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Reimbursement Incentives to Improve Adherence to Follow-Up of Cervical Cancer Cytology Screening Results in Peru

Ferris, Daron G., MD1,2,3,4; Chen, Jessica, BS5; Isaac, Austin, BS2; Braithwaite, Evan, BS5; Beideck, Elena, BS6; Mikail, Nima, BS2; Krotish, Debra, PhD3,4; Waller, Jennifer L., PhD2,7

Journal of Lower Genital Tract Disease: April 2019 - Volume 23 - Issue 2 - p 116–123
doi: 10.1097/LGT.0000000000000459
HPV-Associated Disease: Diagnosis and Management

Objective The purpose of this study was to determine Peruvian women's attitudes toward novel reimbursement incentives used to improve adherence to obtaining cervical cytology test results.

Materials and Methods Women presenting for cervical cancer screening in Peru completed a 34-item Investigational Review Board-approved questionnaire. The questionnaire determined their attitudes toward various reimbursement incentives to improve adherence to obtaining cervical cytology results. Descriptive statistics, generalized linear models, and Kruskal-Wallis tests were used in the analyses.

Results Completed questionnaires were available for 997 women. Most women (51%) would be more likely to return for their Pap result if an incentive was provided, 79% (759/956) agreed that they would pay for the Pap test, and 51% (402/859) would be willing to pay 10 Soles or less. Quechua-speaking women considered follow-up more difficult (p < .0001) but were less likely to return for their Pap results (p < .0001), pay for the Pap test (p < .0001), and afford paying more than 5 Soles (p < .0001) than women who spoke Spanish or both languages. More women who earn 1000 Soles/year or less would likely return if incentivized (p < .0001), felt the incentive would help them remember to return (p = .0047), and would be willing to pay whether there was a rebate (p = .010) as compared with women earning more money.

Conclusions A reimbursement incentive program designed to improve follow-up of cervical cytology test results was acceptable to most Peruvian women. Such a behavioral-modifying program may improve patient follow-up after cervical cytology testing. Implementation may reduce the morbidity and mortality of cervical cancer in remote regions of the country.

From the 1Department of Obstetrics and Gynecology, Georgia Cancer Center, Augusta, GA;

2Augusta University, Augusta, GA;

3CerviCusco, Cusco, Peru;

4Friends of CerviCusco, Blythewood, SC;

5University of Chicago, Chicago, IL;

6Weill Cornell Medicine, New York, NY; and

7Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, Augusta, GA

Correspondence to: Daron G. Ferris, MD, Department of Obstetrics and Gynecology, Georgia Cancer Center, HH-1013, 1423 Harper Street, Augusta University, Augusta, GA 30912. E-mail:;

The authors have declared they have no conflicts of interest.

Supported by New York Academy of Medicine, Friends of CerviCusco (, Weill Cornell Medicine, and the University of Chicago.

The IRB status was approved in Peru (INS-PP-019-11) and Augusta University (611283).

None of the organizations had a role in the study design; collection, analysis, and interpretation of data; writing of the report; and decision to submit the paper for publication.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology