Implementation of second round of HPV-based screening for cervical cancer in programmatic contexts in Argentina

Abstract

[ABSTRACT]: OBJECTIVES: To evaluate implementation of the second round of human papillomavirus (HPV)-based cervical screening, introduced in Argentina in 2012-2014 through the Jujuy Demonstration Project for women 30 years and older, and describe the characteristics of women who adhere to the recommended five-year rescreening interval. METHODS: A retrospective cohort study was conducted based on the data of two rounds of screening. All women aged 30 years or older who had been HPV-tested during the Jujuy Demonstration Project and had a negative result were included. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation. Multivariable regression was used to examine factors associated with adherence to rescreening. RESULTS: Of 42 307 HPV-negative women, 47.9% (n = 20 285) were rescreened in the second round (Reach); 69.2% of health centers provided at least one HPV test at second-round screening (Adoption); and 13.3% (n = 5 639) of women were rescreened within the recommended five-year interval. Among the total rescreened, 9.3% (n = 1 888) were HPV-positive, of which 95.0% underwent triage Pap and 79.2% of the HPV-positive/abnormal Pap women had colposcopy. Considering women rescreened at five years, the second-round detection rate was 5.3/1 000 screened women. Rescreening at five years was significantly higher among women aged 30-44, with public health insurance, and those living in the provincial capital. CONCLUSIONS: Rescreening of HPV-negative women faced challenges linked to its reduced reach, especially if we consider the recommended five-year interval. Our findings suggest that we need to devise specific strategies to increase second-round screening rates.