (4.5)
        Voicemail2 (0.5)
        Not documented9 (2.1)
    Self-reported reasons for not returning for 1-year follow-up (n=139), No. (%)
        No reason specified94 (67.6)
        Repeat testing and follow-up happened at another clinic25 (18.0)
        Moved away from clinic area9 (6.5)
        Successfully contacted and declined4 (2.9)
        Cannot come due to work or personal reasons3 (2.2)
        Could not contact or locate2 (1.4)
        Pregnant2 (1.4)

    • Abbreviations: HPV, human papillomavirus; VIA, visual inspection with acetic acid; SD, standard deviation.

    • ↵a Denominator excludes women who did not return to the clinic.

    • ↵b Denominator excludes women with missing information.

  • TABLE 3.

    Factors Associated With Completion of HPV Retesting Among Women With Initial HPV-Positive VIA-Negative Screening Results, Honduras, N=544a

    Did Not Return to Clinic
    n=139    		Returned to Clinic for HPV Retesting
    n=415
    No. (%) [95%CI]No. (%) [95%CI]Prevalence Ratio (95% CI)P Value
    Number of contactsb
        1 contact46 (20.4) [15.6,26.1]180 (79.7) [73.9,84.4]Ref—
        2 contacts22 (18.6) [12.6,26.8]96 (81.4) [73.2,87.4]1.02 (0.92,1.14).70
        ≥ 3 contacts71 (37.2) [30.6,44.3]120 (62.8) [55.7,69.4]0.79 (0.69,0.90)<.001
    Parity
        No children0 (0)4 (100.0)Ref—
        1 child2 (9.5) [2.3,32.0]19 (90.5) [68.0,97.7]0.91 (0.79,1.04).16
        2 or more children9 (9.6) [5.0,17.5]85 (90.4) [82.5,95.0]0.91 (0.85,0.97).003
        Not documented128 (29.4) [25.3,33.9]307 (70.6) [66.1,74.7]—
    Clinic
        Carrizal26 (33.8) [24.0,45.1]51 (66.2) [54.9,76.0]Ref—
        Las Crucitas25 (52.1) [38.0,65.9]23 (47.9) [34.1,62.0]0.72 (0.52,1.01).06
        San Benito6 (18.8) [8.5,36.3]26 (81.2) [63.7,91.5]1.22 (0.97,1.55).08
        San Miguel14 (14.3) [8.6,22.8]84 (85.7) [77.2,91.4]1.29 (1.08,1.54).005
        Alonzo Suazo41 (37.3) [28.7,46.7]69 (62.7) [53.3,71.3]0.95 (0.76,1.17).62
        Villadela7 (12.1) [5.8,23.4]51 (87.9) [76.6,94.2]1.32 (1.10,1.60).003
        Monterey11 (14.7) [8.3,24.7]64 (85.3) [75.3,91.7]1.29 (1.08,1.55).007
        Pedregal9 (16.1) [8.5,28.3]47 (83.9) [71.7,91.5]1.27 (1.04,1.54).02
    Age category, years
        30–3912 (7.4) [4.2,12.6]150 (92.6) [87.4,95.8]Ref—
        40–496 (4.9) [2.2,10.6]116 (95.1) [89.4,97.8]1.03 (0.97,1.09).38
        50–599 (10.0) [5.3,18.2]81 (90.0) [81.8,94.7]0.97 (0.90,1.05).50
        >602 (8.7) [2.1,29.6]21 (91.3) [70.4,97.9]0.99 (0.86,1.13).84
        Not documented110 (70.1) [62.4,76.7]47 (29.9) [23.3,37.6]——

    • Abbreviations: CI, confidence interval; HPV, human papillomavirus; VIA, visual inspection with acetic acid.

    • ↵a Excludes women < 30 years of age (n=4).

    • ↵b Excludes women who returned spontaneously (n=20).

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Recall Efforts Successfully Increase Follow-Up for Cervical Cancer Screening Among Women With Human Papillomavirus in Honduras
Kerry A. Thomson, Manuel Sandoval, Carolyn Bain, Francesca Holme, Pooja Bansil, Jacqueline Figueroa, Silvia de Sanjosé
Global Health: Science and Practice Jun 2020, 8 (2) 290-299; DOI: 10.9745/GHSP-D-19-00404
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