Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial

Arrossi, Silvina; Thouyaret, Laura; Herrero, Rolando; Campanera, Alicia; Magdaleno, Adriana; Cuberli, Milca; Barletta, Paula; Laudi, Rosa; Orellana, Liliana

doi:10.1016/s2214-109x(14)70354-7

Cited by 217Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

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Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial

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Arrossi, Silvina, Thouyaret, Laura, Herrero, Rolando, Campanera, Alicia, Magdaleno, Adriana, Cuberli, Milca, Barletta, Paula, Laudi, Rosa, Orellana, Liliana·2015·The Lancet Global Health

DOI 10.1016/s2214-109x(14)70354-7

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Abstract

BACKGROUND: Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV DNA self-collection could increase screening coverage, but implementation of this technology is difficult in countries of middle and low income. We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening. METHODS: We did a population-based cluster-randomised trial in the province of Jujuy, Argentina, between July 1, 2012, and Dec 31, 2012. Community health workers were eligible for the study if they scored highly on a performance score, and women aged 30 years or older were eligible for enrolment by the community health worker. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). The primary outcome was screening uptake, measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02095561. FINDINGS: 100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group; nine did not take part. 191 participating community health workers (94 in the intervention group and 97 in the control group) initially contacted 7650 women; of 3632 women contacted by community health workers in the intervention group, 3049 agreed to participate; of 4018 women contacted by community health workers in the control group, 2964 agreed to participate. 2618 (86%) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit, compared with 599 (20%) of 2964 in the control group (risk ratio 4·02, 95% CI 3·44-4·71). INTERPRETATION: Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake, showing that this strategy is effective to improve cervical screening coverage. This intervention reduces women's barriers to screening and results in a substantial and rapid increase in coverage. Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage. FUNDING: Instituto Nacional del Cáncer (Argentina).

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To increase screening coverage, HPV testing has been offered to women via self-collection, removing the need for a pelvic exam, clinic setting and a trained provider.
“To increase screening coverage, HPV testing has been offered to women via self-collection, removing the need for a pelvic exam, clinic setting and a trained provider [12–17].”
From Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (2019) · cites this paper as [13]

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Interpretation Off ering...
(2015)
Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis
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Authors: Arrossi, S., Thouyaret, L., Herrero, R., Campanera, A., Magdaleno, A., Cuberli, M., Barletta, P., Laudi, R., & Orellana, L.
Affiliations: Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
Instituto Nacional del Cáncer (AR)
Centre international de recherche sur le cancer (FR)
Ministerio de Salud (AR)
Corresponding author: Arrossi, Silvina
ORCID: Arrossi, Silvina
Herrero, Rolando
Orellana, Liliana
Venue: The Lancet Global Health
Publisher: Elsevier BV
Published: 2015-02
Volume: 3
Issue: 2
Pages: e85-e94
ISSN: 2214-109X (ISSN-L)
DOI: 10.1016/s2214-109x(14)70354-7
OpenAlex: W2142272848
Cited by: 217
References: 28
Citations by year: 2026: 14 · 2025: 9 · 2024: 21 · 2023: 22 · 2022: 19 · 2021: 15 · 2020: 22 · 2019: 26 · 2018: 21 · 2017: 22 · 2016: 9 · 2015: 17
FWCI: 18.02
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: The Lancet Global Health (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Bushehr University of Medical Sciences Repository (Bushehr University of Medical Sciences) (acceptedVersion)
Americanae (AECID Library) (submittedVersion, cc-by-nc-sa)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Own your potential (DEAKIN) (submittedVersion)
CONICET Digital (CONICET) (submittedVersion, cc-by-nc-sa)
Funders: World Health Organization
National Cancer Institute
Topics: Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords: cervical cancer screening, screening uptake, community health workers, home visits, HPV testing, cervical cancer prevention, resource-limited settings, barriers to screening, women's health
MeSH terms: Adult, Aged, Argentina, Uterine Cervical Neoplasms, Community Health Services, Female, House Calls, Humans, Mass Screening, Middle Aged, Self Care, Vaginal Smears, Papillomavirus Infections

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Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial

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