El Salvador has one of the world’s highest cervical cancer incidence and mortality rates, at 37.2/100,000 and 18.2/100,000, respectively. In an effort to improve cervical cancer screening in El Salvador, the Ministry of Health, in cooperation with Basic Health International, has included additional screening technologies, such as visual inspection with acetic acid and an HPV-DNA-based screening demonstration project into their public sector health system.
Consensus amongst stakeholders from the Ministry of Health, the OBGYN Society, International agencies, non-profits, and other public sector institutions that work on cervical cancer prevention was obtained to develop and support the demonstration project. Training of public sector physicians, nurses, health promoters, and laboratory technicians about HPV screening methods and guidelines was conducted. Research about cost-effectiveness, adherence to recommended screening, screening acceptability, and follow-up were conducted.
The Ministry of Health of El Salvador received a donation of careHPV tests as part of a 3-phase implementation project. This project will provide population-based screening for approximately 30,000 women aged 30-59 living in the Paracentral Region of El Salvador. Currently at Phase 3, 20,000 women have been screened through this project, and it is expected to reach 30 thousand women by 2016. Based on the evidence from the implementation project and the new World Health Organization's Guidelines, national cervical cancer guidelines have been developed by the Ministry of Health. This was done in order to update algorithms, which include HPV testing and managment strategies for HPV positive women. The Ministry of Health is expected to continue scaling up screening with HPV testing until national coverage is reached by 2019.
Implementation of an alternative cervical cancer screening approach in a low resource setting may be feasible but it requires advocacy, training, constant monitoring, and evaluation as well as a research component which will lead to evidence-based policy changes.