Abstract C64: Use of HPV self-sampling to increase screening for cervical cancer in indigenous and rural communities in Guatemala
Authors: Gottschlich Anna , Murchland Audrey , Bevilacqua Kristin , Pineda Andres , Rivera-Andrade Alvaro , Alvarez Christian , Ogilvie Gina , Mendoza-Montano Carlos , Meza Rafael 
Published: March 2017

BACKGROUND: Incidence and mortality rates of cervical cancer in Guatemala, as well as many other low- and middle-income countries, are considerably higher than rates in high-income countries. This is most likely due to low rates of cervical cancer screening in these countries, specifically in indigenous and rural populations. Current estimates suggest that less than 40% of women in Guatemala have ever been screened for cervical cancer, with much lower rates in indigenous and rural communities. We therefore proposed that reliance on Papanicolaou (Pap) and visual inspection with acetic acid (VIA) screening are not the most effective methods for controlling and preventing cervical cancer in indigenous and rural communities in Guatemala. Thus we investigated self-collection HPV tests as an alternative primary method of screening. HPV testing can be administered by a woman herself in the privacy of her home, thus mitigating issues of accessibility and privacy, which we believe to be barriers to screening experienced by women in these populations. We hypothesize that an HPV test will increase rates of follow-up care (Paps/VIAs) in these communities. Our prior study showed that HPV testing was highly acceptable in one indigenous group in Guatemala, and this study aims to expand upon those results to determine whether these tests are acceptable in other populations, and if there is an increase in follow-up care after use of these tests.

METHODS: A randomly selected group of women (N=1000), ages 18-60, residing in two rural communities (Santiago Atitlan, which is approximately 70 kilometers outside of Guatemala City, and Livingston, which is on the Caribbean coast) will be surveyed June-July 2016 to assess risk factors and knowledge of HPV and cervical cancer. Eligible women (ages 25-56 who are not menstruating or pregnant and have not had a hysterectomy) will be asked to self-collect a vaginal sample to be tested for HPV to assess the prevalence in each community, as well as the acceptability of HPV self-sampling as an option for cervical cancer screening. We have seen that HPV testing is acceptable in Santiago, but are interested to see if the test is acceptable in other populations with different ethnic backgrounds. Women will be given their results from the HPV test within a month after data collection and then be contacted 6 months and 1 year after to determine if they followed-up on their results.

RESULTS/FINDINGS: In our pilot study, 93% of women in Santiago were interested in providing a sample and 88% were eligible, showing that the test was highly acceptable in this community. We expect to see similar rates of acceptability in this follow-up study, however this study will be performed in different communities, with varying ethnic compositions, which could alter these rates. Additionally, in our pilot study, 21% of women tested positive for HPV, with 17% testing positive for high risk HPV. We again expect similar results for rates of HPV, but this could differ between communities. We will assess baseline rates of Pap/VIA screening in our surveys and hope to see increased rates of follow-up screening among women who have tested positive for HPV when we contact them at the 6-month and 1-year mark. We may also see increased rates of follow-up care in women who tested negative for HPV, as they have now been exposed to education and information about cervical cancer screening.

CONCLUSIONS: Self-collection HPV testing appears to be an acceptable form of cervical cancer screening in at least one, if not more, indigenous and rural communities in Guatemala. This study will help determine if HPV testing increases the rate at which women receive Pap/VIA screening after receiving their HPV test result. With increased screening for cervical cancer in these communities, the incidence and mortality rates of this disease could be greatly reduced.

**Data collection will conclude in August and all results will be analyzed prior to this conference.

Citation Format: Anna Gottschlich, Audrey Murchland, Kristin Bevilacqua, Andres Pineda, Alvaro Rivera-Andrade, Christian Alvarez, Gina Ogilvie, Carlos Mendoza-Montano, Rafael Meza. Use of HPV self-sampling to increase screening for cervical cancer in indigenous and rural communities in Guatemala. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C64.