HPV-based cervical cancer screening in Nicaragua: from testing to treatment

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...

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Main Authors: Francesca Holme, Francisco Maldonado, Orlando B. Martinez-Granera, Jose Maria Rodriguez, Juan Almendarez, Rose Slavkovsky, Pooja Bansil, Kerry A. Thomson, Jose Jeronimo, Silvia de Sanjose
Format: Article
Language:English
Published: BMC 2020-04-01
Series:BMC Public Health
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12889-020-08601-z
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spelling doaj-d941c30c018e4842a31900e878dc794f2020-11-25T02:55:17ZengBMCBMC Public Health1471-24582020-04-012011910.1186/s12889-020-08601-zHPV-based cervical cancer screening in Nicaragua: from testing to treatmentFrancesca Holme0Francisco Maldonado1Orlando B. Martinez-Granera2Jose Maria Rodriguez3Juan Almendarez4Rose Slavkovsky5Pooja Bansil6Kerry A. Thomson7Jose Jeronimo8Silvia de Sanjose9PATH, Department of Sexual & Reproductive HealthMovicancerMovicancerMovicancerMovicancerPATH, Department of Sexual & Reproductive HealthPATH, Department of Sexual & Reproductive HealthPATH, Department of Sexual & Reproductive HealthJose Jeronimo ConsultingPATH, Department of Sexual & Reproductive HealthAbstract 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.http://link.springer.com/article/10.1186/s12889-020-08601-zCervical cancerScreeningHPV testSelf-samplingFollow-upTreatment
collection DOAJ
language English
format Article
sources DOAJ
author Francesca Holme
Francisco Maldonado
Orlando B. Martinez-Granera
Jose Maria Rodriguez
Juan Almendarez
Rose Slavkovsky
Pooja Bansil
Kerry A. Thomson
Jose Jeronimo
Silvia de Sanjose
spellingShingle Francesca Holme
Francisco Maldonado
Orlando B. Martinez-Granera
Jose Maria Rodriguez
Juan Almendarez
Rose Slavkovsky
Pooja Bansil
Kerry A. Thomson
Jose Jeronimo
Silvia de Sanjose
HPV-based cervical cancer screening in Nicaragua: from testing to treatment
BMC Public Health
Cervical cancer
Screening
HPV test
Self-sampling
Follow-up
Treatment
author_facet Francesca Holme
Francisco Maldonado
Orlando B. Martinez-Granera
Jose Maria Rodriguez
Juan Almendarez
Rose Slavkovsky
Pooja Bansil
Kerry A. Thomson
Jose Jeronimo
Silvia de Sanjose
author_sort Francesca Holme
title HPV-based cervical cancer screening in Nicaragua: from testing to treatment
title_short HPV-based cervical cancer screening in Nicaragua: from testing to treatment
title_full HPV-based cervical cancer screening in Nicaragua: from testing to treatment
title_fullStr HPV-based cervical cancer screening in Nicaragua: from testing to treatment
title_full_unstemmed HPV-based cervical cancer screening in Nicaragua: from testing to treatment
title_sort hpv-based cervical cancer screening in nicaragua: from testing to treatment
publisher BMC
series BMC Public Health
issn 1471-2458
publishDate 2020-04-01
description 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.
topic Cervical cancer
Screening
HPV test
Self-sampling
Follow-up
Treatment
url http://link.springer.com/article/10.1186/s12889-020-08601-z
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