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首页> 外文期刊>Implementation Science >Evaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentina
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Evaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentina

机译：评估社区卫生工作者在家访时提供的HPV自我收集的扩大，以增加对阿根廷胡胡伊省社会弱势筛查不足的女性的筛查

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BackgroundSelf-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women. MethodsWe used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy. ResultsHPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% ( n =?5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period ( p n =?609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% ( n =?320) had follow-up procedures. Of 113 women with positive triage, 66.4% ( n =?75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women ( n =?21/26). Adoption: Of trained CHWs, 69.3% ( n =?422/609) had at least one woman with self-collection; 85.2% ( n =?315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection. ConclusionsThe strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women.
机译：背景技术已经提出了自我收集作为增加难以到达的妇女宫颈筛查覆盖率的策略。但是，对这一战略的执行情况进行大规模评估的情况很少。本文描述了社区卫生工作者在家访期间提供的自我收集的扩大化过程和衡量方法，以此作为一种策略，以覆盖目标人群为目标女性的，筛查年龄在30岁以上，具有公共卫生覆盖范围的女性。方法我们使用了卫生系统框架的改编版来分析扩大规模的关键驱动因素。内容分析方法用于收集和分析来自不同来源的信息。 RE-AIM（有效，有效，采用，实施和维护）模型用于评估策略的影响。结果在2012年在当地进行了RCT（自我收集模式试验，西班牙语的首字母EMA）后，2014年在Jujuy省扩大了HPV自我收集的规模，证明了该策略提高筛查吸收率的有效性。扩大规模的促进因素包括省级卫生系统的组织能力，HPV检测的可持续资金以及当地对该技术价值的共识。覆盖率：2014年，通过Jujuy公共卫生部门的自我收集筛查了9％（2983 / 33,245）的目标女性。有效性：2014年，通过任何HPV测试（自行收集和临床医生收集的测试）筛查了17％（n =？5657 / 33,245）的目标女性，相比之下，2013年之前该比例为11.7％（4579 / 38,981）社区卫生工作者（CHWs）的增加期（pn =？609/723）。在414名HPV +妇女中，有77.5％（n =？320）接受了随访。在113例分诊阳性的女性中，有66.4％（n =？75）接受阴道镜诊断。为80.7％的CIN2 +妇女提供了治疗（n =？21/26）。收养：在受过训练的CHW中，有69.3％（n =？422/609）至少有一名女性具有自理能力;回答评估调查的CHW者中有85.2％（n =？315/368）对自我收集策略感到满意。维护：2015年，有100.0％（723/723）名CHW处于运行状态，而63.8％（461/723）名CHW至少有一名女性具有自我收集能力。结论该策略已成功扩大规模，在CHW中被采用率很高，这导致社会弱势筛查不足妇女的筛查增加。

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