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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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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