Cervical Cancer Screening Coverage Research Articles

Self-testing for human papillomavirus as a screening method for identifying risk groups

Due to the high prevalence of cervical cancer, it is necessary to take measures aimed at reducing its frequency through vaccination, screening, detection and treatment of precancerous conditions. The article presents a systematic analysis of scientific data on the use of testing for self-sampling for human papillomavirus as a tool to improve the effectiveness of screening and detection of precancerous diseases of the cervix. It has been shown that the use of such tests, which are based on polymerase chain reaction (PCR), have similar clinical accuracy compared to sampling by a doctor, and thus this option is promising for expanding the coverage of cervical cancer screening. The presence of expected economic efficiency also determines the relevance and prospects for these tests, but further research is needed to assess their implementation in routine practice.

Vaginal self-sampling for HPV in the context of cervical cancer screening

Abstract Background Effective cervical cancer screening programme has the potential to improve disease outcomes, yet women’s participation rates in Latvia remain suboptimal. Utilizing vaginal self-sampling for HPV, a convenient method, has demonstrated efficacy in boosting participation in under-screened populations. We analysed sociodemographic factors, as well as health behaviours with the preference for vaginal self-sampling procedures for early detection of cervical cancer. Methods Cross-sectional survey (2021-2022) included 1313 women in Latvia. Sampling was done in the colposcopy clinic and among GP practices. In the univariate analysis cervical cancer examination preference (self-test or by a physician) was analysed in association sociodemographic factors, participation in the screening, HPV status, study group, and health-related behaviour. Financed by “Internal consolidation of RSU and external consolidation of RSU with LSPA” (No. 5.2.1.1.i.0/2/24/I/CFLA/005), The EU Recovery and Resilience plan and the state budget, Grant Nr. RSU-PAG-2024/1-0016. Results 48.6 % (n = 538) of the women would prefer to use a vaginal self-test. Higher odds of the vaginal self-test preference were observed among Latvian (OR = 1.4 (1.1-1.8) vs other nationality women, but no other sociodemographic factors showed statistically significant associations. Women in the colposcopy study group (vs GP practices) were more likely to utilize self-sampling (OR = 1.8 (1.4-2.5). Non-participation in cervical cancer screening was related to 2.4 (1.6-3.6) higher odds of self-test preference, but knowledge about screening was related to 1.5 (1.1-2.0) times higher odds. Women who were HPV-negative were more likely to prefer vaginal self-test for HPV (OR = 1.4 (1.1-1.8) in comparison to HPV-positive women. Health-related behaviour did not show any associations. Conclusions Vaginal self-test for HPV can be effectively used to reach under-screened populations and enhance cervical cancer screening coverage. Key messages • The implementation of vaginal self-sampling for HPV testing has the potential to improve participation rates in cervical cancer screening programs among under-screened populations. • Outreach and education activities tailored to specific target groups in population could enhance level of the cervical cancer screening uptake.

Effects of screening coverage and screening quality assurance on cervical cancer mortality: Implication for integrated framework to monitor global implementation of cervical cancer screening programmes.

Cervical cancer is a global health threat and a manifestation of inequality, and screening is an effective intervention. However, little is known about how screening coverage and quality assurance, influence cervical cancer mortality. We aimed to investigate the association between screening coverage, screening quality assurance and cervical cancer mortality among women from countries at different developmental levels. We obtained data on age-standardised mortality from cervical cancer from the GLOBOCAN 2020 database; coverage of cervical cancer screening from World Health Organization (WHO) Global Health Observatory; and cervical screening programme settings and quality assurance from the Cancer Screening in Five Continents (CanScreen5) database. We assessed the dependency of cervical cancer age-standardised mortality on screening coverage and quality assurance by simple and multiple regression models. We also used linear regression models to identify factors that improved the screening coverage. The study included data from 53 countries. Reduced mortality was associated with increased screening programme quality assurance in 22 high-development countries. In 31 low-development countries, screening coverage in women aged 30-49 years was inversely associated with cervical cancer mortality. Political commitment (documentation of the cervical cancer screening policy as law) and financial support (treatment services provided free of charge) positively associated with screening coverage. Screening programmes need strengthening commensurate with local resources and context. Priority should be given to improving screening coverage through stronger political commitment and financial support in low-development countries, and to ensuring good performance at all levels in high-development countries.

Evidence from Europe on implementation, participation and performance of self-collection for cervical cancer screening.

Cervical cancer screening programs reduce the number of cervical cancer cases and deaths, but the success of any screening program is dependent on high participant uptake and coverage and many European countries are observing declining cervical cancer screening coverage to below national targets. Self-collection of vaginal samples for human papillomavirus testing, also termed self-sampling, is one strategy which is being introduced to try to increase screening coverage by removing barriers to participation and it has attracted growing interest and support globally. Informed by peer-reviewed and gray literature, this narrative review starts with a case study from the Netherlands and outlines the self-collection landscape in Europe within the themes of program implementation and relative test performance. It highlights some of the current evidence gaps needed to inform policy decisions on the use of self-collection within screening programs.

Barriers and facilitators to cervical cancer screening among under- and neverscreened women in Flanders, Belgium – a qualitative study on community and healthcare providers’ perspectives

BackgroundCervical cancer is detectable and preventable in premalignant stages. In 2013, a population-based cervical cancer screening (CCS) programme was set up in Flanders (Belgium) promoting screening by means of sending reminder letters. Yet, in 2021, only a CCS coverage of 63.6% has been reached, which is just a bare increase since the implementation of the programme (62.7% in 2013) (Jaarrapport 2022, Centrum voor Kankeropsporing (CvKO), 2022; Jaarrapport 2015, Centrum voor Kankeropsporing (CvKO), 2015).ObjectivesTo explore the characteristics of under- and neverscreened women in Flanders and to gain a better understanding of the barriers that prevent these women from attending CCS as well as factors that may facilitate CCS uptake.MethodsTwelve in-depth interviews and six focus group discussions were conducted with gynaecologists, general practitioners, community health workers and stakeholders providing support to women belonging to potentially underscreened population groups. Reported barriers and facilitators were subsequently classified using the Socio-Ecological Model (SEM). Finally, a causal loop diagram was constructed to visualise the dynamic interrelations among the barriers and facilitators.ResultsStakeholders and healthcare professionals confirm the vulnerability for cervical cancer screening in women with a substance use disorder and women with a migration background. The participation in screening among female sex workers is contingent upon their specific work environment. The group of never- or underscreened women is very heterogeneous and includes many women who are either unaware of CCS or have other priorities. A lack of focus on prevention is the most commonly reported barrier at the healthcare system level. Increasing awareness about cervical cancer (screening) and creating more opportunities for healthcare workers to offer prevention services are the primary facilitators.ConclusionTo improve screening participation in Flanders, different screening strategies tailored to a diversity of women are needed.

Impact of PRECEDE-PROCEED Model Audits in Cancer Screening Programs in Lombardy Region: Supporting Equity and Quality Improvement.

Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE-PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. This study evaluated the application of systemic audits based on the PRECEDE-PROCEED model across Lombardy cancer screening programs. A systematic region-wide audit was performed in 2019, and follow-up audits were performed in 2022-2023. Data were collected using structured analysis methodologies, including epidemiological, behavioural, and organisational assessments. The 2019 audit showed strengths in participation and quality standards but identified challenges in cervical cancer screening coverage and waiting times for assessments. Improvements plans included the digitisation of processes and stakeholder engagement. The 2022-2023 audits reported increased coverage for breast and colorectal screenings, but a slight decline in participation rates and examination coverage. Organisational improvements were noted, yet gaps in training and equity-targeted actions remained. The PRECEDE-PROCEED model audits led to notable improvements in the quality and equity of cancer screening programs in Lombardy. Sustained focus on digital integration, continuous re-training, and targeted equity interventions is essential for further progress.

Abstract B064: Community-informed interventions to address cervical cancer disparities among people experiencing homelessness

Abstract Background: Cervical cancer incidence and mortality rates are up to four-fold higher among people experiencing homelessness (PEH) compared to the housed US population. Even beyond typical social and structural barriers to healthcare, homeless women experience high rates of sexual violence and trauma, often leading to discomfort with cervical cancer screening and delays/refusals of Pap tests. Despite these issues, strategies for appropriate cervical cancer screening in homeless communities are scarce, and no frameworks exist for routine screening in shelters. Methods: Leveraging an established multisectoral community-academic partnership addressing homelessness and health disparities in Indiana, USA, ongoing community-engaged research is examining barriers to cervical cancer screening among PEH and co-designing strategies to address them. Rapid assessment surveys were conducted with PEH at two large homeless service agencies in Indianapolis and Lafayette to document cervical cancer screening coverage and characteristics of individuals who are unscreened/overdue. In-depth interviews explored knowledge of cervical cancer, key barriers and facilitators to screening, and acceptability of shelter-based HPV self-sampling delivered by trusted community health workers (CHW). Results: Of n=167 survey respondents, 48% were white, 38% Black, 7% Hispanic, 7% other. Mean age was 43.18 years, and mean lifetime years of homelessness was 3.18. Nearly half of participants (49%) were unsheltered, 44% stayed at a shelter, the remainder couch-surfed. One third (32%) were unscreened or overdue for screening, far above state and national averages (24% and 22% respectively). The majority (84%) reported wanting to be screened and believing it is important for their health. Provider mistrust and competing priorities surrounding their homelessness were main reported barriers to screening. Qualitative findings identified key benefits, concerns, and preferences for HPV self-sampling, with many participants expressing interest and willingness to adopt this screening method. Conclusion: Despite a vast majority of PEH reporting a desire and willingness to be screened for cervical cancer, key identified barriers limit access for this uniquely vulnerable population. Ongoing qualitative analysis is directly informing community context-specific CHW-delivered cervical cancer education and HPV self- sampling interventions. This work will ultimately lead to broadly implementable strategies for shelter-based routine cancer screening and preventive healthcare delivery for PEH. Citation Format: Natalia M. Rodriguez, Lara Balian, Rebecca Ziolkowski, Xue Case, Kalesia Smith, Janelle Tipton. Community-informed interventions to address cervical cancer disparities among people experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B064.

Ethnic inequalities in coverage and use of women’s cancer screening in Peru

ObjectiveThis study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru.MethodsData from the 2017–2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups.ResultsThe study included 70,454 women aged 30–69. Among women aged 40–69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and − 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and − 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education.ConclusionEthnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas.

Self-Collection for HPV Testing: Potential Issues Related to Performance Measures and Quality Improvement Among Federally Qualified Health Centers.

Most incident cases of cervical cancer in the United States are attributable to inadequate screening. Federally qualified health centers (FQHCs) serve a large proportion of women who are low-income, have no insurance, and are underserved-risk factors for insufficient cervical cancer screening. FQHCs must maintain quality measures to preserve their accreditation, address financial reimbursements, and provide quality care. Implementation of human papillomavirus (HPV) self-collection can improve cervical cancer screening coverage within FQHCs. To understand perspectives from clinical personnel on current cervical cancer screening rates at FQHCs in North Carolina and the impact of implementing HPV self-collection among underscreened patients on screening rates and performance measures. The study used focus groups and key informant interviews. Coding-based thematic analysis was applied to both focus group and interview transcripts. Emergent themes regarding perspectives on self-collection implementation were mapped onto Consolidated Framework for Implementation Research (CFIR) constructs to identify future barriers and facilitators to implementation. Two FQHCs in North Carolina and a cloud-based videoconferencing platform. Six FQHCs in North Carolina; 45 clinical and administrative staff from the 6 FQHCs; 1 chief executive officer (n = 6), 1 senior-level administrator (n = 6), 1 chief medical officer (n = 6), and 1 clinical data manager (n = 6) from each FQHC. Achievement of clinical perspectives. Societal-, practice-, and patient-level factors currently contribute to subpar cervical cancer screening rates. HPV self-collection was expected to improve screening uptake among underscreened women at FQHCs, and thus quality and performance measures, by offering an alternative screening approach for in-clinic or at-home use. Implementation barriers include financial uncertainties and HPV self-collection not yet a Food and Drug Administration-approved test. HPV self-collection has potential to improve cervical cancer screening quality and performance measures of FQHCs. For a successful implementation, multilevel factors that are currently affecting low screening uptake need to be addressed. Furthermore, the financial implications of implementation and approval of HPV self-collection as a test for cervical cancer screening quality measures need to be resolved.

The ESSAG-trial protocol: A randomized controlled trial evaluating the efficacy of offering a self-sampling kit by the GP to reach women underscreened in the routine cervical cancer screening program

BackgroundIn Flanders (Belgium), women not screened for cervical cancer (CC) within the last three years receive an invitation letter from the regional screening organization, the Centre for Cancer Detection (CCD), encouraging them to have a cervical specimen taken by their general practitioner (GP) or gynecologist. However, the coverage for CC screening remains suboptimal (63%). The offer of a self-sampling kit (SSK, for HPV testing) by a GP may trigger participation among women who do not attend regular screening. MethodsThe ESSAG-trial is a cluster-randomized controlled trial with three arms, each including 1125 women aged 31–64 years, who were not screened for CC in the last 6 years. In arm A, GPs offer a SSK when eligible women consult for any reason. In arm B, women receive a personal GP signed invitation letter including an SSK at their home address. In the control arm, women receive the standard invitation letter from the CCD. The primary outcome is the response rate at three months after inclusion. Secondary outcomes are: screen test positivity; compliance with foreseen follow-up among screen-positives; costs per invited and per screened women; as well as contrasts between trial arms and between socio-demographic categories. ConclusionThe ESSAG-trial will assess the effect of GP-based interventions using SSKs on CC screening participation among hard-to-reach populations. Findings will inform policymakers about feasible strategies on increasing CC screening that may be rolled-out throughout the whole region. Trial registrationClinicalTrials.gov: NCT05656976

Coverage and Socioeconomic Inequalities in Cervical Cancer Screening in Low- and Middle-Income Countries Between 2010 and 2019.

Cervical cancer screening is vital in addressing the global burden of cervical cancer. In this study, we describe the coverage and socioeconomic inequalities in the coverage of cervical cancer screening in low- and middle-income countries (LMICs). We analyzed data from the women's recode files of the Demographic and Health Surveys conducted in LMICs from 2010 to 2019 with variables on cervical cancer screening. We included women 21 years or older and determined the proportion of women who were screened for cervical cancer by age categories, wealth quintile, type of place of residence, level of education, and marital status. Socioeconomic inequality was measured using the concentration index (CIX) and the slope index of inequality (SII). A total of 269,506 women from 20 surveys in 16 countries were included in the survey. Generally, there was a low coverage of screening, with lower rates among women age 21-24 years, living in rural areas, in the poorest wealth quintile, with no formal education, and who have never been in union with or lived with a man. The CIX and SII values for screening for cervical cancer were positive (pro-rich) for all the countries except Tajikistan in 2012 where they were negative (pro-poor). The coverage of cervical cancer screening was low in LMICs with variations by the quintile of wealth (pro-rich) and type of place of residence (pro-urban). To achieve the desired impact of cervical cancer screening services in LMICs, the coverage of cervical cancer screening programs must include women irrespective of the type of place and wealth quintiles.

Experiences and perspectives regarding human papillomavirus self-sampling in sub-Saharan Africa: A systematic review of qualitative evidence

IntroductionCervical cancer screening coverage remains low in sub-Saharan Africa (SSA) due to limited access and low uptake of available services by women. The use of HPV-based self-sampling intervention for cervical cancer screening has the potential to increase screening coverage in the region. This study aimed to analyse qualitative evidence on the experiences and perspectives of women, healthcare workers, and policymakers regarding HPV self-sampling. MethodsWe reviewed qualitative studies from January 2011 to March 2023 in PubMed, Scopus, Medline Ovid, Cochrane, and WEB of Science databases for articles with qualitative data on HPV self-sampling from different countries in SSA. The socio-ecological model was used to guide data analysis and the study findings. ResultsThirteen qualitative studies were included for analysis, and they revealed themes under the intrapersonal, interpersonal, community, and health systems constructs of the Socio-ecological model. Intrapersonal themes included the acceptability of self-sampling, self-efficacy, and the perceived value of self-sampling. The interpersonal construct had themes such as women's spousal relationships, peer support, and the health worker's relationship with the women. The community construct had two themes: social stigma and misinformation, and the influence of cultural norms and religion. Finally, the health systems construct had themes such as the setting for self-sampling, follow-up availability of treatment services and education and awareness. ConclusionThis study highlights the factors influencing the acceptability and uptake of an HPV-based self-sampling intervention for cervical cancer screening in SSA. Considering these findings when designing interventions in SSA is crucial to ensure acceptance and demand among end-users. Self-sampling interventions offer the potential to reach many unscreened women and increase cervical cancer screening coverage in SSA, which is an essential strategy towards achieving the World Health Organisation's cervical cancer elimination targets by the close of the century.

Cost-effectiveness of single-visit cervical cancer screening in KwaZulu-Natal, South Africa: a model-based analysis accounting for the HIV epidemic.

Women living with human immunodeficiency virus (WLHIV) face elevated risks of human papillomavirus (HPV) acquisition and cervical cancer (CC). Coverage of CC screening and treatment remains low in low-and-middle-income settings, reflecting resource challenges and loss to follow-up with current strategies. We estimated the health and economic impact of alternative scalable CC screening strategies in KwaZulu-Natal, South Africa, a region with high burden of CC and HIV. We parameterized a dynamic compartmental model of HPV and HIV transmission and CC natural history to KwaZulu-Natal. Over 100 years, we simulated the status quo of a multi-visit screening and treatment strategy with cytology and colposcopy triage (South African standard of care) and six single-visit comparator scenarios with varying: 1) screening strategy (HPV DNA testing alone, with genotyping, or with automated visual evaluation triage, a new high-performance technology), 2) screening frequency (once-per-lifetime for all women, or repeated every 5 years for WLHIV and twice for women without HIV), and 3) loss to follow-up for treatment. Using the Ministry of Health perspective, we estimated costs associated with HPV vaccination, screening, and pre-cancer, CC, and HIV treatment. We quantified CC cases, deaths, and disability-adjusted life-years (DALYs) averted for each scenario. We discounted costs (2022 US dollars) and outcomes at 3% annually and calculated incremental cost-effectiveness ratios (ICERs). We projected 69,294 new CC cases and 43,950 CC-related deaths in the status quo scenario. HPV DNA testing achieved the greatest improvement in health outcomes, averting 9.4% of cases and 9.0% of deaths with one-time screening and 37.1% and 35.1%, respectively, with repeat screening. Compared to the cost of the status quo ($12.79 billion), repeat screening using HPV DNA genotyping had the greatest increase in costs. Repeat screening with HPV DNA testing was the most effective strategy below the willingness to pay threshold (ICER: $3,194/DALY averted). One-time screening with HPV DNA testing was also an efficient strategy (ICER: $1,398/DALY averted). Repeat single-visit screening with HPV DNA testing was the optimal strategy simulated. Single-visit strategies with increased frequency for WLHIV may be cost-effective in KwaZulu-Natal and similar settings with high HIV and HPV prevalence.

Abstract 2143: Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019

Abstract Introduction: Cervical cancer is one of the most common types of cancer among women and it is caused by infection from the human papillomavirus (HPV). The incidence rates of cervical cancer have increased in Indiana from 7.8 in 2008-2012 to 8.4 in 2013-2017. In 2020, the screening rate for cervical cancer among women in Indiana was 76% when compared to a national average of 78%. Women diagnosed at earlier stages for cervical cancer had higher relative survival of 0.98 than those diagnosed at later stages with a relative survival of 0.43. Health insurance status is an important determinant for health outcomes for patients with cancer. This study aims to assess the extent to which health insurance coverage is a contributing factor to the stage of cervical cancer diagnosis. Methods: We examined reported cases of cervical cancer among women (N=2518) using cervical cancer registry data from the Indiana State Department of Health from 2011-2019. Using multinomial logistic regression model, we examined the associations of both race/ethnicity and insurance status with stage of diagnosis after adjusting for age at diagnosis. Results: In this sample, the average age at diagnosis was 48.98 years (SD = 14.98). The largest proportion of the sample was between 45 to 64 years of age (41.7%), Non-Hispanic White (85.5%), had private insurance coverage (41.8%), had cervix uteri, NOS as the primary site of diagnosis (76.5%), lived in a metropolitan area (74.5%) and had squamous cell carcinoma (73.4%). The largest percentage of Non-Hispanic White patients had private insurance (50.9%), whereas the largest percentage of Black patients had Medicaid (39.3%). 20.2% of Hispanic patients were uninsured when compared to 7.7% Non-Hispanic White and 3.6% Black patients. The multivariate analysis shows that women who are uninsured (OR = 2.475) and those who have Medicaid (OR = 2.321) were significantly more likely to be diagnosed at the regional stage than the in-situ stage compared to women with private insurance. Additionally, women who are uninsured (OR = 4.432) and those who have Medicaid (OR = 3.007) were significantly more likely to be diagnosed at the distant stage than in-situ, compared to women with private insurance. Conclusion: The findings show that insurance status is associated with the stage of diagnosis for cervical cancer and detection at regional or distant stages often leads to higher morbidity. Impact - Increased coverage for routine cervical cancer screening and preventive care services is recommended, especially for uninsured women and women with public insurance such as Medicaid or Medicare. Citation Format: Mrithula Suresh Babu, Monica L. Kasting, Natalia M. Rodriguez. Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2143.

Real-World Cervical Cancer Screening Uptake and Predictors of Visual Inspection With Acetic Acid Positivity Among Women Living With HIV in Care Programs in Western Kenya.

To achieve the WHO cervical cancer elimination targets, countries globally must achieve 70% cervical cancer screening (CCS) coverage. We evaluated CCS uptake and predictors of screening positive at two public HIV care programs in western Kenya. From October 2007 to February 2019, data from the Family AIDS Care and Education Services (FACES) and Academic Model Providing Access to Healthcare (AMPATH) programs in western Kenya were analyzed. The study population included women age 18-65 years enrolled in HIV care. Screening uptake was calculated annually and overall, determining the proportion of eligible women screened. Multivariate logistic regression assessed predictors of positive screening outcomes. There were 57,298 women living with HIV (WLWHIV) eligible for CCS across both programs during the study period. The mean age was 31.4 years (IQR, 25.9-37.8), and 39% were on antiretroviral therapy (ART) at the first CCS-eligible visit. Of all eligible women, 29.4% (95% CI, 29.1 to 29.8) underwent CCS during the study period, 27.0% (95% CI, 26.5 to 27.4) in the AMPATH program, and 35.6% (95% CI, 34.9 to 36.4) in the FACES program. Annual screening uptake varied greatly in both programs, with coverage as low as 1% of eligible WLWHIV during specific years. Age at first screening, CD4 count within 90 days of screening, current use of ART, and program (AMPATH v FACES) were each statistically significant predictors of positive screening. CCS uptake at two large HIV care programs in Kenya fell short of the WHO's 70% screening target. Screening rates varied significantly on the basis of the availability of funding specific to CCS, reflecting the limitations of vertical funding programs.

Modeling the Health Impact and Cost-Effectiveness of a Combined Schoolgirl HPV Vaccination and Cervical Cancer Screening Program in Guangdong Province, China.

Low human papillomavirus (HPV) vaccine uptake is a key barrier to cervical cancer elimination. We aimed to evaluate the health impact and cost-effectiveness of introducing different HPV vaccines into immunization programs and scaling up the screening program in Guangdong. We used a dynamic compartmental model to estimate the impact of intervention strategies during 2023-2100. We implemented the incremental cost-effectiveness ratio (ICER) in costs per averted disability-adjusted life year (DALY) as an indicator to assess the effectiveness of the intervention. We used an age-standardized incidence of 4 cases per 100,000 women as the threshold for the elimination of cervical cancer. Compared with the status quo, scaling up cervical cancer screening coverage alone would prevent 215,000 (95% CI: 205,000 to 227,000) cervical cancer cases and 49,000 (95% CI: 48,000 to 52,000) deaths during 2023-2100. If the coverage of vaccination reached 90%, domestic two-dose 2vHPV vaccination would be more cost-effective than single-dose and two-dose 9vHPV vaccination. If Guangdong introduced domestic two-dose 2vHPV vaccination at 90% coverage for schoolgirls from 2023 and increased the screening coverage, cervical cancer would be eliminated by 2049 (95% CI 2047 to 2051). Introducing two doses of domestic 2vHPV vaccination for schoolgirls and expanding cervical cancer screening is estimated to be highly cost-effective to accelerate the elimination of cervical cancer in Guangdong.

Determinants of Cervical Cancer Screening among Female Health Professionals in Harar Town, Eastern Ethiopia: A Cross-Sectional Study.

Early screening for cervical cancer is a key life-saving intervention in reducing maternal mortality and morbidity. Despite the high burden of cervical cancer, the coverage of cervical cancer screening is low in developing countries, including Ethiopia. There is a paucity of information on the utilization of cervical cancer screening among female health professionals in eastern Ethiopia. This study aimedto assess the determinants of cervical cancer screening among female health professionals in Harar town, eastern Ethiopia. An institution-based cross-sectional study was conducted among 232 female health professionals in Harar town from September 01 to 30, 2022. Data were entered using EpiData version 3.1 and analyzed using SPSS version 27.0. Multivariable logistic regression analyses were conducted to identify significant factors for the level of cervical cancer screening. An adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of association and statistical significance declared at p value < 0.05. The prevalence of cervical cancer screening among female health professionals was 16.8% (95% CI: 11%, 22%). Higher education level (AOR = 4.28, 95% CI: 1.68, 10.90), use of contraceptives (AOR = 2.71, 95% CI: 1.17, 6.23), training on cervical cancer screening (AOR = 2.53, 95% CI: 1.05, 6.08), good knowledge about cervical cancer screening (AOR = 3.37, 95% CI: 1.44, 7.91), and positive attitude toward cervical cancer screening (AOR = 5.31, 95% CI: 2.04, 13.83) were independent factors that increased the utilization of cervical cancer screening. One in every six female health professionals was screened for cervical cancer. Education level, contraceptive use, cervical cancer screening training, cervical cancer screening knowledge, and attitude toward cervical cancer screening were the determinants of cervical cancer screening utilization among female health professionals. Improving the health professionals' knowledge and attitude toward cervical cancer screening through upgrading their education level and training on cervical cancer screening would be essential to improving the level of cervical cancer screening.

Spatial distribution and characteristics of women reporting cervical cancer screening in Malawi: An analysis of the 2020 to 2021 Malawi Population-based HIV Impact Assessment survey data.

Malawi has one of the highest incidence and mortality rates of cervical cancer in the world. Despite a national strategic plan and the roll-out of VIA and screen-and-treat services, cervical cancer screening coverage in Malawi remains far below the national target.Using a nationally representative sample of women enumerated in the Malawi Population-based Impact Assessment (MPHIA) survey we estimated the prevalence and spatial distribution of self-reported cervical cancer screening as a proxy for uptake in Malawi. MPHIA was a nationally representative household survey in Malawi, targeting adults aged 15 and above, that employed a cross-sectional, two-stage, cluster design. The primary aim of MPHIA was to assess the regional prevalence of viral load suppression and the progress towards achieving the UNAIDS 95-95-95 goals among adults aged 15 and above. The survey was carried out between January 2020 and April 2021. Prevalence of self-reported cervical cancer screening by different characteristics was estimated accounting for the survey design using the Taylor series approach. We used univariable and multivariable logistic regression approaches to examine associations between the prevalence of cervical cancer screening and demographic characteristics. A total of 13,067 adult (15 years and older) female individuals were surveyed during the MPHIA 2020 to 2021 survey, corresponding to a weighted total of 5,604,578. The prevalence of self-reported cervical cancer screening was 16.5% (95% CI 15.5-18.0%), with women living with HIV having a higher prevalence of 37.8% (95% CI 34.8-40.9) compared to 14.0% (95% CI 13.0-15.0) in HIV negative women. The highest prevalence of screening was reported in the Southwest zone (SWZ) (24.1%, 95% CI 21.3-26.9) and in major cities of Blantyre (25.9%, 95% CI 22.9-29.0), and Lilongwe (19.6%, 95% CI 18.0-21.3). Higher self-reported screening was observed in women who resided in urban regions ((22.7%; 95% CI 21.4-24.0) versus women who resided in rural areas (15.2%; 95% CI 14.0-16.8). Cervical cancer screening was strongly associated with being HIV positive (aOR 2.83; 95% CI 2.29-3.50), ever having been pregnant (aOR 1.93; 95% CI 1.19-3.14), attaining higher education level than secondary education (aOR 2.74; 95% CI 1.67-4.52) and being in the highest wealth quintile (aOR 2.86; 95% CI 2.01-4.08). The coverage of cervical cancer screening in Malawi remains low and unequal by region and wealth/education class. Current screening efforts are largely being focussed on women accessing HIV services. There is need for deliberate interventions to upscale cervical cancer screening in both HIV negative women and women living with HIV.

Clinical Performance of Self-collected Specimen HPV-DNA vs Clinician- collected Specimen HPV-mRNA to Detect High-risk HPV and High-grade Cervical Lesions and Cancer.

Self- collected specimens to detect high-risk (hr) HPV and high-grade cervical lesions (CIN2+) has been introduced aiming to increase cervical cancer screening coverage. The performance of self- collected specimen compared to clinician collected specimen is one major concern. This study aimed to compare self-sampling HPV-DNA and clinician-sampling HPV-mRNA to detect hr-HPV and high-grade cervical lesions. Women with abnormal cervical cytology and/ or positive hr-HPV who attended the colposcopy clinics in 10 tertiary hospitals in Bangkok were enrolled. Self-collected specimens were evaluated for HPV DNA using Cobas® 4800 HPV test prior to the clinician-collected specimens which were tested for HPV mRNA with APTIMA® HPV Assay. Subsequent colposcopy with biopsy was performed. The detection rates of hr-HPV from both HPV tests and their performance to detect high-grade lesions pathology were compared. Data from 497 women's specimens were analyzed. Both samplings had 86.8% concordance rate in detecting hr-HPV (Kappa 0.670; 95% confidence interval [CI] 0.599-0.746, P value < 0.001). The sensitivity (95% CI) of self-collected specimen HPV DNA and clinician- collected specimen HPV-mRNA to detect high-grade lesions were 91.8% (85.4%-96.0%) and 90.2% (83.6%-94.9%) respectively. The corresponding negative predictive values (95% CI) were 91.9% (85.6%-96.0%) and 91.7% (86.0%-95.7%) respectively. HPV DNA testing from self-collected specimen to detect HR-HPV demonstrates high concordance with HPV mRNA testing from clinician-collected specimen. The sensitivity and negative predictive value of both tests to detect high-grade lesions are comparable.

Evaluation of self-sampling-based cervical cancer screening strategy using HPV Selfy CE-IVD test coupled with home-collection kit: a clinical study in Italy

BackgroundPrimary human papillomaviruses (HPV) cervical cancer screening can be strengthened by offering home-collection of biological specimen as a valuable option to increase screening coverage. As recommended by World Health Organization (WHO), screening programs should consider whether the inclusion of HPV self-sampling as a complementary option within their existing screening algorithms could address the gaps in current coverage. However, few HPV screening tests are validated for self-sampling according to international guidelines. This study aimed to test a self-sampling-based screening strategy, complementary to the main screening program based on clinician-collected cervical samples. The study took place in Trieste, Italy, and it aimed to evaluate the feasibility of self-testing at home under an opt-in system during COVID-19 pandemic in order to exploit self-sampling to reduce the screening delay generated by the lockdown.Methods500 women, who should have received the screening call in 2020, were asked, via phone call, to participate in the study. To whom agreed, a home-collection kit, including a vaginal dry swab for specimen collection, was sent. The recipients performed the sample self-collection and sent back the swab through traditional mail using a prepaid envelope. Once received by the hospital, the samples were analyzed with HPV Selfy (Ulisse BioMed, Italy), a CE-IVD HPV screening test specifically validated for self-collection. Results were further compared using cobas® 4800 HPV (Roche, Switzerland).Results80% women sent back their swab, showing one of the highest return rate obtained in comparable studies. 34 HPV-positive women were followed up and underwent the Pap test, that revealed 8 low squamous intraepithelial lesions (LSIL) cases, later triaged to colposcopy. HPV Selfy was confirmed to be an adequate test for self-sampling-based screening.ConclusionsThis study further confirmed the feasibility of self-test at home screening strategy based on self-sampling with an opt-in system as a support method to enhance cervical cancer screening coverage in Italy. Enrolled women showed a high appreciation for this approach. HPV Selfy test demonstrated to be a valuable assay for cervical cancer screening based on home self-collection.Trial registration: ASUGI Trieste n. 16008/2018 and amendment 02-11/09/2020.