Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries

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dc.contributor.authorJoseph, Jessica
dc.contributor.authorDemke, Owen
dc.contributor.authorAmeyan, Lola
dc.contributor.authorBitilinyu-Bango, Joseph
dc.contributor.authorBourgoin, Blandine
dc.contributor.authorDiop, Mamadou
dc.contributor.authorGuèye, Babacar
dc.contributor.authorKama, Jibrin
dc.contributor.authorLubega, Marvin
dc.contributor.authorMadzima, Bernard
dc.contributor.authorMaparo, Tatenda
dc.contributor.authorMhizha, Tasimba
dc.contributor.authorMusoke, Andrew
dc.contributor.authorNabadda, Susan
dc.contributor.authorPhiri, Twambilire
dc.contributor.authorTchereni, Timothy
dc.contributor.authorWiwa, Owens
dc.contributor.authorHariharan, Karen
dc.contributor.authorPeter, Trevor
dc.contributor.authorKhan, Shaukat
dc.date.accessioned2023-02-21T19:27:24Z
dc.date.available2023-02-21T19:27:24Z
dc.date.issued2023-01-06
dc.description.abstractObjectives: To demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa. Setting: 45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda and Zimbabwe. Participants: 15 766 women aged 25–54 years presenting at outpatient departments (Senegal only, general population) or at antiretroviral therapy clinics (all other countries, HIV-positive women only). Eligibility criteria followed national guidelines for cervical cancer screening. Interventions: HPV testing was offered to eligible women as a primary screening for cervical cancer, and HPV-positive women were referred for visual inspection with acetic acid (VIA), and if lesions identified, received treatment or referral. Primary and secondary outcome measures: The primary outcomes were the proportion of HPV-positive women who received results and linked to VIA and the proportion of HPV-positive and VIA-positive women who received treatment. Results: A total of 15 766 women were screened and tested for HPV, among whom 14 564 (92%) had valid results and 4710/14 564 (32%) were HPV positive. 13 837 (95%) of valid results were returned to the clinic and 3376 (72%) of HPV-positive women received results. Of women receiving VIA (n=2735), 715 (26%) were VIA-positive and 622 (87%) received treatment, 75% on the same day as VIA. Conclusions: HPV testing was found to be feasible across the five study countries in a public health setting, although attrition was seen at several key points in the cascade of care, namely results return to women and linkage to VIA. Once women received VIA, if eligible, the availability of on-site cryotherapy and thermal ablation allowed for same-day treatment. With sufficient resources and supportive infrastructure to ensure linkage to treatment, use of HPV testing for cervical cancer screening as recommended by WHO is a promising model in low-income and middle-income countries.en_US
dc.identifier.citationJoseph, J., Demke, O., Ameyan, L., Bitilinyu-Bango, J., Bourgoin, B., Diop, M., Guèye, B., Kama, J., Lubega, M., Madzima, B., Maparo, T., Mhizha, T., Musoke, A., Nabadda, S., Phiri, T., Tchereni, T., Wiwa, O., Hariharan, K., Peter, T., & Khan, S. (2023). Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries. BMJ open, 13(1), e065074. https://doi.org/10.1136/bmjopen-2022-065074en_US
dc.identifier.otherDOI: 10.1136/bmjopen-2022-065074
dc.identifier.urihttps://hdl.handle.net/20.500.14041/5791
dc.language.isoen_USen_US
dc.publisherBMJ Openen_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subjectPublic Healthen_US
dc.subjectGynaecological Oncologyen_US
dc.subjectMolecular Diagnosticsen_US
dc.titleHuman papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countriesen_US
dc.typeArticleen_US
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