69851
document
Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer ( the EMA study ) : a population-based cluster-randomised trial . BACKGROUND Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake . HPV DNA self-collection could increase screening coverage , but implementation of this technology is difficult in countries of middle and low income . We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening . METHODS We did a population-based cluster-randomised trial in the province of Jujuy , Argentina , between July 1 , 2012 , and Dec 31 , 2012 . Community health workers were eligible for the study if they scored highly on a performance score , and women aged 30 years or older were eligible for enrolment by the community health worker . 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group ( offered women the chance to self-collect a sample for cervical screening during a home visit ) or the control group ( advised women to attend a health clinic for cervical screening ) . The primary outcome was screening uptake , measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit . Analysis was by intention to treat . This trial is registered with ClinicalTrials.gov , number NCT02095561 . FINDINGS 100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group ; nine did not take part . 191 participating community health workers ( 94 in the intervention group and 97 in the control group ) initially contacted 7650 women ; of 3632 women contacted by community health workers in the intervention group , 3049 agreed to participate ; of 4018 women contacted by community health workers in the control group , 2964 agreed to participate . 2618 ( 86 % ) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit , compared with 599 ( 20 % ) of 2964 in the control group ( risk ratio 4·02 , 95 % CI 3·44-4·71 ) . INTERPRETATION Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake , showing that this strategy is effective to improve cervical screening coverage . This intervention reduces women 's barriers to screening and results in a substantial and rapid increase in coverage . Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage . FUNDING Instituto Nacional del Cáncer ( Argentina ) .
69852
Intervention_Educational
self-collection of HPV DNA
69853
Intervention_Educational
HPV DNA self-collection
69854
Intervention_Educational
HPV DNA self-collection
69855
Intervention_Educational
intervention group ( offered women the chance to self-collect a sample for cervical screening during a home visit )
69856
Intervention_Control
control group ( advised women to attend a health clinic for cervical screening )
69857
Outcome_Mental
uptake of screening for cervical cancer
69858
Outcome_Mental
screening uptake .
69859
Outcome_Mental
screening coverage
69860
Outcome_Mental
cervical screening .
69861
Outcome_Mental
screening uptake
69862
Outcome_Mental
HPV screening test
69863
Outcome_Mental
HPV test
69864
Outcome_Mental
screening uptake
69865
Outcome_Mental
cervical screening coverage
69866
Outcome_Mental
reduces women 's barriers to screening
69867
Outcome_Mental
and rapid increase in coverage
69868
Outcome_Mental
increase cervical screening coverage
69869
Participant_Condition
countries of middle and low income
69870
Participant_Condition
province of Jujuy , Argentina
69871
Participant_Sex
women
69872
Participant_Age
aged 30 years or older
69873
Participant_Sample-size
200
69874
Participant_Sample-size
191
69875
Participant_Sample-size
94
69876
Participant_Sample-size
97
69877
Participant_Sample-size
7650
69878
Participant_Sex
women
69879
Participant_Sample-size
3632
69880
Participant_Sex
women
69881
Participant_Sample-size
3049
69882
Participant_Sample-size
4018
69883
Participant_Sample-size
2964