Implementation of second round of HPV-based screening for cervical cancer in programmatic contexts in Argentina

Abstract

Objectives. To evaluate implementation of the second round of human papillomavirus (HPV)-based cervical screening, introduced in Argentina in 2012–2014 through the Jujuy Demonstration Project for women 30 years and older, and describe the characteristics of women who adhere to the recommended five-year rescreening interval. Methods. A retrospective cohort study was conducted based on the data of two rounds of screening. All women aged 30 years or older who had been HPV-tested during the Jujuy Demonstration Project and had a negative result were included. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation. Multivariable regression was used to examine factors associated with adherence to rescreening. Results. Of 42 307 HPV-negative women, 47.9% (n = 20 285) were rescreened in the second round (Reach); 69.2% of health centers provided at least one HPV test at second-round screening (Adoption); and 13.3% (n = 5 639) of women were rescreened within the recommended five-year interval. Among the total rescreened, 9.3% (n = 1 888) were HPV-positive, of which 95.0% underwent triage Pap and 79.2% of the HPV-positive/ abnormal Pap women had colposcopy. Considering women rescreened at five years, the second-round detection rate was 5.3/1 000 screened women. Rescreening at five years was significantly higher among women aged 30–44, with public health insurance, and those living in the provincial capital. Conclusions. Rescreening of HPV-negative women faced challenges linked to its reduced reach, especially if we consider the recommended five-year interval. Our findings suggest that we need to devise specific strategies to increase second-round screening rates.