A cluster-randomized trial of self- vs clinician-collection in a community-based HPV-based screening program: The EMA study

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

Congreso; International Conference on HPV 2014; 2014

IPV Society

Background   In Argentina, Jujuy has introduced HPV-based primary screening since 2012. HPV self-collection is highly accepted by women and can reduce barriers to screening. Nonetheless, translation of this acceptability into packages of care that can be delivered at scale remains a major challenge. In Jujuy, community health workers (CHWs) visit houses twice a year for provision of several health services. Self-testing offered by CHWs could increase screening uptake by women from middle and low-income settings.     Objective: to evaluate effectiveness of HPV self-collection delivered at home by CHWs to increase participation in screening.       Methodology: We conducted a cluster randomized trial. Provincial CHWs with good performance in 2011 (488/698) were stratified according to gender and urban/rural setting. A sample of 200 CHWs was randomly selected with stratum proportional allocation. Within each stratum CHWs were randomly assigned (1:1) to the study arms: HPV self-collection offered to women during home-visits and a control group of CHWs who promoted HPV-testing at health centers. The primary end-point was screening uptake within 6 months of CHW visit. The project was led by the National Cancer Institute-Argentina.   Results: During the second semester of 2012, 191 CHWs contacted 3049 and 2964 eligible women from the intervention and control group who accepted to participate in the study. In the intervention arm, 2519 (82.6%) women self-collected their specimens, and 105 were screened at health centers. In total, 2618 (85.9%) women from the intervention group had an HPV-test, compared to 599 (20.2%) women from the control arm (p<0.0001). HPV positivity and detection rates of CIN2+ were 11.8% and 1.2% for self-testing and 11.6% and 1.3% for tests taken by health professionals. Additional analyses are underway considering colposcopic attendance and treatment in both groups.   Conclusion: self-collection for HPV testing offered by CHWs in Argentina is a highly effective method to increase screening uptake.