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Research article
Francesca Holme
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3816-7258
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Background 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.
Methods We 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.
Results 44,635 women were screened with HPV testing; 96.6% of women used self-sampling. 6,776 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.
Conclusions Introduction 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.
Keywords
cervical cancer, screening, HPV test, self-sampling, follow-up, treatment, Nicaragua
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CURRENT STATUS: Published
View the published article at BMC Public Health.
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Posted 30 Mar, 2020
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On 26 Mar, 2020
Editorial decision: Accept
On 26 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 12 Mar, 2020
Review #2 received
Received 04 Mar, 2020
Reviewer #1 agreed
On 21 Feb, 2020
Reviewer #2 agreed
On 21 Feb, 2020
Review #1 received
Received 21 Feb, 2020
Editor assigned
On 20 Feb, 2020
Reviewers invited
Invitations sent on 20 Feb, 2020
Submission checks complete
On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
No comments provided
Editorial decision: Major revision
On 22 Jan, 2020
Reviewer #3 agreed
On 06 Jan, 2020
Reviewer #4 agreed
On 06 Jan, 2020
Review #3 received
Received 06 Jan, 2020
Review #2 received
Received 06 Jan, 2020
Reviewer #2 agreed
On 03 Jan, 2020
Reviewer #1 agreed
On 21 Dec, 2019
Review #1 received
Received 21 Dec, 2019
Reviewers invited
Invitations sent on 18 Dec, 2019
Editor assigned
On 10 Dec, 2019
Submission checks complete
On 22 Nov, 2019
Editor invited
On 22 Nov, 2019
First submitted
On 29 Oct, 2019
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Subject Areas
Sexual & Reproductive Medicine
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See the published version of this preprint at BMC Public Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Francesca Holme
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3816-7258
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Public Health.
Version 3
Posted 30 Mar, 2020
No community comments so far
Submission checks complete
On 26 Mar, 2020
Editorial decision: Accept
On 26 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 12 Mar, 2020
Review #2 received
Received 04 Mar, 2020
Reviewer #1 agreed
On 21 Feb, 2020
Reviewer #2 agreed
On 21 Feb, 2020
Review #1 received
Received 21 Feb, 2020
Editor assigned
On 20 Feb, 2020
Reviewers invited
Invitations sent on 20 Feb, 2020
Submission checks complete
On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
No comments provided
Editorial decision: Major revision
On 22 Jan, 2020
Reviewer #3 agreed
On 06 Jan, 2020
Reviewer #4 agreed
On 06 Jan, 2020
Review #3 received
Received 06 Jan, 2020
Review #2 received
Received 06 Jan, 2020
Reviewer #2 agreed
On 03 Jan, 2020
Reviewer #1 agreed
On 21 Dec, 2019
Review #1 received
Received 21 Dec, 2019
Reviewers invited
Invitations sent on 18 Dec, 2019
Editor assigned
On 10 Dec, 2019
Submission checks complete
On 22 Nov, 2019
Editor invited
On 22 Nov, 2019
First submitted
On 29 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Sexual & Reproductive Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Public Health.
Background 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.
Methods We 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.
Results 44,635 women were screened with HPV testing; 96.6% of women used self-sampling. 6,776 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.
Conclusions Introduction 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.
Figure 1
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