Participation and Follow-Up Compliance in Cervical Cancer Screening According to Delivery Strategy for HPV Self-Collection: A Community Trial in Underserved Colombian Areas.

Low- and middle-income countries (LMIC) continue to bear a high burden of cervical cancer (CC). Women's participation in CC screening is challenging in LMICs, but self-collection of HPV tests has shown increased participation in controlled trials. However, data from real-world studies and data on follow-up compliance after positive screening test results are scant. A two-arm community trial was conducted in four municipalities from two different territories in Colombia (HPV self- and clinician-collected tests). A comparison of participation and follow-up compliance was done between arms, both delivered through campaigns and routine screening. Women aged 30-50 without screening records within the previous 30 months were eligible. HPV-positive women were recalled for triage/treatment in a second visit. A follow-up was done at 6 months. In total, 1400 women were expected, but only 532 attended the screening visit. Participation rates were 49% (95% CI: 46-53) in the self-collected and 26% (95% CI: 22.8-29.5) in the clinician-collected arm. Campaigns resulted in higher participation than routine screening for both collection methods (p < 0.05), and significant differences by territory were observed. Follow-up compliance was 89.6% and 71% at triage/treatment and 6-month visits, respectively, without significant differences between study arms. HPV self-collection resulted in higher participation than clinician collection; however, it did not directly translate to screening coverage. Therefore, delivery strategies and contextual barriers should be carefully analyzed for successful implementation. Anyhow, the increased participation and high compliance with the triage/treatment visit support the relevance and suitability of alternative programmatic approaches for HPV-based screening.