Table 1 Specification of core component of EMA strategy following Proctor model [25]
Core component: training | |
Actor | National and Local Training team experts in Cervical Cancer Prevention, HPV test and Health Communication. Experts that participated in EMA Study (RCT and Scaling Up in Jujuy province). |
Actions | To provide training through different techniques (with experts´ presentations, discussions in small groups, and role playing) regarding: cervical cancer prevention and HPV, HPV results. To evaluate knowledge acquired during the training (self-administered survey) |
Target of the action | Health promoters in charge of the offer of self-collection, health supervisors, health professionals involved in EMA strategy implementation in La Matanza. |
Temporality | Pre-implementation phase |
Dose | Two workshops |
Implementation outcome | Adoption and Fidelity |
Justification | Health education/training of implementers |
Core component: offer of self-collection | |
Actor | Trained health promoters |
Actions | To identify the target population: age, pregnancy, previous screening. To provide information about HPV test and cervical cancer To explain on how to perform self-collection |
Target of the action | Women aged 30 and over |
Temporality | Implementation phase |
Dose | 10 min step-by-step explanation of how to do self-collection |
Implementation outcome | Acceptability and Fidelity |
Justification | Door to door offer is effective to increase screening uptake and acceptability of HPV self-collection [3–6]. |
Core component: sample handling and transportation | |
Actor | Health promoters who offer self-collection /supervisors/ health professionals involved in cervical cancer prevention program |
Actions | To label collectors with the woman’s name and the national unique identification number. To fill in HPV forms. To transport samples at room temperature to primary health care centers. To assure that specimens arrive to HPV laboratory within 14 days after sample collection. |
Target of the action | Women aged 30+ who performed HPV self-collection |
Temporality | Implementation phase: Labelling collector: during self-collection offer. Transportation: within 14 days after sample collection. |
Dose | Always |
Implementation outcome | Fidelity |
Justification | Protocol of identification and transportation of samples following manufacturer’s instructions. |
Core component: follow-up and treatment | |
Actor | Health professionals in charge of triage Pap in primary health centers (e.g., gynecologist, obstetricians, nurses), Gynecologist in charge of colposcopy and treatment (second and third-level hospitals) |
Actions | Follow-up and treatment should be organized according to national guidelines [13]: (1) HPV-positive women should be referred to cytology triage. HPV-positive women with normal cytology should repeat the HPV test in 18 months. (2) Women with abnormal cytology (atypical squamous cells of undetermined significance; atypical cells cannot rule out high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesions; and cancer) should be referred to colposcopy, and biopsy if needed. (3) Biopsies should be reported according to cervical intraepithelial neoplasia (CIN) terminology. Identified cases of CIN2+ should be treated according to standard protocols (loop electrosurgical excision procedure (LEEP) for CIN2+) and (4) HPV-negative women should be advised to repeat screening in 5 years. |
Target of the action | HPV-positive women |
Temporality | Implementation phase: after an HPV-positive results |
Dose | Always |
Implementation outcome | Fidelity |
Justification | Adherence to triage, diagnosis and treatment are essential to reduce cervical cancer incidence and mortality |