HPV-based cervical cancer screening in Nicaragua: from testing to treatment.

BACKGROUND: In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. METHODS: We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self- vs. provider-collected sampling. RESULTS: Forty-four thousand six hundred thirty-five women were screened with HPV testing; 96.6% of women used self-sampling. Six thousand seven hundred seventy-six women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04-0.08, p < 0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29. CONCLUSIONS: Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of self-sampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.

Reducing violence in poor urban areas of Honduras by building community resilience through community-based interventions.

OBJECTIVES: To examine the impact of a 3 year community-based violence prevention intervention on risk of violence and social capital in two poor urban communities in Honduras in 2011-2014. METHODS: A quasi-experimental design pre and post implementation of the intervention was conducted based on data from two randomly selected samples using the same structured questionnaire in 2011 and in 2014. RESULTS: Community members had a 42 % lower risk of violence in 2014 compared to 2011. There was a positive relation between participation in the intervention and structural social capital, and participants had more than twice the likelihood of engaging in citizenship activities compared to the general population. CONCLUSIONS: The intervention contributed to decreasing violence and increasing community resilience in two urban areas in Honduras. Citizenship activities and active community participation in the violence prevention agenda rather than social trust and cohesion characteristics was affected by the intervention. This research introduces important lessons learned to future researchers aiming to retrieve very sensitive data in a similarly violent setting, and provides strong research opportunities within areas, which to this date remain undiscovered.