Implementation of WHO guidelines for cervical cancer screening, diagnosis and treatment: Knowledge and perceptions of health providers from Argentina

Abstract

Abstract BackgroundThe 2021 the World Health Organization (WHO) guidelines on cervical cancer screening and treatment provide countries with evidence-based recommendations to accelerate the disease elimination. However, evidence shows that adherence by health providers to screening guidelines is low. We conducted a study in Argentina aimed to analyze knowledge and perceptions regarding the 2021 WHO Guidelines by health providers. Methods A qualitative study was carried out based on individual, semi-structured interviews with health providers who specialize in gynecology (n=15). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. Results Although health providers perceive WHO as a reliable institution, they do not know the 2021 guidelines, their supporting evidence, and its elaboration process. Their clinical practice is mainly guided by local recommendations developed by national professional medical associations (PMAs). For interviewees, dissemination of WHO guidelines should be done through health authorities and national PMAs, mainly through in-service training. Health providers had a positive assessment regarding WHO Recommendation 1 (screen, triage, treatment for women aged 30+ with HPV-testing every 5 to 10 years) and they perceived a favorable climate for its implementation. HPV-testing followed by triage was considered a low complexity practice, enabling a better detection of HPV, a better selection of the patients who will need diagnosis and treatment, and a more efficient use of health system resources. However, they suggested adapting this recommendation by removing screening interval beyond 5 years. WHO Recommendation 2 (screen-and-treat approach with HPV-testing for women aged 30+ every 5 to 10 years) was predominantly rejected by interviewees, was considered an algorithm that does not respond to women's needs and that was not adequate for the Argentinean context. Regarding the HPV-test modality, clinician-collected tests was the preferred mode. Health providers considered that HPV self-collection should be used primarily among socially vulnerable women to increase screening coverage. Conclusions Dissemination of WHO guidelines among health providers should be widely carried out, especially in settings that could benefit of a screen-and-treat approach. It is essential to identify areas of partnership and collaboration with PMAs in the implementation of WHO guidelines.