Abstract
BackgroundIn 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.MethodsWe 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.ResultsForty-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.ConclusionsIntroduction 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.
Highlights
In Nicaragua, cervical cancer is the leading cause of cancer death among women
Human papillomavirus (HPV) positivity ranged among provinces from 14.2% in Chinandega to 16.2% in Chontales, with a value of 16.0% in Carazo
HPV prevalence was slightly lower in women with selfcollected samples (15.3, 95% confidence intervals (CI) 14.9–15.6) as compared
Summary
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. Human papillomavirus (HPV) testing is a superior screening method compared to Pap, offering higher sensitivity and a better long-term predictive value [4, 5]. When combined with an adequate system for following up screen-positive women and access to efficient treatment, HPV testing has the potential to reduce cervical cancer incidence and mortality in low-resource settings, overcoming some of the challenges associated with previous screening methods [6,7,8,9]. Countries are called upon to set programmatic goals that include, among others, screening of 70% of women twice between the ages 35 to 45 and treatment of 90% of screen-positive women [10]
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