CoheaHr is an European research consortium funded by the 7th framework program of the European Union (Health-F3-2013-603019). Europe’s leading research institutes on HPV-related diseases are part of the consortium, including in total 12 partners from 11 different European countries. The consortium represents specialists from a wide array of disciplines including epidemiologists, virologists, gynaecologists, pathologists, health economists, molecular biologists, viral transmission modellers and statisticians.

CoheaHr stands for “Comparing health services interventions for the prevention of HPV-related cancer”. The main objective of the consortium was to build a reliable resource on the effectiveness and cost-effectiveness of the different preventive strategies against HPV-related disease. This resource contains:

  1. new data obtained from implementation studies;
  2. new long-term follow-up from randomized studies;
  3. long-term predictions from mathematical models;
  4. systematic reviews and meta-analyses

7th framework program of the European Union


CoheaHr was divided into five research topics, which included four new implementation studies in the first three research topics. The fourth research topic involved mathematically modelling of both existing data as well as the newly collected data in the CoheaHr studies. The fifth research topic involved building a data-ware house and conducting pooled analyses.

CoheaHr Methods - The Project


Offering self-sampling for hrHPV testing is a feasible and effective mean for detecting CIN2+ in screening non-attendees but the clinical accuracy of hrHPV self-sampling versus clinician sampling had never been studied in a proper randomized manner.
Screening HPV self-sampling with HPV screening on clinician-collected samples were compared in:

  • A randomized pilot implementation trial in the Dutch and Finnish screening settings, and
  • A pooled comparative analysis using data imported in the national cervical screening registry in Sweden.
Moreover, proficiency panels specially designed to evaluate the performance of HPV screening were distributed for comparison of HPV testing laboratory performances.


Cancer risk will be significantly reduced in vaccinated women. If screening programmes are not changed for vaccinated women - the number of unnecessary referrals will likely increase, leading to unnecessary costs.
To evaluate the impact of vaccination in screening, two studies were conducted:

  • Study A: 4-year follow-up of a Finnish community trial to evaluate different screening policies in adolescents vaccinated at age 13-15
  • Study B: A randomized trial in Sweden and Italy to evaluate the influence of vaccination at age 22-23 (two years prior to screening start age) on the performance of cervical HPV-based screening


Vaccination trials have documented that vaccine efficacy among adult women up to age 45/55 is excellent provided they are HPV negative at the time of vaccination. However, HPV vaccination coverage of adult women in Europe is low to very low.
A multinational study in 9 European countries was conducted to identify global and local determinants of acceptability, HPV vaccine compliance, logistics and programmatic issues of vaccinating women 25-45 years attending routine cervical cancer screening


In order to provide direct estimates of positive and undesired effects of different preventive policies for cervical cancer as well as to estimate parameters of the natural history of HPV infection and pre-cancer/cancer, the following activities were performed:

  • Update and extension of a previously stablished standardized data warehouse of European trials on HPV screening conducted in vaccinated and unvaccinated women as part of the PreHdict project (European funded project FP7-HEALTH-242061).
  • Conduction of pooled analyses using such standardised datasets.
  • Conduction of meta-analyses using such standardised datasets and other studies not included.


Mathematical models can be used to describe the natural history of HPV infection and therefore predict the impact of different screening and vaccination strategies at a population level.
As part of the activities conducted within this project, two dynamic transmission models were optimised and extended with the aim to assess different cervical cancer prevention strategies and their cost-effectiveness.


European Union’s Seventh Framework Programme

This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no FP7-F3-2013-603019.

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