PHS120 - Preventing Cervix-Uterus Cancer in Argentina. Structrure, Organization and Results

Abstract

In preparation of the self-administered HPV test in Argentina, the goal of this paper is to document the Federal Program for the Prevention of Cervix-Uterus Cancer (PNPCCU) operation at the first level of care and its upstream linkages at the secondary and tertiary levels, identifying process and outputs indicators. The project designed and implemented a series of questionnaires distributed to the local Ministry of Health, each one of its four Programmatic Regions, a sample of 111 health care centers (CAPs), cito/colposcopy labs and gynecology services in charge of treating cancer. Information about procedures to take Papanoicolau samples, submit them to labs, receive results and communicate them to patients was collected. Descriptive statistics, robust MLS and logistics regressions were used to analyze the dataset. The outreach activities through sanitary agents have a potential deficit in capturing eligible women (35-60 years old). Although 63,6-70% of CAPs reports systematic mechanisms to submit Pap samples to labs according to norm, strong idiosyncratic-informal criteria prevail, with mix effects on efficacy in outputs. A significant proportion of centers are not able to meet PNPCCU recommendation of a maximum four-week time-span between samples is taken at CAPs and results reach patients. Time gaps (one-to-four weeks) are found across regions between the time abnormal results are identified and treatments are initiated. Besides, coverage of such cases is completely addressed and dropout rates are nil. The econometric analysis provides insights about the poor influence of context variables on process indicators (Paps performed, and number of weeks since sample is performed and results reach the patient). Also, the analysis identifies that the reduction of idle-times in identification and communication as well the improvement of equitable results are under the span of action of CAPs and the coordination of the primary level’s health care network.