Cervical cancer prevention in El Salvador: A prospective evaluation of screening and triage strategies incorporating high‐resolution microendoscopy to detect cervical precancer

Cervical cancer remains a leading cause of cancer death for women in low‐ and middle‐income countries. The goal of our study was to evaluate screening and triage strategies, including high‐resolution microendoscopy (HRME), to detect cervical abnormalities concerning for precancer at the point of care. Women (n = 1824) were enrolled at the Instituto de Cáncer de El Salvador. All underwent screening by both human papillomavirus (HPV) testing using careHPV and visual inspection with acetic acid (VIA). Screen‐positives, along with 10% of screen‐negatives, were invited to return for a follow‐up examination that included triage with VIA, colposcopy and HRME imaging. Biopsies were taken of any abnormalities identified. If no abnormalities were identified, then the worst scoring site by HRME was biopsied. The sensitivities of HPV testing and VIA to screen for cervical intraepithelial neoplasia Grade 2 or more severe diagnoses (CIN2+) were 82.1% and 75% (P = .77), while the specificities were 90.4% and 80.9% (P