Barriers for implementing the HPV-DNA test as a primary cervical cancer-screening technique in a demonstrative area of Colombia
Keywords:
Uterine Cervical Neoplasms, Screening, Human papillomavirus, Theoretical Models, Colombia, DNA-HPV probes, PRECEDE-PROCEDE modeAbstract
Objective: To identify the barriers for the implementation of a cervical cancer-screening program based on human papillomavirus (HPV) testing in Colombia.
Methods: The Precede-Proceed model was applied in four municipalities of Cundinamarca and two of Boyacá. Secondary and primary data were analyzed from 74 institutional surveys, 18 focus groups (with community leaders and health professionals), and 12 interviews (health authorities)
Results: The most relevant barriers were identified as follows:
1) Social barriers: in Duitama, the municipality with a religious tradition, HPV infection is represented as a venereal disease.
2) Epidemiological barrier: the absence of a register for definitive diagnosis of pre-neoplasic lesions.
3) Behavioral barriers: Pap smear laboratories are not centralized, some are not accredited and colposcopies are not standardized.
4) Health professionals overestimate Pap smear sensitivity and they are over worried about HPV infection among women younger than 30 years.
5) Administrative barriers: positive screened women need to have an authorization from Health Insurance Enterprises in order to access the diagnosis and treatment of cervical lesions.
Conclusions: Colombia presents barriers to the operation of an organized screening program that make it dificult to achieve the expected objectives with the technological change from the use of cytology to molecular testing.
Author Biographies
Carolina Wiesner, Instituto Nacional de Cancerología (INC)
Grupo de Prevención y Detección Temprana de Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, D.C., Colombia
Facultad de Ciencias Sociales, Universidad Externado de Colombia, Bogotá, D. C., Colombia
Lina Rincón, Instituto Nacional de Cancerología (INC)
Grupo de Prevención y Detección Temprana de Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, D. C., Colombia
Óscar Gamboa, Instituto Nacional de Cancerología
Unidad de Análisis, Subdirección de Investigaciones, INC, Bogotá, D. C., Colombia
Marion Piñeros, Instituto Nacional de Cancerología
Subdirección de Investigaciones, INC, Bogotá, D. C., Colombia
Mauricio González, Instituto Nacional de Cancerología
Grupo de Ginecología Oncológica, INC, Bogotá, D. C., Colombia
Natascha Ortiz, Fundación Universitaria de Ciencias de la Salud (FUCS)
Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, D. C., Colombia
Gustavo Hernández, Instituto Nacional de Cancerología
Grupo de Investigación Epidemiológica, INC, Bogotá, D. C., Colombia
Mónica Molano, Instituto Nacional de Cancerología
Grupo de Biología del Cáncer, INC, Bogotá, D. C., Colombia
Ruth Robles, Secretaría de Salud de Boyacá
Secretaría de Salud de Boyacá, Tunja, Colombia
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