Author:
Holme Francesca,Maldonado Francisco,Martinez-Granera Orlando B.,Rodriguez Jose Maria,Almendarez Juan,Slavkovsky Rose,Bansil Pooja,Thomson Kerry A.,Jeronimo Jose,de Sanjose Silvia
Abstract
Abstract
Background
In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion.
Methods
We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self- vs. provider-collected sampling.
Results
Forty-four thousand six hundred thirty-five women were screened with HPV testing; 96.6% of women used self-sampling. Six thousand seven hundred seventy-six women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04–0.08, p < 0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29.
Conclusions
Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of self-sampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.
Funder
Bill and Melinda Gates Foundation
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health
Reference30 articles.
1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.
2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 17 June 2019. https://www.hpvcentre.net/statistics/reports/XWX.pdf. Accessed 8 Aug 2019.
3. Cuzick J, Arbyn M, Sankaranarayanan R, et al. Overview of human papillomavirus-based and other novel options for cervical Cancer screening in developed and developing countries. Vaccine. 2008;26:K29–41. https://doi.org/10.1016/j.vaccine.2008.06.019.
4. Cuzick J, Clavel C, Petry K-U, et al. Overview of the European and north American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119(5):1095–101. https://doi.org/10.1002/ijc.21955.
5. Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. JNCI J Natl Cancer Inst. 2005;97(14):1072–9. https://doi.org/10.1093/jnci/dji187.
Cited by
15 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献