Development of a Cervical Cancer Screening Program in Rural Guatemala.

Background: In San Lucas Tolimán (SLT), Guatemala, a rural municipality with a large Indigenous population, women seeking cervical cancer screening face many barriers. We describe the process from design to implementation of a culturally appropriate and accessible cervical cancer screening and treatment pilot program for women aged 30-49 years.

Methods: After conducting a community needs assessment, we trained community health workers (CHWs) on basic cervical cancer pathophysiology and human papillomavirus (HPV) self-swab kit use. CHWs provided educational seminars and enrolled interested, eligible women in a mobile health application. Women collected samples at home and returned completed kits to CHWs, who sent the kits to a partner lab. Women who were positive for HPV received follow-up care at the local hospital, where physicians had received training in visual inspection with acetic acid (VIA) with same-day cryotherapy or thermocoagulation. Women with advanced lesions received access to care from gynecologists free of cost.

Results: Between February and November 2023, of the 230 women eligible to participate in the program, 132 completed HPV self-swabs and received results, and 34 received positive HPV tests (25.76% prevalence). Sixty-seven women had VIA exams as their first screening. Women who received VIA exams had an overall positivity rate of 24.47% (23/94). Twenty-three women received treatment: cryotherapy (n=8), thermocoagulation (n=7), or loop electrosurgical excision procedure (n=8). SLT had higher HPV-positivity rates than nearby Escuintla (21.6%; P=.29) and significantly higher than Santiago Atitlán (17.4% HPV+; P=.02).

Conclusion: Our screening program found significantly higher HPV-positivity rates in SLT than in previous Guatemalan studies. Our research reinforces that adequately treating cervical cancer in Guatemala requires accompaniment during care and economic support to make care affordable or free. Based on our pilot program, organizations worldwide can further invest in culturally sensitive cervical cancer screening and treatment.