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

Area of Science:

• Oncology
• Public Health
• Virology

Background:

• Cervical cancer remains a significant global health burden, particularly in low-resource settings.
• Effective screening strategies are crucial for early detection and prevention.
• Human papillomavirus (HPV) is the primary cause of cervical cancer.

Purpose of the Study:

• To evaluate self-collected HPV testing as a primary cervical cancer screening method in a low-resource setting.
• To assess the utility of self-collected HPV testing within a screen-and-treat approach.
• To determine the optimal age group for HPV-based cervical cancer screening programs.

Main Methods:

• Prospective enrollment of 789 women in a cervical cancer screening campaign in Cameroon.
• Unsupervised self-collected HPV testing (Self-HPV) and physician-collected HPV testing (Physician-HPV).
• Cytology analysis and evaluation of HPV test performance against abnormal cytology (ASC-US+).

Main Results:

• HPV prevalence was 14.6% for Self-HPV and 12.7% for Physician-HPV (Cohen's kappa = 0.74).
• Both tests demonstrated similar HPV positivity for detecting ASC-US+.
• Women aged 30-49 showed increasing cytological abnormalities and decreasing HPV prevalence, suggesting this age group is optimal for screening.

Conclusions:

• Self-collected HPV testing is a viable primary screening tool in resource-limited environments.
• A triage test is necessary to identify women with significant precancer or cancer following HPV screening.
• The findings support the integration of self-collected HPV testing into cervical cancer control strategies.