Evidence map›Paper›PMID 40355876›Full record

Trial reportImplementation science : IS2025

A pragmatic randomized trial to compare strategies for implementing primary HPV testing for routine cervical cancer screening in a large healthcare system.

Chun R Chao, Nancy Cannizzaro, Erin E Hahn, Ernest Shen, Chunyi Hsu, Quyen Ngo-Metzger, Michael K Gould, Corrine E Munoz-Plaza, Michael H Kanter, Patricia Wride and 10 more

Registry-linked trialAbstract readPragmatic Clinical TrialRandomized Controlled TrialComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04371887 (Comparing Strategies for Implementing Primary HPV Testing for Routine Cervical Cancer Screening), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04371887 naunknown statusnot on this map

Comparing Strategies for Implementing Primary HPV Testing for Routine Cervical Cancer Screening

TypeinterventionalSponsorChun ChaoRan2019 to 2023Enrolled45,000ConditionsCervical Cancer, Human Papillomavirus, Health Knowledge, Attitudes, Practice, Health Care UtilizationArmsLocal Tailoring
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. An introduction to implementation science in rehabilitation medicine.PM & R : the journal of injury, function, and rehabilitation · 2025
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Chun R ChaoDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA. chun.r.chao@kp.org.ORCID 0000-0002-6072-4954
Nancy CannizzaroDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Erin E HahnDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Ernest ShenDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Chunyi HsuDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Quyen Ngo-MetzgerDepartment of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
Michael K GouldDepartment of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
Corrine E Munoz-PlazaDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Michael H KanterDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Patricia WrideDepartment of Obstetrics and Gynecology, Anaheim Medical Center, Kaiser Permanente Southern California, Anaheim, CA, USA.
Lena H AjamianDepartment of Family Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA.
Melissa HodeibDepartment of Obstetrics and Gynecology, Riverside Medicine Center, Kaiser Permanente Southern California, Riverside, CA, USA.
Benjamin I BroderDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.
Ivette T CurielSouthern California Permanente Medical Group Operations, Kaiser Permanente Southern California, Pasadena, CA, USA.
Alicia CastanedaDepartment of Obstetrics and Gynecology, Anaheim Medical Center, Kaiser Permanente Southern California, Anaheim, CA, USA.
Stephanie K OngDepartment of Ambulatory Care, Anaheim Medical Center, Kaiser Permanente Southern California, Anaheim, CA, USA.
Krishnansu TewariDepartment of Gynecologic Oncology, Obstetrics and Gynecology, University of California, Irvine, CA, USA.
Ramez N EskanderDepartment of Gynecologic Oncology, Obstetrics and Gynecology, University of California, San Diego, USA.
Devansu TewariDepartment of Obstetrics and Gynecology, Anaheim Medical Center, Kaiser Permanente Southern California, Anaheim, CA, USA.
Brian S MittmanDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2 Floor, Pasadena, CA, 91101, USA.

Funding

Patient-Centered Outcomes Research Institute CDR-2018C1-10987
6 · The paper itself

Abstract

backgroundRecent updates to national guidelines recommend primary human papillomavirus (HPV) screening for routine cervical cancer screening alongside previously recommended screening options. However, limited guidance exists for implementation approaches that best facilitate cancer screening practice substitution and achieve optimal stakeholder-centered outcomes. We compared "centrally-administered + locally-tailored" (here after referred to as locally-tailored) vs. "centrally-administered + usual care" (here after referred to as centrally-administered) approaches for achieving substitution of HPV and cytology co-testing with primary HPV screening for routine cervical cancer screening to examine the effect of local tailoring on implementation and stakeholder-centered outcomes.

methodsWe conducted a pragmatic, cluster randomized trial embedded in the Kaiser Permanente Southern California (KPSC) health system, randomly assigning site groups to study arms at the level of the geographic service area (12 service area randomized). The study took place between 2020-2022. Centrally-administered implementation strategy bundles included physician and staff educational activities. Sites in the locally-tailored arm underwent local needs assessment followed by local selection, tailoring and deployment of implementation strategy bundles. The primary outcome was the proportion of primary HPV screenings among all screenings performed. Secondary stakeholder-centered outcomes included patient (knowledge, emotional reaction, satisfaction, volume of patient inquiries) and provider outcomes (perception, knowledge, acceptance, and satisfaction) measured via repeated surveys or electronic health records. The generalized estimating equation framework and the difference-in-differences approach were used to compare outcomes across study arms.

resultsThe proportion of appropriate screenings (i.e., use of primary HPV screening) during the post-intervention period was high, with no observed difference between study arms: 98.4% (95% confidence interval [CI] 96.3%-100%) for the locally-tailored arm and 99.1% (95% CI: 97.8%-100%) for the centrally-administered arm (p = 0.34). There were no statistically or clinically significant differences in patient- and provider- outcomes between study arms.

conclusionsPrimary HPV screening was feasible and demonstrated high fidelity in all KPSC service areas. The locally-tailored practice substitution approach and centrally-administered practice substitution approach both achieved near complete uptake of primary HPV screening. Further, similar effects on stakeholder-centered outcomes were observed for both approaches. However, generalizability of our findings may be limited due to unique features of our integrated health system.

trial registrationNCT04371887. Registered 30 April 2020, URL: https://clinicaltrials.gov/study/NCT04371887?cond=primary%20HPV%20screening&rank=5 .

Indexed as

Early Detection of CancerMass ScreeningPapillomavirus InfectionsUterine Cervical NeoplasmsAdultCaliforniaFemaleHumansImplementation ScienceMiddle AgedPapillomaviridaeCervical cancer screeningConstrained choice implementationEmbedded researchImplementation approachLocally-tailoredPractice substitutionPragmatic trialPrimary HPV screening

Identifiers

PMID40355876
PMCPMC12067918

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.