Abstract 39: Factors Associated With Receiving Results and Attending Colposcopy in Patients With Positive HPV Screens in Mexico City
Authors: León-Maldonado Leith , Hernández-Ramírez Raul U. , Torres-Ibarra Leticia , Spiegelman Donna , Sheth Sangini S , Lazcano-Ponce Eduardo , Cadena-Fiscal José Damián , Salmerón Jorge 
Published: June 2023

Abstract
Purpose: Unlike in high-income countries, where cervical cancer (CC) screening programs have resulted in a dramatic decrease in incidence and mortality of this nearly fully preventable disease, in low- and middle-income countries, the impact of these programs has been limited. Poor follow-up to abnormal cancer screening tests lessens the benefit of CC screening. We sought to identify multilevel factors at the level of patient, provider, and healthcare system related to receipt of screening results and attendance to colposcopy among patients with positive screening results in a CC screening program in Mexico.
Methods: We studied 1,351 patients who were scheduled for colposcopy after testing positive for high-risk human papillomavirus in two screening demonstration studies conducted in Mexico City’s Tlalpan District (2017-2018). Multilevel factors associated with receipt of screening results and with adherence to a colposcopy appointment were identified using multivariable logistic regression.
Results: Participants had a median age of 40 years, 58% had less than high school education, and 74% had a Pap screening recently (i.e., in the last 5 years). Fifty-five percent of participants retrieved their screening results at the healthcare facility before being reminded to do so. Greater adherence to obtaining screening test results was associated with providing an email address as contact information (Odds Ratio 1.35 [95% Confidence Interval 1.03-1.77]), attending a facility with family medicine (1.54 [1.07-2.21]), and receiving care from experienced nurses (1.85 [1.30-2.70]). Fifty-seven percent of participants attended their first scheduled colposcopy appointment. Providing a phone number as contact information was linked to improved adherence to colposcopy (1.27 [1.01-1.59]), whereas longer travel time between the healthcare facility and the colposcopy clinic was associated with a decrease in colposcopy adherence (0.68 [0.49-0.94]). Having a Pap recently was positively associated with better compliance with both outcomes (1.36 [0.96-1.94] for receiving results; 1.59 [1.10-2.29] for colposcopy adherence).
Conclusion: We identified multilevel factors associated with abnormal test follow-up in patients in Mexico City. Additional research is necessary to design and test components for a multilevel intervention to address these factors and enable successful implementation of the follow-up process for abnormal screens from screening to diagnosis and treatment.
Citation Format: Leith León-Maldonado, Raul U. Hernández-Ramírez, Leticia Torres-Ibarra, Donna Spiegelman, Sangini S Sheth, Eduardo Lazcano-Ponce, José Damián Cadena-Fiscal, Jorge Salmerón. Factors Associated With Receiving Results and Attending Colposcopy in Patients With Positive HPV Screens in Mexico City [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 39.