Practical considerations around using Xpert® HPV in low-income countries, focusing on Malawi

Cubie, Heather; Haar, Reynier Ter; Morton, David; Kafwafwa, Savel; Kabota, Beatrice; Mdetsa, B.; Chauwa, H.; Kawonga, Edson; Mautanga, Mike; Mwenitete, I.; Teakle, Ngari; Nkhoma, R.; Campbell, Christine; Grant, Liz; Bruce, Ishmael; Brown, Helen; Walker, Graeme; Deeny, Miriam; Stanczuk, Grazyna; McMullen, William

doi:10.1016/s2055-6640(20)30513-6

Cited by 1 publication

(3 citation statements)

References 4 publications

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“…Almost 2500 Xpert HPV tests were performed in the small laboratory at the Nkhoma Hospital. HR-HPV prevalence was found to be 21.2% with HPV 31+ significantly more prevalent than HPV 16/18/45, 25 comparable to previously published results based on 750 routine screening results. 24 Quality measures included regular use of internal quality control (IQC) samples and reproducibility was assured through both intra- and inter-laboratory testing.…”

Section: Primary Screening With Hpvsupporting

confidence: 89%

“…However, we also found that self-taken vaginal swabs taken by women as soon as they arrived at the clinic were highly acceptable and indeed preferable for women and gave similar levels of HPV positivity to provider-taken samples. 25 There are increasing numbers of reports of the effectiveness of self-sampling with Xpert HPV testing from LMIC, 28,29 summarized in a recent meta-analysis. 30 It should be noted, however, that the Nkhoma programme was designed to test the practicalities of testing with Xpert HPV, but was not designed to be part of a clinical management algorithm.…”

Section: Findings From Nkhoma Studiesmentioning

confidence: 99%

“…This point has not been reached and additional costs of testing associated with sample collection can add a further US$2 approximately. We have tried alternative collection media, with comparable results 25 and we understand that manufacturers now recognize the needs of LMICs and that affordable, validated collection systems are in the pipeline. Self-collected samples add to the feasibility and are surely the way of the future.…”

Section: Hpv Screeningmentioning

confidence: 99%

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Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cubie

Campbell

2020

Womens Health (Lond Engl)

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Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

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Section: Primary Screening With Hpvsupporting

confidence: 89%