CAPE (Cervical Cancer Prevention in El Salvador) introduces a low-cost HPV-DNA test into a public sector program. At 19%, El Salvador has one of the lowest screening rates in Latin America. Coverage rates are poor and follow-up for abnormal cytology is inadequate. Started in October 2012, CAPE consists of three phases. The aim is to implement a phased program that will ultimately screen 30,000 women. The true impact of this program lies in its final Phase wherein the program is handed over to the government of El Salvador, and the Ministry of Health makes it the national screening program. Results of phase 2 of the program (n=8,050) are presented.
8,050 women, age 30-49, were screened in phase 2. 6,737 had both self- and provider-collected careHPV samples and 1,298 had only provider-testing. The agreement between both forms of sampling was 83.6% with a kappa of 0.71. Women with provider-collected HPV-positive results were referred to treatment using the strategy their community followed. Cohort A was referred to colposcopy, and Cohort B had immediate visual triage and was treated with cryotherapy.
Overall, 489 (12.3%) of 3,963 women in Cohort A and 465 (11.4%) of 4.087 women in Cohort B tested HPV-positive. In Cohort A, all were referred for colposcopy—387 (79.1%) attended colposcopy in less than 6 months, and 203/489 (41.5%) were eventually treated. In Cohort B, 397/465 (85%) received immediate treatment and 56 (12%) were referred to colposcopy, of these women 408/465 (87.0%) were eventually treated.
A pilot program introducing HPV testing was successfully implemented in a low-resource setting. Requiring women to return for a colposcopy made them less likely to complete treatment. Outreach to women who had not been screened recently helped find women at higher risk for HPV.