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Efficient high-risk human papillomavirus screening through pooled testing: a simulation study based on real-world
Fengming Pan1, Marcel Jw Greuter2, Jaap Ar Koot3
1Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Journal of Global Health
|July 24, 2026
Summary
Pooled high-risk human papillomavirus (hrHPV) testing can significantly reduce the number of tests needed for cervical cancer screening. This approach is particularly effective in low-prevalence settings, offering cost savings for resource-limited countries.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Molecular Diagnostics
Background:
- The World Health Organization endorses high-risk human papillomavirus (hrHPV) testing for cervical cancer screening.
- Pooling samples can decrease the cost of widespread hrHPV testing.
- This study evaluates the test-saving potential of pooled hrHPV testing in low- and middle-income countries (LMICs).
Purpose of the Study:
- To simulate and quantify the test-saving impact of pooled hrHPV testing strategies.
- To assess the efficiency of two- and three-stage pooling methods.
- To analyze the influence of hrHPV prevalence on pooling effectiveness.
Main Methods:
- Simulated two- and three-stage hrHPV pooling using real-world data from Bangladesh and Uganda.
- Calculated tests per stage, total tests, and percentage of tests saved.
- Conducted sensitivity analysis on the impact of pooling on sensitivity and specificity, focusing on the false-negative rate (FNR).
Main Results:
- In Bangladesh (2.10% hrHPV prevalence), two-stage and three-stage pooling saved 71.21% and 77.21% of tests, respectively.
- In Uganda (22.52% hrHPV prevalence), two-stage pooling (3 samples/pool) saved 15.34% of tests.
- Higher FNR was observed in low-prevalence settings with two-stage pooling, considering potential sensitivity and specificity losses.
Conclusions:
- Pooled hrHPV testing offers significant potential to reduce test utilization and expand screening capacity in resource-limited settings.
- Lower hrHPV prevalence enhances the efficiency of pooled testing strategies.
- Pooled hrHPV testing presents a viable, cost-effective option for LMICs, meriting further validation despite potential minor impacts on sensitivity and specificity.
