Introduction of HPV testing for cervical cancer screening in The Scale-Up project Central America: The Scale-Up project
Introduction of HPV testing for cervical cancer screening in The Scale-Up project Central America: The Scale-Up project
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DOI：
10.1016/j.ypmed.2020.106076
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发表时间：
2020-06-01
影响因子：
5.1
通讯作者：
de Sanjose, Silvia
中科院分区：
文献类型：
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作者：
Holme, Francesca;Jeronimo, Jose;de Sanjose, Silvia
扩大项目在危地马拉、洪都拉斯和尼加拉瓜的选定公共卫生中心引入了阴道自我采样和低成本人乳头瘤病毒（HPV）检测作为宫颈癌筛查的主要方法。我们评估特定国家在筛查方面取得的成就：目标覆盖、分类和治疗。 2015 年至 2018 年间，向 30 岁以上的女性提供宫颈癌筛查。 HPV 阳性女性的分诊基于醋酸或巴氏涂片的目视检查。汇总数据包括接受筛查的女性总数、自我采样的使用、年龄、自上次筛查以来的时间、HPV 结果、分类测试、分类结果和治疗。共有 231,741 名女性接受了 HPV 筛查，占该项目目标人群的 85.8%。危地马拉的 HPV 阳性率 (12.4%) 低于洪都拉斯和尼加拉瓜（分别为 14.5% 和 14.2%，p < 0.05）。在危地马拉、尼加拉瓜和洪都拉斯，分别有 84.2%、85.8% 和 50.1% 的 HPV 阳性女性完成了后续分类测试。在分流测试呈阳性的患者中，危地马拉、尼加拉瓜和洪都拉斯分别有 84.7%、67.1% 和 58.8% 的患者接受了治疗。尼加拉瓜的首次筛查率最高（55.8%），该国也广泛使用自我采样（97.1%）。扩大规模项目表明，在高负担、低资源环境下大规模宫颈癌筛查和治疗干预是可以实现的。自我取样和烧蚀治疗是该项目取得成就的关键。数据监测、随访失败以及筛查呈阳性女性的分诊方法仍然是取得成功的关键。
The Scale-Up project introduced vaginal self-sampling and low-cost human papillomavirus (HPV) testing as the primary approach for cervical cancer screening in selected public health centers in Guatemala, Honduras, and Nicaragua. We evaluate the country-specific accomplishments in screening: target-coverage, triage, and treatment. Between 2015 and 2018, cervical cancer screening was offered to women at least 30 years of age. Triage of HPV-positive women was based on visual inspection with acetic acid or Pap. Aggregated data included total women screened, use of self-sampling, age, time elapsed since last screening, HPV results, triage tests, triage results, and treatment. A total of 231,741 women were screened for HPV, representing 85.8% of the target populations within the project. HPV positivity was lower in Guatemala (12.4%) compared to Honduras and Nicaragua (14.5% and 14.2%, respectively, p < 0.05). A follow-up triage test was completed for 84.2%, 85.8%, and 50.1% of HPV-positive women in Guatemala, Nicaragua, and Honduras, respectively. Of those with a positive triage test, 84.7%, 67.1%, and 58.8% were treated in Guatemala, Nicaragua, and Honduras, respectively. First-time screening was highest in Nicaragua (55.8%) where self-sampling was also widely used (97.1%). The Scale-Up project demonstrated that large-scale cervical cancer screening and treatment intervention in a high-burden, low-resource setting can be achieved. Self-sampling and ablative treatment were key to the project's achievements. Data monitoring, loss to follow-up, and triage methods of screen-positive women remain critical to full success.