Primary HPV-based screening has been examined in randomized trials and more recently in few pilot programs. Current recommendations encourage implementation of HPV-based screening in the context of an organized program. Making the transition from trial evidence to real-life settings requires careful monitoring and evaluation. Using a comparative health effectiveness research approach, HPV-based screening has been rolled-out with women randomly allocated to contemporary comparison groups. This has allowed for evaluating effects, logistics, and acceptability of the new screening test in the context of routine practice.
An example from the organized screening program of Stockholm County will be used to illustrate the comparative health effectiveness research approach. Women over 30 were randomly allocated 1:1 to cytology- or HPV-based screening. Indicators including participation following invitation to screening, detection rates, and acceptability were monitored.
Preliminary results from primary HPV-based screening implementation in the organized screening program of Stockholm County have shown non-inferior attendance compared to cytology-based screening. The overall number of cytologies performed has decreased in the HPV-arm and similar detection rates for high grade lesions were found in both arms. Questions regarding screening test results have increased. Implementing in a randomized-fashion in the context of an organized, routine program has allowed for monitoring and evaluation in real-life practice.