Please use this identifier to cite or link to this item: http://repositorio.cedes.org/handle/123456789/4508
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dc.contributor.authorArrossi, Silvinaen_US
dc.contributor.authorPaolino, Melisaen_US
dc.contributor.authorLaudi, Rosaen_US
dc.contributor.authorCampanera, Aliciaen_US
dc.contributor.authorThouyaret, Lauraen_US
dc.date.accessioned2019-05-22T02:29:41Z-
dc.date.available2019-05-22T02:29:41Z-
dc.date.issued2017-
dc.identifier.urihttp://repositorio.cedes.org/handle/123456789/4508-
dc.description.abstractBACKGROUND: Self-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women. METHODS: We used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy. RESULTS: HPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% (n = 5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period (p < 0.0001). IMPLEMENTATION: Training about the strategy was provided to 84.2% (n = 609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% (n = 320) had follow-up procedures. Of 113 women with positive triage, 66.4% (n = 75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women (n = 21/26). Adoption: Of trained CHWs, 69.3% (n = 422/609) had at least one woman with self-collection; 85.2% (n = 315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection. CONCLUSIONS: The strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women.en_US
dc.language.isoenen_US
dc.publisher1748-5908en_US
dc.subjectARGENTINAen_US
dc.subjectNEOPLASIAS DEL CUELLO UTERINOen_US
dc.subjectImplementación de Plan de Saluden_US
dc.subjectDetección Precóz del Cánceren_US
dc.titleEvaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentinaen_US
dc.typeArtículoen_US
dc.identifier.doi1748-5908-
dc.identifier.doi1-
dc.identifier.doi17-
dc.identifier.doi12-
dc.identifier.doi10.1186/s13012-017-0548-1-
dc.identifier.pmid28193227-
item.fulltextWith Fulltext-
item.grantfulltextopen-
crisitem.author.deptCEDES. Centro de Estudio de Estado y Sociedad-
crisitem.author.deptÁrea de Salud, Economía y Sociedad-
crisitem.author.deptCEDES. Centro de Estudio de Estado y Sociedad-
crisitem.author.deptÁrea de Salud, Economía y Sociedad-
crisitem.author.parentorgCEDES. Centro de Estudio de Estado y Sociedad-
crisitem.author.parentorgCEDES. Centro de Estudio de Estado y Sociedad-
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