The prevalence of hrHPV among the isolated community in the Highland of Bario, Sarawak, East Malaysia

Abstract

Background Malaysia has introduced the free Pap smear as the primary cervical cancer screening program since the 1960s but has only achieved the national coverage of 22%. The coverage would be much lower in the rural communities especially in Sarawak where many villages and communities are still living in low resource settings and inaccessible by road. In this study, we have evaluated Qiagen’s careHPV system as a point-of-careHPV diagnostic test together with the visualization using acetic acid (VIA) in the isolated communities in the Highland of Bario, Sarawak, East Malaysia. Methods Women attending the cervical cancer outreach program were recruited. Consent was obtained and a cervical swab was clinician-collected and screened for High-risk HPV DNA using the careHPV system. Cervical examination using VIA was offered to all women age <50-year. hrHPV positive women were recruited during their follow-up session and the second cervical swab was collected for HPV genotyping using consensus primer-nested PCR to elucidate the infecting HPV genotypes. Results Seventy-five women aged 27-83 (mean age 55) attended the cervical cancer screening clinic and 8% (n=6/75) of them were positive for hrHPV. Only 33 women were screened using VIA and 21.2% (n=7/33) were found to be positive. A majority of the women (58.6%) were above the age of 50-year and not recommended for VIA to be performed. Thus, it was not feasible to correlate the results obtained from the HPV DNA test and VIA. Only four hrHPV positive women returned for follow-up and genotyping revealed HPV52 in 2 of four women tested suggesting that HPV52 may be the predominant genotype in Bario. Conclusions The careHPV system is portable and can be used in low resource settings as long as reliable electricity is available. We found that careHPV HPV DNA test is more objective compared to VIA and can be used to screen women outside the recommended eligible age. This is especially true for older women in the rural who have never had any form of cervical cancer screening before.

Malaysian Women’s Viewpoint on HPV Screening and Vaccination: A Study on Barriers

“…The Malaysian Ministry of Health has tackled these issues by introducing other prevention strategies. In 2010, free HPV immunisation was incorporated into Malaysian school health programs to vaccinate 250,000 school girls [ 3 ]. In recent years, the National Population and Family Development Board (LPPKN) started to provide free HPV DNA Pap smear screening tests for married, widowed, or divorced Malaysian women aged 25 to 65 years old [ 4 ].…”