Durability of clinical performance afforded by self-collected HPV testing: A 15-year cohort study in China

Zhang, Li; Xu, Xiaoqian; Hu, Shangying; Chen, Feng; Zhang, Xun; Pan, Qin-Jing; Zhang, Wenhua; Feng, Ruimei; Li, Dong; Zhang, Qian; Ma, Jun-Fei; Sauvaget, Catherine; Zhao, Fanghui; Qiao, You‐Lin; Sankaranarayanan, Rengaswamy

doi:10.1016/j.ygyno.2018.09.012

Cited by 14 publications

(9 citation statements)

References 35 publications

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“…Efforts should be made to encourage women to follow up with treatment. It will be counterproductive if women with HIV are encouraged to participate in cervical cancer screening, but women with positive screening results are not properly managed [ 14 , 76 , 77 , 78 ]. However, the cost of treatment may discourage most women from following up, as most of these women may not have insurance or cannot afford it.…”

Section: Discussionmentioning

confidence: 99%

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

et al. 2022

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Introduction. Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.

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Section: Discussionmentioning

confidence: 99%

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

et al. 2022

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“…Women negative on both careHPV and PCR HPV tests were considered to be normal due to the extremely low risk of high-grade cervical lesions in them. 11,12 We evaluated the accuracy of HPV primary screening and HPV screening followed by two assumptive triage strategies (genotyping for HPV16/18 or HPV16/18/31/33/45/52/58) by calculating detection rate, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Screening efficiency was evaluated by the number of colposcopies required to yield one cervical intraepithelial neoplasia grade two or worse (CIN2+).…”

Section: Discussionmentioning

confidence: 99%

“…The ‘gold standard’ for estimating test accuracies in the HPV positive women was either a normal colposcopic diagnosis with SCJ entirely visible (TZ Type 1) or a histopathology diagnosis (when colposcopy was abnormal and/or SCJ partially/not visible (TZ Types 2 and 3). Women negative on both care HPV and PCR HPV tests were considered to be normal due to the extremely low risk of high‐grade cervical lesions in them …”

Section: Methodsmentioning

confidence: 99%

Comparative performance evaluation of different HPV tests and triaging strategies using self‐samples and feasibility assessment of thermal ablation in ‘colposcopy and treat’ approach: A population‐based study in rural China

Zhao

Duan

et al. 2020

Intl Journal of Cancer

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Human papillomavirus (HPV) test, self-sampling and thermal ablation for cervical intraepithelial neoplasia (CIN) have been developed separately to increase screening coverage and treatment compliance of cervical cancer screening programmes. A large-scale study in rural China screened 9,526 women with their combinations to explore the optimal cervical cancerscreening cascade in the real-world. Participants received careHPV and polymerase chain reaction (PCR) HPV tests on selfcollected samples. Women positive on either HPV test underwent colposcopy, biopsy and thermal ablation in a single visit. Samples positive on either HPV test were retested for genotyping. Absolute and relative performance of HPV tests, triage strategies, 'colposcopy and thermal ablation' approach were statistically evaluated. PCR HPV test detected 33.3% more CIN grade two or worse (CIN2+) at a cost of 28.1% more colposcopies compared to careHPV. Sensitivities of PCR HPV and careHPV tests to detect CIN2+ were 96.7 and 72.5%. Specificities for the same disease outcome were 82.1 and 86.0%. Triaging HPV-positive women with HPV16/18 genotyping considerably improved the positive predictive value for CIN2+ (4.8-5.0 to 18.2-19.2%). Ninety-six women positive on HPV and having abnormal colposcopy were eligible for thermal ablation and all accepted same-day treatment, contributing to 64.6% being treated appropriately (CIN1+ on histopathology), which reached up to 84.8% among women positive on HPV 16/18 triage. No serious side-effects/ complications were reported. The combination of PCR HPV test followed by HPV 16/18 triaging on self-collected samples and colposcopy of triage positive women followed by immediate thermal ablation might be the appropriate screening cascade for rural China.

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“…Both self-sampled and clinician-sampled HPV tests with a PCR assay have better sensitivity and can allow for longer screening intervals than cytology-based screening programs. For example, a 15-year cohort study in rural China found that while HPV testing with self-sampling was less sensitive than physician-sampling, it performed equally on screening efficiency and predicting cumulative cases, and was as sensitive as high-quality cytology in detecting cumulative CIN2-3 cases ( 111 ).…”

Section: Resultsmentioning

confidence: 99%

A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities

Shin

Gui

Mugo

et al. 2021

Front. Public Health

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The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.

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Durability of clinical performance afforded by self-collected HPV testing: A 15-year cohort study in China

Cited by 14 publications

References 35 publications

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

Comparative performance evaluation of different HPV tests and triaging strategies using self‐samples and feasibility assessment of thermal ablation in ‘colposcopy and treat’ approach: A population‐based study in rural China

A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities

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