Abstract IA13: Introduction of HPV self-collection in Argentina, main results, and lessons
Authors: Arrossi Silvina 
Published: September 2020

Abstract
Background: Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV self-collection could increase screening coverage, but implementation of this technology is difficult in countries with low-income settings. In Argentina, during 2012-2014 we implemented the Jujuy Demonstration (JDP) to introduce HPV testing as primary screening. As part of the JDP, we investigated whether offering HPV self-collection during routine home visits by community health workers could increase cervical screening.
Methods: We describe the programmatic components developed for each phase of HPV self-collection implementation as well as present data about its performance to detect CIN2+ lesions. For that we analyzed data from the national screening information system (SITAM); we reviewed program documents, presentations, and reports; and we also analyzed qualitative/quantitative data about HPV self-collection acceptability by women and health providers.
Results: Acceptability and effectiveness of HPV self-collection to increase screening-uptake was evaluated in a research project (The EMA Project) carried out in 2012 in the province of Jujuy. The project combined qualitative research with a Cluster Randomized Trial. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). Results showed that HPV-self collection was accepted by women and health providers, and effective to increase screening uptake (risk ratio 4·02, 95% CI 3·44–4·71). HPV-testing CIN2+ detection rate was 1.15%. Results from the EMA Project were used to design and develop key components of the scaling-up phase (training and communication materials, protocols, and guidelines). In 2014 HPV self-collection was extended to the whole province as a strategy to increase screening among socially vulnerable women. It was offered by 70% of the 700 provincial community health workers. Facilitators of self-collection scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. In 2014, self-collection represented 38% of total HPV testing and, if we consider the whole JDP, 10% of screening in the target population was achieved through self-collection. CIN2+ detection rate of HPV self-collection when used as a programmatic strategy was 0.6%; this decrease in relation to the detection rate found in the EMA Project is probably explained by a loss to follow-up.
Conclusion: HPV self-collection was successfully scaled up, with a high level of adoption among health providers, which resulted in increased screening among socially vulnerable underscreened women.
Citation Format: Silvina Arrossi. Introduction of HPV self-collection in Argentina, main results, and lessons [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA13.