Resource-Adapted Triage Strategies for Women Testing HPV Positive With Self-Collected Vaginal Samples in Cameroon.

Area of Science:

• Oncology
• Virology
• Public Health

Background:

• The World Health Organization (WHO) recommends HPV-DNA testing for cervical cancer screening in low- and middle-income countries (LMICs).
• Current WHO guidelines lack detailed strategies for triaging HPV-positive women, particularly regarding extended HPV genotyping.
• Effective triage is crucial for risk stratification and scalable management in resource-limited settings.

Purpose of the Study:

• To evaluate various screening and triage strategies for HPV-positive women using extended HPV genotyping.
• To assess these strategies based on locally available resources and CIN3+ risk.
• To provide evidence-based recommendations for cervical cancer screening in LMICs.

Main Methods:

• Retrospective analysis of data from the 3T study (2018-2022) including HPV self-sampling, VIA, and HPV genotyping.
• Evaluation of 35 screening and triage strategies integrating extended HPV genotyping with or without cytology or VIA.
• Assessment of strategies using CIN3+ risk as the primary outcome measure.

Main Results:

• Among 868 HPV-positive women, 9% had CIN3+ lesions.
• HPV types 31/33/35/52/58 were most prevalent; HPV16 and HPV18/45 posed the highest CIN3+ risks.
• Strategies combining extended genotyping with cytology offered the best sensitivity and specificity balance.
• In settings without cytology/VIA, direct treatment for the 8 highest-risk HPV types was optimal.
• When cytology/VIA were available, strategies involving HPV16/18/45/31/33/35/52/58 with reflex triage showed the best trade-off.

Conclusions:

• The study proposes resource-adapted screening and triage strategies for HPV-positive women.
• Extended HPV genotyping can enhance risk stratification and guide management decisions.
• These strategies aim to improve cervical cancer prevention in LMICs by optimizing resource utilization.