PREVENTION OF CERVICAL CANCER IN ARGENTINA, CONTRIBUTIONS FROM IMPLEMENTATION SCIENCE

ARROSSI SILVINA; SANCHEZ ANTELO, VICTORIA ; PAOLINO MELISA

Congreso; LXVI REUNIÓN ANUAL DE LA SOCIEDAD ARGENTINA DE INVESTIGACIÓN CLÍNICA (SAIC); 2021

Cervical cancer is one of the leading causes of cancer death among women in Argentina. Human papilloma- virus (HPV) screening allows for self-collection with po- tential to reduce barriers to screening and increase cov- erage. Implementation science was used to introduce and evaluate performance and implementation of HPV self-collection in Argentina. Main questions were: Would it be acceptable for women? Would it be effective to in- crease screening uptake? What were main challenges associated with the strategy when scaled-up?HPV self-collection was introduced in Argentina through the EMA Project, a mix method study carried out in the province of Jujuy: it included a pragmatic cluster ran- domized trial and qualitative research to evaluate ac- ceptability and adoption by different stakeholders. The study showed that HPV self-collection offered to women by community health workers (CHWs) during home vis- its was accepted by women and health providers, and it resulted in a four-fold difference in screening uptake between arms. Between 2015 and 2017 the strategy was introduced in 4 additional provinces.Main challenges when scaling-up HPV-Self collection were analyzed through a fidelity study carried out in La Matanza (Buenos Aires Metropolitan Area). Results showed that there were adaptations regarding the offer of self-collection, which were the result of the different social context where women live, and their relationshipwith health promoters. As a result, the contact was short- er, with fewer pieces of information provided to women during the offer. This did not impact the quality of the sample taken by women who did accept self-collection, but it might have an impact on the overall acceptability. We also observed that adherence to follow-up was chal- lenging, with reduced level of triage when compared to levels obtained in the EMA randomized controlled trial. The ATICA study was designed to evaluate effective- ness of an mHealth-based intervention (text messages used to communicate with positive women and CHWs) to increase adherence to triage by HPV+ women who performed self-collection. The study was an effective- ness-implementation hybrid type I trial and used a mixed-methods approach. Results showed that most women accepted receiving text messages; the interven- tion was effective at increasing triage adherence among HPV+ women.Summarizing, the studies showed that when offered by CHWs, HPV-self collection is acceptable to women and health providers, and effective to increase screening up- take. However, when scaled-up further adjustments of the offer will be probably needed. Adherence to Triage by HPV+ can be challenging. mHealth methods are ef- fective to communicate with women with reduced access to the health system, they increase triage, and they are accepted by women.