Participation and Follow‐Up Compliance in Cervical Cancer Screening According to Delivery Strategy for HPV Self‐Collection: A Community Trial in Underserved Colombian Areas

ABSTRACT

Low‐ and middle‐income countries (LMIC) continue to bear a high burden of cervical cancer (CC). Women's participation in CC screening is challenging in LMICs, but self‐collection of HPV tests has shown increased participation in controlled trials. However, data from real‐world studies and data on follow‐up compliance after positive screening test results are scant. A two‐arm community trial was conducted in four municipalities from two different territories in Colombia (HPV self‐ and clinician‐collected tests). A comparison of participation and follow‐up compliance was done between arms, both delivered through campaigns and routine screening. Women aged 30–50 without screening records within the previous 30 months were eligible. HPV‐positive women were recalled for triage/treatment in a second visit. A follow‐up was done at 6 months. In total, 1400 women were expected, but only 532 attended the screening visit. Participation rates were 49% (95% CI: 46–53) in the self‐collected and 26% (95% CI: 22.8–29.5) in the clinician‐collected arm. Campaigns resulted in higher participation than routine screening for both collection methods ( p  < 0.05), and significant differences by territory were observed. Follow‐up compliance was 89.6% and 71% at triage/treatment and 6‐month visits, respectively, without significant differences between study arms. HPV self‐collection resulted in higher participation than clinician collection; however, it did not directly translate to screening coverage. Therefore, delivery strategies and contextual barriers should be carefully analyzed for successful implementation. Anyhow, the increased participation and high compliance with the triage/treatment visit support the relevance and suitability of alternative programmatic approaches for HPV‐based screening.