Introduction of HPV testing for cervical cancer screening in Central America: The Scale-Up project

https://doi.org/10.1016/j.ypmed.2020.106076Get rights and content
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Highlights

  • Central America successfully implemented HPV testing in public sector clinics.

  • HPV testing using self-sampling holds great promise to increase coverage of cervical cancer screening.

  • Follow-up of screen positives is a critical component step for an effective screening program.

  • Thermal ablation of precancerous lesions may be critical in increasing treatment coverage.

  • Basic health information systems are required for monitoring and mitigating loss to follow-up.

Abstract

The Scale-Up project introduced vaginal self-sampling and low-cost human papillomavirus (HPV) testing as the primary approach for cervical cancer screening in selected public health centers in Guatemala, Honduras, and Nicaragua. We evaluate the country-specific accomplishments in screening: target-coverage, triage, and treatment. Between 2015 and 2018, cervical cancer screening was offered to women at least 30 years of age. Triage of HPV-positive women was based on visual inspection with acetic acid or Pap. Aggregated data included total women screened, use of self-sampling, age, time elapsed since last screening, HPV results, triage tests, triage results, and treatment. A total of 231,741 women were screened for HPV, representing 85.8% of the target populations within the project. HPV positivity was lower in Guatemala (12.4%) compared to Honduras and Nicaragua (14.5% and 14.2%, respectively, p < 0.05). A follow-up triage test was completed for 84.2%, 85.8%, and 50.1% of HPV-positive women in Guatemala, Nicaragua, and Honduras, respectively. Of those with a positive triage test, 84.7%, 67.1%, and 58.8% were treated in Guatemala, Nicaragua, and Honduras, respectively. First-time screening was highest in Nicaragua (55.8%) where self-sampling was also widely used (97.1%). The Scale-Up project demonstrated that large-scale cervical cancer screening and treatment intervention in a high-burden, low-resource setting can be achieved. Self-sampling and ablative treatment were key to the project's achievements. Data monitoring, loss to follow-up, and triage methods of screen- positive women remain critical to full success.

Keywords

Screening
HPV
Cervical cancer
Thermal ablation
Health information system

Cited by (0)

This work was supported by the Bill & Melinda Gates Foundation, Seattle, WA [Grant number OPP1086544]. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Foundation.

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Scale-Up project team: Karla Alfaro, Pooja Bansil, Andrea Chacon, Xiomara Celeste Gonzalez, Gail Gustavson, Mary McMurtry, Amy Heyden, Jose Saul Lobo, Maria Suyapa Lopez, Mauricio Maza, Doris Rodriguez, Jose Maria Rodriguez, Marta Julia Ruiz.