HPV self-sampling as primary screening test in sub-Saharan Africa: Implication for a triaging strategy

Abstract

Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (Self-HPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US1) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa 5 0.74). HPV positivity by cytological diagnosis for ASC-US1 was similar with the two tests. positive predictive value of the Self-HPV for ASC-US1 was 20.4; odds ratio and number needed to treat were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer.

Effectiveness of a two‐stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low‐income setting

“…9 HPV infection is a very common condition in young women with prevalence over 25% in those aged younger than 30 years in Cameroon. 14 Studies carried out in other African countries found a PPV for HPV testing to be lower than 30%. [15][16][17] These findings indicate that a triage test following a positive HPV result is necessary to limit the rate of false positive and consequently the harms of overtreatment.…”

Microarray-in-a-tube system in the function of detection human papillomavirus genotypes

“…HPV genotypes were identified from differences in the relatively conserved L1, E6 and E7 open reading frame, when HPV gene sequences had a less-than 90 % homology with L1, E6 and E7 open reading frame, it was defined as a new HPV genotype [19]. Because of the complicated structure of HPV trait, each HPV genotype can only aim at the structure specificity to develop the corresponding vaccine research [21][22][23]. There are at present no effective treatments for human papilloma virus, so only through large-scale physical examination acquire a very large number of first-hand data about the epidemic characteristics of HPV in China [21,24,25].…”

“…Because of the complicated structure of HPV trait, each HPV genotype can only aim at the structure specificity to develop the corresponding vaccine research [21][22][23]. There are at present no effective treatments for human papilloma virus, so only through large-scale physical examination acquire a very large number of first-hand data about the epidemic characteristics of HPV in China [21,24,25].…”

Recent advances in understanding and preventing human papillomavirus-related disease

“…However, the effectiveness of screening by self-sampling is determined in part by the performance of the HPV PCR test when applied to self-samples 23 . To bridge the prevention gap in low-/middle- income settings, approaches such as hrHPV self-testing are viable and enable invitation of communities who test positive to attend further triaging 24, 25 . Visual inspection of the cervix with acetic acid (VIA) or Lugol’s iodine (VILI) is a particularly simple and low-cost screening tool that enables trained healthcare workers to detect abnormalities with a speculum examination.…”