Effectiveness of HPV self-collection offered by community health workers at home visits to increase screening uptake (EMA study): A cluster randomized trial

ARROSSI S; THOUYARET L; HERRERO R; CAMPANERA A; MAGDALENO B; CUBERLI M; BARLETTA P; ORELLANA L

The Lancet Global Health

The Lancet

Año: 2015 p. 85 - 94

2214-109X

Background: Failure to achieve high screening coverage is a major problem in cervical cancer prevention programs. We aimed to assess the effect on women´s screening uptake of HPV selfcollection offered by community health workers (CHWs). Methods: We undertook a cluster-randomized trial in Jujuy, Argentina. Clusters were CHWs working in Jujuy´s public health system by 06/2012 and evaluated with good performance. 200 CHWs were randomly selected and assigned 1:1 to offer during home-visits HPV self-collection (intervention group, IG) or to promote clinician-collected HPV-testing (control group, CG). Eligible women were aged≥30, and living in a household visited by study CHWs. Primary outcome was screening uptake, defined at individual participant level: proportion of women with any HPV-test six months after the CHW visit. Secondary outcomes included CIN2+ detection rates. CIN2+ cases per 1000 women are reported. Trial registered with ClinicalTrials.gov (NCT02095561). Results: 94 and 97 CHWs in the IG and CG respectively enrolled 6013 women. In the IG 2618/3049 (85*9%) women had a self-collected or clinician-collected HPV-test, compared to 599/2964 (20*2%) HPV-tested women from the CG(Risk Ratio 4*02, 95%CI 3*44-4*71). CIN2+ detection rates were 1*15% (29/2519) and 1*29% (9/698) among women with self-collected tests and clinician-collected tests respectively, difference not statistically significant. CIN2+ cases per 1000 participating women was 10*2 (31/3049) and 2*4 (7/2964) in the IG and CG respectively (p=0*0002). Interpretation: HPV self-collection offered by CHWs is highly effective to rapidly increase screening uptake and detection of cancer precursors. Funding: Instituto Nacional del Cáncer (Argentina).