In Argentina, Dr. Silvina Arrossi directed the “Demonstration Study for the Introductions of the HPV Test” between the years 2012-2014 with the aim of evaluating the performance of the test as primary screening in programmatic conditions. The project included more than 50.000 women from the Jujuy province, and demonstrated that incorporating the HPV test duplicated the National Cervical Cancer Prevention Program’s ability to detect precancerous and cancerous lesions.
Furthermore, it identified the central components of the use of the HPV Test at a programmatic level as a communication strategy, algorithms of follow-up care and treatment, and work manuals for the implementation of the HPV test.
During the 1990s, the breakthroughs in molecular biology identified the causal relation between HPV and cervical cancer (CC), which promoted the development of two new technologies for CC prevention: the HPV test and the vaccine against HPV.
The HPV test is a highly effective screening method. In diverse studies, it has been shown that the HPV test is more effective than the Papanicolaou test as a primary screening to detect precancerous lesions Furthermore, it has a high negative predictive value (NPV) which allows reduced screening frequencies.
Moreover, the HPV test can be taken by self-collection, which allows women to take the test themselves. This reduces adverse consequences of the structural and symbolic barriers which, many times, make it impossible to carry out the screening in the health care institutions.
About Self-Collection (SC)
A particular characteristic of the self-collection lies in that, by means of this method, screening is available to women who do not usually visit their health clinics and would therefore have a higher risk of not adhering to follow-up care or treatment. Thus, in a screening context based on the self-collection of the HPV test, the triage becomes a fundamental step in the process of cervical cancer prevention: it is the first method to identify HPV positive women (HPV+) who have a higher risk of developing cancer, and who would require diagnosis and treatment.
The Jujuy Demonstration Study in 2012, the National Cancer Institute along with the Jujuy Province’s Ministry of Health and the International Agency for Research on Cancer (IARC-OMD), implemented the research study EMA- Evaluación Modalidad Autotoma (Evaluation Methodology Self-Collection)
The EMA study was a cluster randomized trial which involved over 200 community health workers and 6000 women. The aim of this study was to evaluate the effectiveness of the HPV self-collection strategy in an attempt to increase screening coverage.
Moreover, in the framework of the EMA Study, quantitative and qualitative studies were carried out in order to understand women’s and the health care institutions’ perspectives on the self-collection.
Due to these results in 2014, in the province of Jujuy, self-collection was incorporated as a public health policy strategy.
Currently, the implementation of this method has reached the provinces of Misiones, Tucumán and Catamarca, as well as the La Matanza municipality in the province of Buenos Aires.