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

Autores
Arrossi, Silvina; Paolino, Melisa Delia; Laudi, Rosa; Gago, Juan Ezequiel; Campanera, Alicia; Marín, Oscar; Falcón, Cristina; Serra, Verónica; Herrero, Rolando; Thouyaret, Laura
Año de publicación
2019
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
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. Funding: Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.
Fil: Arrossi, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Paolino, Melisa Delia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Laudi, Rosa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina
Fil: Gago, Juan Ezequiel. Centro de Estudios de Estado y Sociedad; Argentina. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina
Fil: Campanera, Alicia. Ministerio de Salud de la Provincia de Jujuy; Argentina
Fil: Marín, Oscar. Hospital Pablo Soria; Argentina
Fil: Falcón, Cristina. Hospital Pablo Soria; Argentina
Fil: Serra, Verónica. Ministerio de Salud de la Provincia de Jujuy; Argentina
Fil: Herrero, Rolando. No especifíca;
Fil: Thouyaret, Laura. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina
Materia
Cancer
HPV
Prevention
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/129506
Acceder
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network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort studyArrossi, SilvinaPaolino, Melisa DeliaLaudi, RosaGago, Juan EzequielCampanera, AliciaMarín, OscarFalcón, CristinaSerra, VerónicaHerrero, RolandoThouyaret, LauraCancerHPVPreventionhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: 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. Funding: Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.Fil: Arrossi, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Paolino, Melisa Delia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Laudi, Rosa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Gago, Juan Ezequiel. Centro de Estudios de Estado y Sociedad; Argentina. Ministerio de Salud. Instituto Nacional del Cáncer; ArgentinaFil: Campanera, Alicia. Ministerio de Salud de la Provincia de Jujuy; ArgentinaFil: Marín, Oscar. Hospital Pablo Soria; ArgentinaFil: Falcón, Cristina. Hospital Pablo Soria; ArgentinaFil: Serra, Verónica. Ministerio de Salud de la Provincia de Jujuy; ArgentinaFil: Herrero, Rolando. No especifíca;Fil: Thouyaret, Laura. Ministerio de Salud. Instituto Nacional del Cáncer; ArgentinaElsevier2019-06info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/129506Arrossi, Silvina; Paolino, Melisa Delia; Laudi, Rosa; Gago, Juan Ezequiel; Campanera, Alicia; et al.; Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study; Elsevier; The Lancet Global Health; 7; 6; 6-2019; 772-7832214-109XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(19)30048-8info:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(19)30048-8info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-10-15T15:29:41Zoai:ri.conicet.gov.ar:11336/129506instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-10-15 15:29:42.121CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
spellingShingle 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, Silvina
Cancer
HPV
Prevention
title_short Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_full Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_fullStr Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_full_unstemmed Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
title_sort Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study
dc.creator.none.fl_str_mv Arrossi, Silvina
Paolino, Melisa Delia
Laudi, Rosa
Gago, Juan Ezequiel
Campanera, Alicia
Marín, Oscar
Falcón, Cristina
Serra, Verónica
Herrero, Rolando
Thouyaret, Laura
author Arrossi, Silvina
author_facet Arrossi, Silvina
Paolino, Melisa Delia
Laudi, Rosa
Gago, Juan Ezequiel
Campanera, Alicia
Marín, Oscar
Falcón, Cristina
Serra, Verónica
Herrero, Rolando
Thouyaret, Laura
author_role author
author2 Paolino, Melisa Delia
Laudi, Rosa
Gago, Juan Ezequiel
Campanera, Alicia
Marín, Oscar
Falcón, Cristina
Serra, Verónica
Herrero, Rolando
Thouyaret, Laura
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cancer
HPV
Prevention
topic Cancer
HPV
Prevention
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv 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. Funding: Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.
Fil: Arrossi, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Paolino, Melisa Delia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Laudi, Rosa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina
Fil: Gago, Juan Ezequiel. Centro de Estudios de Estado y Sociedad; Argentina. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina
Fil: Campanera, Alicia. Ministerio de Salud de la Provincia de Jujuy; Argentina
Fil: Marín, Oscar. Hospital Pablo Soria; Argentina
Fil: Falcón, Cristina. Hospital Pablo Soria; Argentina
Fil: Serra, Verónica. Ministerio de Salud de la Provincia de Jujuy; Argentina
Fil: Herrero, Rolando. No especifíca;
Fil: Thouyaret, Laura. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina
description 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. Funding: Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.
publishDate 2019
dc.date.none.fl_str_mv 2019-06
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/129506
Arrossi, Silvina; Paolino, Melisa Delia; Laudi, Rosa; Gago, Juan Ezequiel; Campanera, Alicia; et al.; Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study; Elsevier; The Lancet Global Health; 7; 6; 6-2019; 772-783
2214-109X
CONICET Digital
CONICET
url http://hdl.handle.net/11336/129506
identifier_str_mv Arrossi, Silvina; Paolino, Melisa Delia; Laudi, Rosa; Gago, Juan Ezequiel; Campanera, Alicia; et al.; Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study; Elsevier; The Lancet Global Health; 7; 6; 6-2019; 772-783
2214-109X
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
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info:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(19)30048-8
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
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eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
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dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
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reponame_str CONICET Digital (CONICET)
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instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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