Abstract 47: Human Papillomavirus (HPV) Cervical Cancer Screening and Secondary Prevention in Côte d’Ivoire: Time From Testing to Treatment
Authors: Gouesse Rita-Josiane , Dodo Mathurin , Kouassi Jean-Claude , Boni Simon , Setoh Joel , Zadi Ida , Bertram Meg , Shissler Tracey , Huang Lisa , Daceney Nemdia , Adoubi Innocent , Gauvreau Cindy , Kabue Mark 
Published: June 2023

Abstract
Purpose: Cervical cancer is both preventable and curable, yet, in Côte d’Ivoire, it is the second deadliest cancer affecting women. The Unitaid-funded SUCCESS project is supporting the Ivorian Ministry of Health (MOH) to eliminate cervical cancer through a screen-and-treat strategy with primary Human papillomavirus (HPV) DNA testing for secondary prevention. However, little is known about the challenges and opportunities of HPV-testing in Côte d’Ivoire. Here, we aimed to analyze the time elapsed between testing and results reception to highlight critical implementation steps.
Methods: We analyzed preliminary cohort study data of women aged 25-49 years who underwent HPV-testing at 10 health facilities, April-November 2022. After phone-call notification of result availability, results were delivered in-person by the healthcare provider, along with counseling. Visual acetic acid inspection (VIA) followed for HPV-positive, and treatment (same-day thermal ablation (TA) or loop electrical excision procedure) for VIA-positive women. Participants were followed through each step to document the test-to-treatment process and compute the expected testing-to-treatment time. Logistic regression was used to explore factors associated with VIA completion after an HPV-positive test.
Results: 1868 women (median age 37 [Inter Quartile Range: 33-41]) years were enrolled by November 2022, of whom 1712 (91.6%) preferred self-sampling. Overall, 948 (50.7%) results were available at health facility level; 240 (25.3%) within 30 days, 322 (34%) within 30-60 days and 386 (40.7%) after 60 days. There were 189 (19.9%) HPV-positive women of whom 56 (30%) underwent VIA. The average duration from testing to TA was 70.1±42.1 days, with 61.4±41.8 days from sample collection to results reception, and 27.5±29.8 days from reception to VIA. Women encountering a duration of 30-60 (OR 0.33, 95%CI: [0.16-0.68]) or more than 60 (OR 0.52, 95%CI: [0.29-0.94]) days between testing and result reception were less likely to complete VIA compared with those with less than 30 days.
Conclusion: Our findings suggest that test-to-treatment completion is likely to be affected by insufficiencies in sample/result processing and return to women. Hopefully, the upcoming deployment of 07 testing platforms under the MoH’s initiative to expand laboratory coverage along with advanced strategies to improve client follow-up and treatment, will help overcome these challenges.
Citation Format: Rita-Josiane Gouesse, Mathurin Dodo, Jean-Claude Kouassi, Simon Boni, Joel Setoh, Ida Zadi, Meg Bertram, Tracey Shissler, Lisa Huang, Nemdia Daceney, Innocent Adoubi, Cindy Gauvreau, Mark Kabue. Human Papillomavirus (HPV) Cervical Cancer Screening and Secondary Prevention in Côte d’Ivoire: Time From Testing to Treatment [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 47.