Implementation Research To Evaluate Scaling-up Of HPV-Self Collection In The Province Of Jujuy, Argentina


1 Departamento de Salud, economía y Sociedad, CEDES/CONICET
2 Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional de Cáncer, Buenos Aires, Argentina
3 Programa Provincial de Prevención de Cáncer Cervicouterino, San Salvador de Jujuy, Argentina

Purpose: We carried-out implementation research to evaluate scaling-up of HPV self-collection offered by community health workers (CHW) during home visits in Jujuy, Argentina. In 2014 findings from previous mix-methods research (The EMA project) were used to expand HPV self-collection as a provincial strategy to increase HPV-testing among screening under-users. We report selected monitoring outcomes for the first year of the scaling-up phase.
Methods: We analyzed data program from the national online screening information system using the RE-AIM framework. Presented outcomes are Reach: percentage of screened under-users; Efficacy: positivity; detection of CIN2+; Adoption: percentage of CHWs with at least one woman with self-collected test; Implementation: percentage of trained CHWs, percentage of women with completion of follow-up. Maintenance: Number of women with self-collected tests during second year of the scaling-up (2015).
Results: Protocols, referral network and training components were developed; triage cytology was recommended for HPV+ women. In total 568/698 CHWs were trained to offer the strategy. In 2014, a total of 12780 women aged 30+ were HPV-screened in the Jujuy public health sector, 38% (n=4866) of them with self-collected tests. Among women with self-collected tests 85% (n=4133/4866) were screening under-users vs. 61% (n=4820/7914) of women with clinician-collected tests at health centers (p<0.0001). Of the total of trained CHWs, 75% (426/568) had at least one woman with self-collection. HPV positivity was 13%; 75% (473/633) of HPV+ women had triage follow-up, and among triage+ women 55% (80/146) had colposcopy results. The number of women with CIN2+ lesions was 22. In 2015, 4627 women had self-collected tests.
Conclusions: results indicate that programmatic implementation of HPV-self collection is effective to increase screening, especially among under-users. Triage of HPV+ women and colposcopy follow-up remain a challenge.
Funding source: National Cancer Institute, Argentina, in collaboration with Jujuy Ministry of Health.