Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study

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Background Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011–14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection w...

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Autores principales: Arrossi, Silvina, Paolino, Melisa, Laudi, Rosa, Gago, Juan, Campanera, Alicia
Formato: Artículo
Lenguaje:en_US
Publicado: The Lancet Global Health 2019
Materias:
HPV
PREVENCION DE CANCER DE CUELLO UTERINO
ARGENTINA
Acceso en línea:http://repositorio.cedes.org/handle/123456789/4488
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30048-8/
https://doi.org/10.1016/S2214-109X(19)30048-8
Aporte de:
Respositorio Digital CRIS del CEDES - Centro de Estudios de Estado y Sociedad de Centro de Estudios de Estado y Sociedad (CEDES)
id I61-R167123456789-4488
record_format dspace
institution Centro de Estudios de Estado y Sociedad (CEDES)
institution_str I-61
repository_str R-167
collection Respositorio Digital CRIS del CEDES - Centro de Estudios de Estado y Sociedad
language en_US
orig_language_str_mv en_US
topic HPV
PREVENCION DE CANCER DE CUELLO UTERINO
ARGENTINA
spellingShingle HPV
PREVENCION DE CANCER DE CUELLO UTERINO
ARGENTINA
Arrossi, Silvina
Paolino, Melisa
Laudi, Rosa
Gago, Juan
Campanera, Alicia
Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
topic_facet HPV
PREVENCION DE CANCER DE CUELLO UTERINO
ARGENTINA
description Background Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011–14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection was introduced as a programmatic strategy in 2014. We aimed to evaluate the effectiveness of programmatic HPV testing to detect cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) in comparison with cytology-based screening. Methods We did a population-based, before-and-after retrospective cohort study using data from the National Cervical Cancer Prevention Program for the Jujuy province in northwest Argentina. We obtained data for the cytology-based screening period from Jan 1, 2010, until Dec 31, 2011, and for the HPV-based screening period from Jan 1, 2012, until Dec 31, 2014. The primary outcome was detection of histologically diagnosed CIN2+ among women aged 30 years and older. To assess the outcomes in all individuals included in the study, we used multivariable logistic regression and propensity score matching. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used for the before-and-after analysis of programmatic dimensions. Findings Of the 29 631 women who underwent cytology-based screening in 2010–11, CIN2+ was detected in 236 (0·8%) individuals. Of the 49 565 women HPV tested in 2012–14 (clinician-collected tests, n=44 700; self-collection tests, n=4865), 693 (1·4%; 658 clinician-collected tests; 35 self-collection tests) were found to have CIN2+ after the first round of screening. Compared with cytology-based screening, the odds ratio of being diagnosed with a CIN2+ lesion was 2·34 (95% CI 2·01–2·73; p<0·0010) with clinician-collected tests, and 1·08 (0·74–1·52; p=0·68) when screened with self-collection tests, after controlling for age and health insurance status. Screening coverage was similar in both periods (52·7% vs 53·2%); improvements of programmatic indicators were observed in the HPV testing period in relation to laboratory centralisation, lower overscreening (6·6% vs 0·0%), higher adherance to age recommendations (79·3% vs 98·8%), and a decrease of inadequate samples (3·6% vs 0·2%). Interpretation HPV testing in middle-income settings increases detection of CIN2+ lesions and allows for improvement of programmatic indicators. Evidence suggests that the introduction of HPV testing will accelerate the reduction of cervical cancer burden.
format Artículo
author Arrossi, Silvina
Paolino, Melisa
Laudi, Rosa
Gago, Juan
Campanera, Alicia
author_facet Arrossi, Silvina
Paolino, Melisa
Laudi, Rosa
Gago, Juan
Campanera, Alicia
author_sort Arrossi, Silvina
title Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_short Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_full Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_fullStr Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_full_unstemmed Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_sort programmatic human papillomavirus testing in cervical cancer prevention in the jujuy demonstration project in argentina: a population-based, before-and-after retrospective cohort study
publisher The Lancet Global Health
publishDate 2019
url http://repositorio.cedes.org/handle/123456789/4488
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30048-8/
https://doi.org/10.1016/S2214-109X(19)30048-8
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