De Pilotos Locais a Programas Escaláveis: Implementando o Rastreamento do Câncer Cervical Baseado em Human Papillomavirus na América Latina

PURPOSE Cervical cancer is a leading cause of cancer death among women in Latin America, where many countries are classified as low- and middle-income and experience some of the highest incidence and mortality rates globally. The WHO has launched a global strategy to eliminate cervical cancer as a public health problem, setting 90-70-90 targets by 2030, including 70% screening coverage with a high-performance test, preferably human papillomavirus (HPV) testing, at ages 35 and 45. This narrative review synthesizes recent experience with HPV-based cervical cancer screening in Latin America, highlighting local pilots and programmatic implementations, key barriers and facilitators, and lessons with potential for global impact. METHODS We conducted a narrative review of publications and reports from 2010 to 2026 on HPV-based screening in Latin American countries, using PubMed and major global health sources. We prioritized studies describing real-world implementation or large research platforms such as the International Agency for Research on Cancer-led ESTAMPA study, programmatic HPV testing in Argentina and Mexico, and self-sampling initiatives in rural Ecuador, including quantitative and qualitative assessments of barriers, facilitators, and acceptability. RESULTS Across Latin America, HPV testing has been introduced at scale or in large pilots through initiatives such as ESTAMPA, which evaluates organized HPV-based screening and triage strategies in multiple sites and informs approaches for scale-up. Argentina has been a regional pioneer: the province of Jujuy was the first to implement HPV testing as the primary screening method, including community health worker–delivered self-collection, and has now implemented a second round of HPV-based screening. Experience from nine Latin American countries shows that HPV testing is feasible and a promising tool to reduce cervical cancer burden, although higher test costs and health system constraints remain challenges. In rural Ecuador, diagnostic studies showed that vaginal and urine self-sampling have sensitivity and specificity comparable to clinician-collected samples, while community-based pilots reported high acceptability, with perceived advantages such as comfort, privacy, and time savings. CONCLUSION Latin American experiences demonstrate that HPV-based screening and self-sampling can be effectively implemented in diverse health systems, particularly when integrated with primary care and supported by community outreach. These local “laboratories” of implementation reveal common barriers and key facilitators and offer practical lessons for other settings.