Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries

ObjectivesTo demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa.Setting45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda an...

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Bibliographic Details
Published in:	BMJ open Vol. 13; no. 1; p. e065074
Main Authors:	Joseph, Jessica, Demke, Owen, Ameyan, Lola, Bitilinyu-Bango, Joseph, Bourgoin, Blandine, Diop, Mamadou, Guèye, Babacar, Kama, Jibrin, Lubega, Marvin, Madzima, Bernard, Maparo, Tatenda, Mhizha, Tasimba, Musoke, Andrew, Nabadda, Susan, Phiri, Twambilire, Tchereni, Timothy, Wiwa, Owens, Hariharan, Karen, Peter, Trevor, Khan, Shaukat
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 06-01-2023 BMJ Publishing Group LTD BMJ Publishing Group
Series:	Original research
Subjects:	Ablation Acetic Acid Cervical cancer Cryotherapy Diagnostics Drug therapy Early Detection of Cancer - methods Female gynaecological oncology HIV Human immunodeficiency virus Human papillomavirus Human Papillomavirus Viruses Humans Infections Malawi Mass Screening - methods Medical screening molecular diagnostics Nucleic Acids Papillomaviridae - genetics Papillomavirus Infections - prevention & control Public health Testing laboratories Uterine Cervical Neoplasms - prevention & control Womens health Malawi United States > US Senegal Africa Zimbabwe Uganda Nigeria molecular diagnostics gynaecological oncology public health
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Summary:	ObjectivesTo demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa.Setting45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda and Zimbabwe.Participants15 766 women aged 25–54 years presenting at outpatient departments (Senegal only, general population) or at antiretroviral therapy clinics (all other countries, HIV-positive women only). Eligibility criteria followed national guidelines for cervical cancer screening.InterventionsHPV testing was offered to eligible women as a primary screening for cervical cancer, and HPV-positive women were referred for visual inspection with acetic acid (VIA), and if lesions identified, received treatment or referral.Primary and secondary outcome measuresThe primary outcomes were the proportion of HPV-positive women who received results and linked to VIA and the proportion of HPV-positive and VIA-positive women who received treatment.ResultsA total of 15 766 women were screened and tested for HPV, among whom 14 564 (92%) had valid results and 4710/14 564 (32%) were HPV positive. 13 837 (95%) of valid results were returned to the clinic and 3376 (72%) of HPV-positive women received results. Of women receiving VIA (n=2735), 715 (26%) were VIA-positive and 622 (87%) received treatment, 75% on the same day as VIA.ConclusionsHPV testing was found to be feasible across the five study countries in a public health setting, although attrition was seen at several key points in the cascade of care, namely results return to women and linkage to VIA. Once women received VIA, if eligible, the availability of on-site cryotherapy and thermal ablation allowed for same-day treatment. With sufficient resources and supportive infrastructure to ensure linkage to treatment, use of HPV testing for cervical cancer screening as recommended by WHO is a promising model in low-income and middle-income countries.
Bibliography:	Original research ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2044-6055 2044-6055
DOI:	10.1136/bmjopen-2022-065074