Abstract oral session 2014 World Cancer Congress

Introducing careHPV into a public sector screening program in El Salvador (#341)

Miriam Cremer 1 , Mauricio Maza 2 , Karla Alfaro 2 , Julia Gage 3 , Philip Castle 4 , Jane Kim 5
  1. University of Pittsburgh Medical Center, Pittsburgh, PA, United States
  2. Basic Health International, San Salvador, El Salvador
  3. National Cancer Institute,
  4. Global Coalition against Cervical Cancer,
  5. Harvard School of Public Health,

Background and Context: CAPE (Cervical Cancer Prevention in El Salvador) introduces a low-cost HPV-DNA test into a public sector program. At 19%, El Salvador has one of the lowest screening rates in Latin America. Coverage rates are poor and follow-up for abnormal cytology is inadequate.

Aim: Started in October 2012, CAPE consists of three phases. The aim is to implement a phased program that will ultimately screen 30,000 women. The true impact of this program lies in its final Phase wherein the program is handed over to the government of El Salvador, and the Ministry of Health makes it the national screening program. Results of phase 2 of the program (n=8,053) are presented.

Strategy/Tactics: 8,035 women, age 30-49, were screened in phase 2. 6,737 had both self- and provider-collected careHPV samples and 1,298 had only provider-testing. The agreement between both forms of sampling was 83.6% with a kappa of 0.45. HPV-positive women were referred to treatment using the strategy their community followed. Cohort A was referred to colposcopy, and Cohort B had immediate visual triage and was treated with cryotherapy.

Programme/Policy Process: A pilot program introducing HPV testing was successfully implemented in a low-resource setting. Requiring women to return for a colposcopy made them less likely to complete treatment. Outreach to women who had not been screened recently helped find women at higher risk for HPV.

Outcomes/What was learned: Overall, 341 (12.5%) women were HPV positive in Cohort A, and 325 (11.3%) were positive in Cohort B. Currently, 2,736 women in Cohort A (70.1%), and 2,889 women in Cohort B (77.9%) have completed their 6-month follow-up. In Cohort A, all were referred for colposcopy—313 attended their appointment, and 243 were eventually treated. 29.9% have not yet completed follow-up and were not included in the analysis. In Cohort B, 257/325 received immediate treatment.