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Mapping the HPV Detection Landscape in Botswana: A Narrative Review of Diagnostic Platforms and Their Impact on
1Botswana-University of Pennsylvania Partnership Gaborone Botswana.
Background And Aim:
Cervical cancer is a major public health issue in Botswana, driven by high HIV prevalence and limited screening access. Molecular detection of high-risk human papillomavirus (hrHPV) is crucial for prevention and early diagnosis. The aim of this narrative review is to synthesize studies evaluating seven HPV detection platforms used in Botswana, focusing on diagnostic performance, feasibility, and scalability.
Methods:
A comprehensive literature search was conducted across PubMed, PMC, Google Scholar, and regional repositories up to July 2025 to identify studies evaluating HPV detection platforms in Botswana. Eligible studies included those assessing molecular HPV assays or genotyping tools in Botswana populations, reporting diagnostic performance or feasibility data. Data extracted covered study population characteristics, sample types, detection platforms, hrHPV prevalence, and performance metrics. Findings were qualitatively synthesized to compare platforms by sample type and application, as heterogeneity precluded meta-analysis.
Results:
The Cepheid Xpert HPV assay, with near-point-of-care capability, self-sampling suitability, and high sensitivity (96%) and specificity (90%), is well-suited for national programs despite costs of $15-$25 per test. AmpFire, costing $10-$15 per test, requires minimal equipment, offers good field feasibility (92% sensitivity, 88% specificity), and is promising for community deployment. Laboratory-based assays like Roche Linear Array and Abbott RealTime deliver broader genotyping and > 93% sensitivity but require centralized infrastructure. PathoChip microarray detects novel HPV types yet is cost-prohibitive (> $150/test). Double-nested PCR aids retrospective formalin-fixed paraffin-embedded (FFPE) analysis but lacks practicality. These platforms collectively enhance cervical cancer prevention strategies in Botswana.
Conclusions:
This review identifies feasible HPV detection platforms for Botswana's cervical cancer control. Cepheid Xpert and AmpFire assays offer accurate, affordable, and field-ready options for early diagnosis and wider screening access. Integrating these molecular tools into existing HIV and reproductive health services could enhance prevention, early detection, and progress toward WHO cervical cancer elimination goals.

