Cervical cancer screening in a low‐resource setting: a pilot study on an HPV‐based screen‐and‐treat approach

Abstract

Cervical cancer (CC) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV (HR‐HPV) DNA using the point‐of‐care Xpert HPV assay. All HPV‐positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR‐HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR‐HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR‐HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16‐ and/or HPV18/45‐positive is a practical approach for the treatment of CIN2+. The combination of HPV‐testing and VIA/VILI for CC screening might reduce overtreatment.

Selecting human papillomavirus genotypes to optimize the performance of screening tests among South African women

“…35 In addition, GX HPV testing has met international performance standards for use in primary cervical cancer screening. 30 Several countries have piloted the GX HPV test including South Africa, 36 Cameroon, 37 UK, 30 Zambia, 38 Saudia Arabia, and the USA. 39,40 Sensitivity rates in detecting CIN2+ ranged from 63.2% to 98.7% and specificity ranged from 42.6% to 90.3%.…”

Exploring women's preferences for HPV‐based cervical cancer screening in South Africa

“…One way to facilitate scale‐up of molecular testing is to use point‐of‐care technologies. Performed using benchtop analyzers, point‐of‐care HPV tests would enable same‐day testing and treatment . One such testing platform (GeneXpert; Cepheid, Sunnyvale, CA, USA) is already widely available across Sub‐Saharan Africa owing to its use in the diagnosis of HIV and tuberculosis.…”

Self- versus physician-collected samples for the follow-up of human papillomavirus-positive women in sub-Saharan Africa

“…Our previous experience has demonstrated that the use of NaCl 0.9% is a valid medium for HPV analysis on Self-HPV. 18 The use of this medium, however, has not yet been proven effective for Dr-HPV. Therefore, the NaCl 0.9% was used for Self-HPV sample analysis, whereas the SurePath medium, as recommended by the manufacturers, was used for the analysis of Dr-HPV samples.…”