To assess adherence to the recommended 12-month virological follow-up among women aged 30-65 years living in Brittany (France) who had a positive high-risk HPV test with normal cytology (hrHPV+ / Cytology-) within the French national program of organized cervical cancer screening, and to identify factors associated with follow-up compliance.

We conducted a retrospective observational study using data from the Regional Cancer Screening Coordination Center of Brittany collected between July 2020 and March 2023. Women with hrHPV+/Cytology- screening result were included. The primary outcome was completion of a repeat hrHPV test between 6 and 12 months after the initial result, in accordance with French Health Authority (HAS) recommendations. Secondary outcomes included analyze of women characteristics according to age, geographical area, initial sampler taker, and declaration of a general practitioner.

Among 762 113 eligible women, 12 985 (1.7%) had a hrHPV+/Cytology- result. At 1 year, 28.5% had no documented follow-up, and only 21.3% underwent follow-up in accordance with French recommendations, corresponding to 29.8% of women who were followed. Among women with appropriate follow-up, 53% remained hrHPV+, and 81.4% of these were referred for colposcopy. Loss of follow-up was more common among young women, those living in non-urban areas. Conversely, recommended follow-up was more frequent in areas with higher health care availability and among women managed by gynecologists.

Implementation of guideline-recommended follow-up after hrHPV+/Cytology- screening remains suboptimal, despite well-documented increased risks of high grade precancerous lesions and invasive cancer in this population. Strategies to improve adherence include personalized reminders, use of self-sampling, personalized invitations to screening, harmonization of professional practices, and optimization of colposcopy referral pathways.