Implementing HPV DNA Testing Into A Public Cervical Cancer Screening Program In El Salvador

Karla ALFARO, Basic Health International, El Salvador
MAZA M. 1 , GAGE J. 2 , FELIX J. 3 , CASTLE P. 4,5 , JANE K. 6 , CREMER M. 1,7

1 Basic Health International, Colonia San Francisco, Avenida los Camelias #14, San Salvador, El Salvador
2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rockville, MD, USA
3 Department of Pathology, University of Southern California, 2011 Zonal Ave, Los Angeles, CA, USA
4 Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, USA
5 Global Coalition Against Cervical Cancer, 3800 Fairfax Dr. Ste. 5, Arlington VA, USA
6 Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Ave., Boston, MA, USA
7 Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH, USA

Purpose: CAPE (Cervical Cancer Prevention in El Salvador) introduces a low-cost HPV-DNA test into a public sector program. During phase 2 of the project, 8 thousand women were expected to be part of the project. To increase adherence to screening, different interventions of recruitment strategies were adopted. For the management of HPV positive women, two treatment algorithms were compared to select the best management for HPV+ women. The results of this phase would help decision making on the scale up of the project.
Methods: Health promoters were trained on HPV and cervical cancer in order for them to educate and recruit women aged 30-49 at the community. 8205 women were contacted at home to participate in the screening. Additional methods were used, such as home visits and opportunistic screening at the health units in order to screened 8,000 women targeted for this phase. Women with HPV+ results followed two treatment strategies, colposcopy management (CM) or screen and treat (ST) if they were cryotherapy eligible. 
Results: 8,050 women were screened in this phase. 81.1% (6,656/8,025) of women recruited at the community attended to their appointment, 1,062 women had an opportunistic screening and 332 women were screened at home. Of the women screened, 489/3,963 (12.3%) and 465/4,087 (11.4%) of women in the CM and ST tested HPV-positive respectively. In the CM all were referred for colposcopy—and 216/489 (44.2%) attended within 6 months. In the ST, 397/465 (85%) received immediate treatment.
Conclusions: Training and education, as well as combination of different recruitment techniques shows a higher adherence to screening. The ST strategy outcome vs the ST, allowed stakeholders to adopt screen and treat modality for the scale up of the project.
Funding source: Einhorn Family Trust Fund, Union for International Cancer Control