Abstract:
BACKGROUND : The WHO strategy for cervical cancer elimination strives to achieve
70% coverage with high-performance cervical screening. While few low- and
middle-income countries have achieved this, high-risk human papillomavirus
(hrHPV) self-testing creates the possibility to rapidly upscale access to highperformance
cervical screening across resource settings. However, effective
hrHPV screening requires linkage to follow-up, which has been variable in prior
studies. This study developed and tested an implementation strategy aimed at
improving screening and linkage tofollow-up care in South EastDistrict in Botswana.
METHODS : This study performed primary hrHPV self-testing; those with positive
results were referred for a triage visit. Withdrawals for any reason, loss-to
follow-up between hrHPV test and triage visit, and number of call attempts to
give hrHPV results were also documented. Acceptability of the program to
patients was measured as the proportion of patients who completed a triage
visit when indicated, meeting the a priori threshold of 80%. Feasibility was
defined as the proportion of participants receiving the results and attending
follow-up. To assess the associations between participant characteristics and
loss-to-follow-up we used log-binomial regressions to estimate risk ratios and
95% confidence intervals (CI).
RESULTS : Enrollment of 3,000 women occurred from February 2021 to August
2022. In total, 10 participants withdrew and an additional 33 were determined
ineligible after consent, leaving a final cohort of 2,957 participants who
underwent self-swab hrHPV testing. Half (50%) of participants tested positive
for hrHPV and nearly all (98%) of participants received their hrHPV results,
primarily via telephone. Few calls to participants were required to
communicate results: 2,397 (82%) required one call, 386 (13%) required 2 calls,
and only 151 (5%) required 3–5 calls. The median time from specimen
collection to participant receiving results was 44 days (IQR, 27–65). Of all
hrHPV positive participants, 1,328 (90%) attended a triage visit.
DISCUSSION : In a large cohort we had low loss-to-follow-up of 10%, indicating that
the strategy is acceptable. Telephonic results reporting was associated with high
screening completion, required few calls to participants, and supports the
feasibility of hrHPV self-testing in primary care followed by interval triage.
