{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:55:59Z","timestamp":1790909759119,"version":"4.1.0"},"reference-count":46,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,4,18]]},"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical cancer is the leading cause of cancer death for women in Uganda, despite the potential for prevention through organised screening. Community-based self-collected human papillomavirus (HPV) testing has been proposed to reduce barriers to screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Our objective was to evaluate the cost-effectiveness of the Advances in Screening and Prevention of Reproductive Cancers (ASPIRE) trial, conducted in Kisenyi, Uganda in April 2014 (n=500). The trial compared screening uptake and compliance with follow-up in two arms: (1) community-based (ie, home or workplace) self-collected HPV testing (facilitated by community health workers) with clinic-based visual inspection with acetic acid (VIA) triage of HPV-positive women (\u2018HPV-VIA\u2019) and (2) clinic-based VIA (\u2018VIA\u2019). In both arms, VIA was performed at the local health unit by midwives with VIA-positive women receiving immediate treatment with cryotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We informed a Monte Carlo simulation model of HPV infection and cervical cancer with screening uptake, compliance and retrospective cost data from the ASPIRE trial; additional cost, test performance and treatment effectiveness data were drawn from observational studies. The model was used to assess the cost-effectiveness of each arm of ASPIRE, as well as an HPV screen-and-treat strategy (\u2018HPV-ST\u2019) involving community-based self-collected HPV testing followed by treatment for all HPV-positive women at the clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcomes were reductions in cervical cancer risk and incremental cost-effectiveness ratios (ICERs), expressed in dollars per year of life saved (YLS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HPV-ST was the most effective and cost-effective screening strategy, reducing the lifetime absolute risk of cervical cancer from 4.2% (range: 3.8%\u20134.7%) to 3.5% (range: 3.2%\u20134%), 2.8% (range: 2.4%\u20133.1%) and 2.4% (range: 2.1%\u20132.7%) with ICERs of US$130 (US$110\u2013US$150) per YLS, US$240 (US$210\u2013US$280) per YLS, and US$470 (US$410\u2013US$550) per YLS when performed one, three and five times per lifetime, respectively. Findings were robust across sensitivity analyses, unless HPV costs were more than quadrupled.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Community-based self-collected HPV testing followed by treatment for HPV-positive women has the potential to be an effective and cost-effective screening strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-020484","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T03:45:34Z","timestamp":1528775134000},"page":"e020484","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2285-8599","authenticated-orcid":false,"given":"Alex K","family":"Mezei","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather N","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Women\u2019s Health Research Institute, British Columbia Women\u2019s Hospital and Health Centre, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Sy","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Regan","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheona M","family":"Mitchell-Foster","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josaphat","family":"Byamugisha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda"},{"name":"Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musa","family":"Sekikubo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda"},{"name":"Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeli","family":"Rawat","sequence":"additional","affiliation":[{"name":"Women\u2019s Health Research Institute, British Columbia Women\u2019s Hospital and Health Centre, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Singer","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Centre for Health Evaluation and Outcome Sciences, St. Paul\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina S","family":"Ogilvie","sequence":"additional","affiliation":[{"name":"Women\u2019s Health Research Institute, British Columbia Women\u2019s Hospital and Health Centre, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane J","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. 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