Evaluation of the effectiveness of high-risk human papilloma self-sampling test for cervical cancer screening in Bolivia

Abstract

Background: In Bolivia the incidence and mortality rates of uterine cervix cancer are the highest in America. The main factor contributing to this situation is the difficulty of establishing and maintaining quality prevention programs based on cytology. We aimed to evaluate the effectiveness of HR-HPV testing on self-collected samples to detect cervical intra-epithelial neoplasia and identify the best combination of screening tests. Methods: A total of 469 women, divided in two groups, were included in this study. The first group included 362 women that underwent three consecutively primary screening tests: self-collected sampling for HR-HPV detection, conventional cervical cytology and visual inspection under acetic acid (VIA). The second group included 107 women referred with a positive HR-HPV test that underwent conventional cervical cytology and VIA. The presence of high grade intraepithelial lesion (CIN 2+) or invasive cancer was verified by colposcopy and biopsy. Result: In the screening group the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer were 100, 76, 44% for the VIA, HR-HPV test and cytology, respectively. In the referred group, the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer by VIA and cytology were 100 and 81%, respectively. Conclusions: VIA and HR-HPV self-sampling were the best combination to detect CIN2+ lesions. Cytology analysis gave the poorest performance.

Assessing Barriers Encountered by Women in Cervical Cancer Screening and Follow-Up Care in Urban Bolivia, Cochabamba

“…Approved by the Bio-ethics committee of the Universidad Mayor de San Simon, Cochabamba, the study was performed in 2 successive phases and covered the urban and rural areas of the department of Cochabamba, Bolivia ( Figure 1 ). Phase 1 of the study investigated the demand side through the beneficiaries’ perception, HPV-positive women screened during a pilot project [ 6 ]. The aim of the pilot was to assess acceptability and clinical effectiveness of an inexpensive HR-HPV DNA detection strategy on self-collected samples to detect high grade intraepithelial lesions and cervical cancers.…”

“…In total, we covered 9 different municipalities grouped in 7 provinces ( Figure 1 and Figure S1 and Table S1 in Supplementary material File S1 ). We contacted every woman involved in the pilot project [ 6 ] as well as women from the general population in the department of Cochabamba ( Figure 1 ).…”

“…Data collection was conducted in 2 successive phases. In the first phase, semi-structured interviews were conducted targeting three key populations: healthcare professionals (HCP), promotoras (community-based agents) and HPV-positive patients screened during the pilot study [ 6 ]. Interviews were carried out from February 16th until July 6th 2018.…”

“…In Bolivia, only cytological analysis, and visual inspection under acetic acid (VIAA) are included in the national screening program. However, Bolivian screening coverage is poor, being between 20–33%, and performance is not satisfactory [ 5 , 6 ]. New screening methods based on HR-HPV DNA detection combined with VIAA or cytological analysis can not only improve early detection of cervical cancer but can also be performed on self-collected samples [ 7 , 8 ].…”

“…A pilot study was conducted in the department of Cochabamba to enable self-sampling cervical cancer screening. During the process, we observed a low rate of follow-up in women diagnosed as HR-HPV DNA positive and/or with VIAA positive precancerous lesions [ 6 ].…”