Abstract
BackgroundCervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala.MethodsA cohort of 956 women was recruited in 2016 and followed for 2 years for the HPV Multiethnic Study (HPV MES). At baseline, women answered a questionnaire assessing cervical cancer screening history and were offered self-collection HPV testing. Women were re-contacted yearly to determine receipt of additional screening. Statistical changes in screening behavior before and throughout study participation, stratified by self-collection status, were assessed using McNemar pair tests for proportions. Alluvial plots were constructed to depict changes in individual screening behavior. The odds of changes in Pap-compliance (screened in past 3 years), given collection status, were assessed using multivariate logistic regressions.ResultsReported screening rates increased 2 years after enrollment compared to rates reported for the 3 years before study entry among women who collected a sample (19.1% increase, p < 0.05), received results of their test (22.1% increase, p < 0.05), and received positive (24.2% increase, p < 0.1) or negative results (21.7% increase, p < 0.05). However, most increases came from one community, with minimal changes in the other. The adjusted odds of becoming Pap compliant were higher for women who collected a sample vs. did not (OR: 1.48, 95% CI: 0.64, 3.40), received their result vs. did not (OR: 1.29, 95% CI: 0.52, 3.02), and received a positive result vs. negative (OR: 2.43, 95% CI: 0.63, 16.10).ConclusionsParticipation in self-collection HPV testing campaigns may increase likelihood of involvement in screening programs. However, results varied between communities, and reporting of screening histories was inconsistent. Future work should identify what community-specific factors promote success in HPV testing programs and focus on improving education on existing cervical cancer interventions.
Highlights
Cervical cancer is a leading cause of death in low- and middle-income countries
Since the introduction of cervical cancer screening, incidence and mortality rates have been relatively low in high-income countries (HICs) [2], demonstrating the potential to reduce the global burden of cervical cancer with improved screening
To assess the changes in ever-screening and compliance at an individual level, we explored the flow across screening groups for all waves, using alluvial plots, which group categorical data into flows that can be traced across time points
Summary
Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala. Cervical cancer in low- and middle-income countries (LMICs) accounted for approximately 90% of the 311, 000 cervical cancer deaths worldwide in 2018 [1]. Since the introduction of cervical cancer screening, incidence and mortality rates have been relatively low in high-income countries (HICs) [2], demonstrating the potential to reduce the global burden of cervical cancer with improved screening. There is a need for alternative prevention strategies in LMICs. Guatemala is a middle-income country in Central America with a population of approximately 15 million [4]. Lack of screening among women in Guatemala [6] contributes to an exceptionally high cervical cancer incidence rate of 21.2 per 100,000 women, compared to 6.5 per 100,000 women in the United States, where screening is more common [7]
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