Barriers and Facilitators of Programmatic HPV Testing: Lessons Learnt From Two In-Depth Provincial Case Studies Ten Years After the Jujuy Demonstration Project in Argentina

Abstract

[ABSTRACT]: Introduction: Achieving the global goal of cervical cancer elimination faces major challenges, particularly in ensuring the large-scale and sustained implementation of proven technologies. In Argentina, HPV testing as primary screening was introduced through the Jujuy Demonstration Project (JDP) in 2012. The aim of this study is to analyze barriers and facilitators of the implementation of HPV testing in two provinces—Jujuy, and Catamarca—a decade after the JDP’s completion.

Methods: We carried out a descriptive in-depth case study using a mixed-method approach, using qualitative and quantitative methods. Data were collected through participant observations in health services, semi-structured interviews with key informants, analysis of secondary sources, and program indicators. Barriers and facilitators were analyzed using an adapted Health System Framework focusing on four key dimensions: stewardship, organizational capacity, financing, and technology.

Results: Regarding stewardship, reduced technical support and monitoring from the National Program emerged as significant barrier. About financing, the most critical obstacle was the national interruption in the provision of HPV tests. Although both provinces have initiated procedures to purchase tests using provincial funds, this process was constrained by limited financial resources and competing priorities. Finally, regarding organizational capacity, challenges persisted in maintaining laboratory centralization, sustaining the offer of self-collection, and fully utilizing information systems for program monitoring. Facilitators related to stewardship included the stability of human resource in both provinces and the long-standing institutional recognition and leadership of provincial program staff. Sustained adherence to national guidelines and the existence of provincial resolutions were key enablers of continuity. In addition, acceptability of the technology remained high, with HPV testing continuing to be widely accepted in both provinces.

Conclusions: Our findings reveal barriers and facilitators in the implementation ten years after JDP finalization, providing valuable lessons for scaling up HPV-based screening in national cancer control programs.