HPV: more than 36 million women do not take preventive exams, says study

A survey estimates that more than 36 million women between 25 and 64 years old did not undergo at least one cervical cytopathological examination — also known as pap smear — within three years. Data comes from a study carried out by the non-governmental organization (NGO) ImpulsoGov, based on data from the Health Information System for Primary Care (Sisab) of the Ministry of Health.

The Pap smear is the most common preventive gynecological exam to identify precursor lesions of cervical cancer. It helps detect abnormal cells in the organ’s lining that can be treated before they become cancerous. The recommendation is that the exam be carried out, in principle, annually and, after two consecutive exams with negative results, every three years.

To carry out the survey, seven indicators were considered from the old Primary Health Care (PHC) financing program, Previne Brasil, which was in force until April 2024. Among these indicators was compliance with up to 40% of women having Pap smear collection in primary care.

“Cytopathology is also an indicator that, historically, comes below [das metas definidas] and there are several factors for this. Firstly, it is a very large population, there are many women as the target audience. So, you have to adapt your service to be able to accommodate all these women”, observes Juliana Ramalho, public health manager at ImpulsoGov, in an interview with CNN .

“Other than that, the exam itself is very demanding. Today, in our country, we have women who fulfill the role of heads of the family, who work a lot and cannot leave to make an appointment, collect the test and return for follow-up. Women don’t always have the support they need to take three days off from their tasks,” he adds. “It is necessary to support states and municipalities to be able to expand this cytopathology collection and reduce the time until the test results are obtained. This result has to come faster for these women.”

How was the survey carried out?

ImpulsoGov carried out the analysis considering data from Sisab, official data from the Ministry of Health and publicly available data. For this, the denominators (people considered in the target audience of a given indicator) and the numerators (people who received the service defined in a given indicator) were considered for each of the seven indicators that were considered by the old Previne Brasil program:

  1. Proportion of pregnant women with at least 6 prenatal consultations carried out, the 1st being up to the 12th week of pregnancy;
  2. Proportion of pregnant women undergoing tests for syphilis and HIV;
  3. Proportion of pregnant women receiving dental care;
  4. Proportion of women with cytopathology collection in PHC;
  5. Proportion of 1-year-old children vaccinated in PHC against Diphtheria, Tetanus, Whooping Cough, Hepatitis B, infections caused by Haemophilus influenzae type B and inactivated Poliomyelitis;
  6. Proportion of people with hypertension, with consultation and blood pressure measured during the semester;
  7. Proportion of people with diabetes, with consultation and glycated hemoglobin requested in the semester.

Previne Brasil was the financing model for Primary Health Care (PHC), established in 2019 and which was replaced by an ordinance published on April 10, 2024. With Previne Brasil, the federal financial transfer to municipalities was distributed based on four components, including the payment-for-performance component, which considered the achievement of goals in the above indicators.

THE GM/MS Ordinance No. 3,493on April 10, 2024, instituted a new methodology for Federal Co-financing of the Primary Health Care Floor within the scope of the Unified Health System (SUS), replacing Previne Brasil.

According to article 8 of the ordinance, the first installment of federal co-financing of PHC that is transferred from the National Health Fund to the Municipal Health Funds considering the new federal co-financing methodology for PHC was carried out from installment 5, in May 2024.

Survey provides an overview of primary health care in Brazil

The survey carried out by ImpulsoGov also brings other relevant data about the indicators considered by Previne Brasil, with information referring to the second four months of 2024.

The findings point to a greater challenge for broad vaccination coverage of children and for monitoring people with chronic non-communicable diseases. The study estimated that:

  • 80% of 1-year-old children received the polio vaccine, below the target of 95%;
  • More than 29 million people with hypertension did not have a consultation or blood pressure measured in the semester (from March to August);
  • More than 12 million people with diabetes did not have an appointment or glycated hemoglobin requested in the semester (from March to August).

“At the global public health level, we have been talking a lot about chronic non-communicable diseases. The whole world is looking at this. But speaking exclusively about Brazil, we have a population that is aging and living longer, life expectancy is increasing and chronic diseases are also growing a lot”, observes Ramalho.

“There needs to be greater investment in the health system to cover this population that is growing and has this type of demand. The importance of looking at this data is to think about efficient public policies to promote health and prevent diseases, in the short, medium and long term”, he adds.

Furthermore, the survey points to a greater reach of the target audience by indicators related to the proportion of one-year-old children vaccinated in PHC against diphtheria, tetanus, whooping cough, hepatitis B, infections caused by Haemophilus influenzae type B and inactivated poliomyelitis; the proportion of pregnant women undergoing tests for syphilis and HIV; the proportion of pregnant women receiving dental care; and the proportion of pregnant women with at least six prenatal consultations carried out, the first being the 12th week of pregnancy.

Data can help define priorities

For Ramalho, the survey indicates that there are millions of people who are not having their health monitored, which, in the future, could mean a financial impact on the public health system.

“A person with properly controlled diabetes can spend their entire life being monitored by Primary Health Care, which is a cheaper level. This prevents the condition from worsening”, he explains.

The worsening of a patient’s clinical condition, without proper monitoring and treatment, can bring suffering to them and their well-being and greater demand on the public health system, in the specialist’s view.

“The importance of data and information is being able to prioritize resources. It is necessary to prioritize actions and the data works as a lighthouse, a direction to where management can allocate more resources and define a focus, without forgetting all the others”, he concludes.

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This content was originally published in HPV: more than 36 million women do not take preventive exams, says study on the CNN Brasil website.

Source: CNN Brasil

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