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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
Open accessAbstract
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 [12–17].”
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Bonilla, J., Amaya-Guío, J., Olaya-García, P., & Bonilla-Bula, L. (2018) · Revista Colombiana de Obstetricia y Ginecología · doi:10.18597/rcog.3149 · Cited by 2
Williams, C. K. O. (2018) · Springer eBooks · doi:10.1007/978-3-319-99238-9_1
Acceptability of HPV self-sampling tests: Talanoa with women and health workers in Samoa
Tafuna’i, M. (2019) · Otago University Research Archive (University of Otago)
Xiong, S., Ghebre, R. G., Kulasingam, S., Mason, S. M., Pratt, R. J., & Lazovich, D. (2022) · Research Square · doi:10.21203/rs.3.rs-1762475/v1
Caracterización de los programas de tamizaje de cáncer de cuello uterino en América Latina
Fernández-Deaza, G. P. (2021) · doi:10.11144/javeriana.10554.52935
A Brief Summary of the Current Role of Human Papillomavirus Testing in Cervical Cancer Screening
Van, T. T. (2023) · Clinical Microbiology Newsletter · doi:10.1016/j.clinmicnews.2023.08.002 · Cited by 1
Antelo, V. S., Paolino, M., & Arrossi, S. (2023) · Salud Ciencia y Tecnología · doi:10.56294/saludcyt2023624
Self-citationPereira, S. D. G., Nobre, L., Ribeiro, M., Carvalho, P., Morais, A., Sousa, R., Moniz, A. P., Matos, F., Fernandes, G., Pimentel, J. P., et al. (2024) · medRxiv · doi:10.1101/2024.04.05.24305323
WITHDRAWN: A brief summary of the current role of HPV testing in cervical cancer screening
Van, T. T. (2024) · Clinical Microbiology Newsletter · doi:10.1016/j.clinmicnews.2023.10.003
RetractedPensar el cáncer de cuello de útero
Espinoza, M. (2023) · SigMe · doi:10.14409/sigme.2023.1.e0007
Antelo, V. S., Paolino, M., & Arrossi, S. (2024) · Salud Ciencia y Tecnología · doi:10.56294/saludcyt2024624
Self-citationLucksom, P. G., Sherpa, M. L., Pradhan, A., & Sherpa, M. L. (2024) · The Journal of Obstetrics and Gynecology of India · doi:10.1007/s13224-024-02049-6
Types, Diagnosis and Treatment of Cervical Cancer
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Lee, F., Islam, J. Y., Mutua, M. M., Kabare, E., Manguro, G., Waweru, W., Mandaliya, K. N., Shafi, J., McClelland, R. S., & Smith, J. S. (2025) · Sexually Transmitted Infections · doi:10.1136/sextrans-2024-056159
Hu, J., Wang, H., Zhao, S., Huang, L., Chen, X., Zhao, X., Zhang, Y., & Zhao, F. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103205
Kenyan Men and Cervical Cancer Prevention: Insights from a National Survey
Moucheraud, C., Ochieng, E., Golub, G. M., Navario, P., Sacks, E., Abdillahi, H., & Hoffman, R. M. (2025) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-25-0987
Fletcher, R., Ampofo, E. A., Badzi, C. D., & Saah, A. (2025) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2025.102254
Paolino, M., Antelo, V. S., Cuberli, M., Curotto, M., Pera, A. L., Binder, F., Mazzadi, J. D., Firmenich, B., & Arrossi, S. (2024) · Figshare · doi:10.6084/m9.figshare.26561075
Self-citation
Metadata
- 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
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 3
- Issue
- 2
- Pages
- e85-e94
- ISSN
- 2214-109X (ISSN-L)
- 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
- 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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