학술논문
Community-integrated self-collected HPV-based cervix screening in a low-resource rural setting: a pragmatic, cluster-randomized trial
Document Type
Original Paper
Author
Gottschlich, Anna; Payne, Beth A.; Trawin, Jessica; Albert, Arianne; Jeronimo, Jose; Mitchell-Foster, Sheona; Mithani, Nadia; Namugosa, Ruth; Naguti, Priscilla; Pedersen, Heather; Rawat, Angeli; Simelela, Princess Nothemba; Singer, Joel; Smith, Laurie W.; van Niekerk, Dirk; Orem, Jackson; Nakisige, Carolyn; Ogilvie, Gina
Source
Nature Medicine. 29(4):927-935
Subject
Language
English
ISSN
1078-8956
1546-170X
1546-170X
Abstract
Effective approaches to improve coverage of self-collected human papillomavirus (HPV)-based cervix screening (SCS) as well as attendance at treatment for HPV-positive participants are needed to inform policy on optimal integration of cervical cancer screening programs within existing infrastructure in low-resource settings. ASPIRE Mayuge was a pragmatic cluster-randomized trial in rural Mayuge district, Uganda, comparing the superiority of two recruitment implementation strategies for SCS: Door-to-Door versus Community Health Day. Villages were randomized (unblinded) to a strategy, and participants aged 25–49 years with no previous history of hysterectomy or treatment for cervical cancer or pre-cancer were eligible. Participants completed a survey and participated in SCS. The primary outcome was rate of attendance at treatment after a positive SCS. The trial randomized 31 villages and 2,019 participants included in these analyses (Door-to-Door: 16 clusters, 1,055 participants; Community Health Day: 15 clusters, 964 participants). Among HPV-positive participants, attendance at treatment rates were 75% (Door-to-Door) and 67% (Community Health Day) (P = 0.049). Participants in the Community Health Day intervention were less likely to attend treatment compared to Door-to-Door (risk ratio = 0.78, 95% confidence interval: 0.64–0.96). No adverse events were reported. Policymakers in low-resource settings can use these results to guide implementation of SCS programs. ISRCTN registration: 12767014. ClinicalTrials.gov registration: NCT04000503.
The ASPIRE Mayuge trial in rural Uganda showed that implementation of door-to-door HPV screening led to better attendance of follow-up treatment services but requires more personnel compared to community health days.
The ASPIRE Mayuge trial in rural Uganda showed that implementation of door-to-door HPV screening led to better attendance of follow-up treatment services but requires more personnel compared to community health days.