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Rol ML, Picconi MA, Ferrera A, Sánchez GI, Hernández MDLL, Lineros J, Peraza A, Brizuela M, Mendoza L, Mongelós P, Cabrera Y, Rodríguez de la Peña M, Correa RM, Terán C, Colque Reynaga D, García L, Ramírez AT, Hernández-Nevarez P, Doimi F, Ramón M, Arias-Stella J, Zúñiga M, Villagra V, Bobadilla ML, Cardinal L, Valls J, Lucas E, Baena A, Fleider L, Venegas G, Cruz-Valdez A, Rodríguez G, Calderón A, Wiesner C, Luciani S, Broutet N, Herrero R, Almonte M. Implementing HPV testing in 9 Latin American countries: The laboratory perspective as observed in the ESTAMPA study. Front Med (Lausanne) 2022; 9:1006038. [PMID: 36465901 PMCID: PMC9714610 DOI: 10.3389/fmed.2022.1006038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings. Methods We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored (1 = compliant, 0 = not compliant) and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described. Results Seven of 12 laboratories had high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs. Conclusion High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a "culture of quality" should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening.
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Affiliation(s)
- Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - María de la Luz Hernández
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- SMS-Oncology, Amsterdam, Netherlands
| | - Joana Lineros
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Ana Peraza
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Marisol Brizuela
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Yessy Cabrera
- Grupo de Infección y Cáncer, Universidad de Antioquia, Medellín, Colombia
| | | | - Rita Mariel Correa
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Deisy Colque Reynaga
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Arianis Tatiana Ramírez
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Franco Doimi
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | - María Ramón
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | | | - Michael Zúñiga
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru
- Liga contra el Cáncer, Lima, Peru
| | | | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | | | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, United States
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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