El impacto de la prueba de VPH en los programas de tamizaje en América Latina: el caso de Argentina

Arrossi, Silvina

doi:10.21149/9257

Cited by 13 publications

(15 citation statements)

References 27 publications

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“…An analysis of the programmatic effect of introducing HPV testing showed that HPV testing is an opportunity to change inefficient components of screening programmes. 26 Therefore, HPV testing has been recommended as a strategy to simplify and improve screening organisation. 27 Some concerns exist about the increased CIN2+ detection frequency representing overdiagnosis of lesions that would not have progressed to invasive cancer.…”

Section: Discussionmentioning

confidence: 99%

Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study

Arrossi

Paolino

Laudi

et al. 2019

The Lancet Global Health

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Background Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011-14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection was introduced as a programmatic strategy in 2014. We aimed to evaluate the effectiveness of programmatic HPV testing to detect cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) in comparison with cytology-based screening. Methods We did a population-based, before-and-after retrospective cohort study using data from the National Cervical Cancer Prevention Program for the Jujuy province in northwest Argentina. We obtained data for the cytology-based screening period from Jan 1, 2010, until Dec 31, 2011, and for the HPV-based screening period from Jan 1, 2012, until Dec 31, 2014. The primary outcome was detection of histologically diagnosed CIN2+ among women aged 30 years and older. To assess the outcomes in all individuals included in the study, we used multivariable logistic regression and propensity score matching. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used for the before-and-after analysis of programmatic dimensions. Findings Of the 29 631 women who underwent cytology-based screening in 2010-11, CIN2+ was detected in 236 (0•8%) individuals. Of the 49 565 women HPV tested in 2012-14 (clinician-collected tests, n=44 700; self-collection tests, n=4865), 693 (1•4%; 658 clinician-collected tests; 35 self-collection tests) were found to have CIN2+ after the first round of screening. Compared with cytology-based screening, the odds ratio of being diagnosed with a CIN2+ lesion was 2•34 (95% CI 2•01-2•73; p<0•0010) with clinician-collected tests, and 1•08 (0•74-1•52; p=0•68) when screened with self-collection tests, after controlling for age and health insurance status. Screening coverage was similar in both periods (52•7% vs 53•2%); improvements of programmatic indicators were observed in the HPV testing period in relation to laboratory centralisation, lower overscreening (6•6% vs 0•0%), higher adherance to age recommendations (79•3% vs 98•8%), and a decrease of inadequate samples (3•6% vs 0•2%). Interpretation HPV testing in middle-income settings increases detection of CIN2+ lesions and allows for improvement of programmatic indicators. Evidence suggests that the introduction of HPV testing will accelerate the reduction of cervical cancer burden.

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Section: Discussionmentioning

confidence: 99%

Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study

Arrossi

Paolino

Laudi

et al. 2019

The Lancet Global Health

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“…Onboarding screen: inquires about the medical indication received after the HPV-positive result. It offers the following as possible answers: “You must get a Papanicolaou (Pap) smear in 1 year,” “You must undergo a colposcopy,” “You must get a biopsy,” “You must return in 18 months,” and “You must return in 5 years.” The list of responses to this question was based on the guidelines for the prevention of CC established by the health authorities in Argentina [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

“…Triage tests are used to identify HPV-positive women who will require diagnosis and treatment. In Argentina, the prevalence of high-risk HPV among screened women is around 13% [ 5 ]. HPV-positive women with negative triage will require rescreening in 12/18 months.…”

Section: Introductionmentioning

confidence: 99%

A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina

Antelo¹,

Szwarc²,

Paolino³

et al. 2022

JMIR Form Res

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Background Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective This study aims to understand HPV-tested women’s perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users’ needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions Providing information that meets women’s needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women.

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“…Globally, in 2018, 570,000 women were diagnosed with cervical cancer (CC), and 311,000 died from this cause, constituting the fourth in frequency among women and the fourth as a cause of death. Approximately 84% of all CCs and 88% of all deaths caused by this cancer occurred in lower resource countries [ 1 – 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Infection by human papillomavirus (HPV) has been clearly established as a necessary cofactor for the development of CC. The use of cervical cytology, known as Papanicolaou testing, as well the addition of HPV co-testing has significantly improved the detection and treatment of precursor and preinvasive cervical lesions, allowing to identify patients who are at greater risk of developing CC [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the prevalence of therapeutic targets in cervical cancer

Patrono

Calvo

Franco

et al. 2021

ecancer

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Cervical Cancer (CC) is a significantly prevalent disease in developing countries. Currently, targeted therapies are not a primary standard of care in CC. This information could be crucial for developing directed therapies and patient screening for biomarkers that would allow personalised treatment of CC. This systematic review aimed to estimate the prevalence of potential therapeutic targets such as the epidermal growth factor receptor (EGFR) and the PI3K/Akt/mTOR and Ras/Raf/MAPK pathways in patients with CC, identified through genomic and non-genomic testing. Studies were identified through an ad-hoc search strategy from the available on MEDLINE (Ovid), CENTRAL, LILACS, SCOPUS, through the Clinical Trial registry on Clinicaltrials.gov, International Clinical Trials Registry Platform, RENIS (Argentine National Registry of Health Research) and grey literature sources. We included 74 studies which represented a total pool of 7,862 participants. Forty-five studies informed mutations of EGFR, with a combined positivity rate of 53% (95%CI: 45%-60%; I 2 = 95%). Twenty studies informed the presence of mutations in PIK3CA with a combined positivity rate of 30% (95%CI: 21%-39%; I 2 = 96%). Twentythree studies reported a mutation in Ras, with a combined positivity rate of 14% (95%CI: 8%-21%; I 2 = 95%). Raf mutations were informed in six studies. Six studies informed the presence of Akt mutations, two studies informed mTOR mutations and only one study reported mutations of MAPK. The most frequently described therapeutic targets were EGFR, and the PIK3CA and Ras pathways, though inconsistency in positivity rates was significant. Our study did not allow the identification of any specific clinical characteristics that might explain the observed heterogeneity. Despite the overall good quality of the included studies, the applicability of these results to patients' general population with CC is still unclear.

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El impacto de la prueba de VPH en los programas de tamizaje en América Latina: el caso de Argentina

Cited by 13 publications

References 27 publications

Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study

Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study

A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina

A systematic review and meta-analysis of the prevalence of therapeutic targets in cervical cancer

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