Effectiveness of HPV-Testing in Cervical Cancer Prevention in the Jujuy Demonstration Project in Argentina: A Population-Based, Quasi-Experimental Study

Background HPV-testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2012-2014). It involved testing women aged 30 attending the public health system with clinician-collected (CC) HPV-tests. HPV-self-collection (SC) was introduced as programmatic strategy in 2014. Methods In this quasi-experimental study, we used multivariable logistic regression and propensity matching scores (PMS) to evaluate the effectiveness of programmatic HPV-testing to detect CIN2 in comparison to cytology, using data from the National Cervical Cancer Prevention Program. The primary outcome was detection of histologically diagnosed CIN2 among women aged 30 screened between Jan 1, 2010, and Dec 31, 2014. RE-AIM framework was used for pre-post analysis of programmatic dimensions (Reach, Effectiveness, Adoption, Implementation and Maintenance). Findings Among the 29,631 women cytology-screened between 2010-2011, 236 CIN2 were detected. Among the 49,565 women HPV-tested in 2012-2014 (CC-tested= 44,700; SC-tested=4,865) the figure was 693 (658 CC-tests; 35 SC-tests). Compared to cytology, the odds of being diagnosed CIN2 were 2·34 (95% CI 2·01-2·73, p<0·001), and OR:1·08, (95% CI 0·74, 1·52, p=0·680), when screened with CC-testing and SC-testing respectively, after controlling for age and health insurance status. Improvement of programmatic indicators were observed in the HPV-testing period for the effectiveness, implementation and adoption dimension of RE-AIM. Reach was similar in both periods, but SC-testing allowed for increased coverage of HPV-testing. Interpretation HPV-testing in middle-income countries highly increases detection of CIN2 lesions and allows for improvement of programmatic indicators. Funding: Argentinean National Cancer Institute, National Council of Scientific and Technologic Research. Declaration of Interest: None declared.