Impact of the COVID-19 pandemic on human papillomavirus–based testing services to support cervical cancer screening

Abstract

Introduction:The World Health Organization elimination goal for cervical cancer relies on screening 70% of women at ages 35 and 45, preferentially through molecular HPV testing. The SARS-CoV-2 pandemic has led to an unprecedented demand for molecular tests and platforms. Our objective was to gain insight into the impact of SARS-CoV-2 on the actual or anticipated shortage of tests, equipment, consumables, and staff required to deliver molecular HPV laboratory services and to consider the implications for the sustainability and development of cervical screening programs. Methods: A 19-item online questionnaire was created and made available online between December 2020 and February 2021. Five companies with clinically validated HPV and SARS-CoV-2 tests in their portfolios were invited to provide a statement on the volumes of molecular COVID-19 tests produced, relevant changes to manufacturing capacity, and their current and post-pandemic strategy for HPV tests. Results: We received responses from 57 laboratories representing 30 countries and six continents. Among these, 74% reported experiencing a supply shortage, 54% reported a shortage of personnel, and 33% reported delays in ordering equipment. Three companies described expansion of manufacturing lines, investment in diagnostic infrastructure, and scale-up of manufacturing capacity. Two companies specifically referred to opportunities for the use of platforms for COVID-19 testing to support HPV testing in time. Conclusions:The demand for SARS-CoV-2 testing is competing with HPV testing, compounded by a shortage of staff. This represents a challenge for existing laboratory services and for settings keen to implement HPV-based screening. However, supply challenges may be addressed in time, given the significant investment in manufacturing capacity. In addition, innovation around molecular COVID-19 testing systems may result in solutions that address the shortage of rapid low-cost HPV testing systems for low-resource settings. Finally, because the demand for COVID-19 testing is likely to decrease, this may release both workforce and platform capacity for high-throughput HPV testing. The global health community should be alert to the opportunities around innovation and capacity if cervical cancer elimination goals are to be reached.

Human Papillomavirus Detection by Whole-Genome Next-Generation Sequencing: Importance of Validation and Quality Assurance Procedures

“…The SARS-CoV-2 pandemic has brought about an exponential increase in molecular testing and associated infrastructure, including that required to support sequence-level variant detection. This is likely to pay dividends for the establishment of “cross organism working” to a diagnostic standard [ 89 ]. Certainly, NGS has the potential to support risk stratification of patients with HPV-associated disease through its ability to detect types within tissue with exquisite sensitivity and through providing subtle insights into aspects of HPV infection that may be predictive of outcome (integration pattern and status, delineation of dominant variant(s), and viral load).…”

O impacto da pandemia da COVID-19 no rastreamento do câncer de colo uterino em Teresina – PI

“…Ainda assim, é possível perceber que não existe uma correlação negativa forte entre a queda no número de exames citopatológicos e o aumento do número de casos de COVID-19 em 2020 (gráfico 3), ou seja, a curva ascendente de casos novos não é o único fator que interfere negativamente para a piora do rastreamento. Para Murewanhema (2021) e Poljak et al (2021), outros fatores relacionados à pandemia, como falta de suprimentos para testes diagnósticos, sobrecarga dos funcionários de laboratórios e escassez de EPI´s, além do medo da contaminação pelo novo coronavírus, podem ter influenciado negativamente o sistema de rastreamento. Sendo que, em diversos países, uma das primeiras atitudes tomadas pelos gestores em saúde foi a de interromper o rastreamento, ainda que os casos fossem incipientes.…”

“…Além do mais, a média dos casos de COVID-19 no primeiro período de 2020 foi menor do que a do segundo período em cerca de 1966 casos, o que em tese faria do segundo período um momento de maior dificuldade para a realização dos exames de rastreamento, porém essa diferença da média não foi estatisticamente significante, havendo apenas um maior desvio padrão para o primeiro período (gráfico 4). Essa interrupção dos serviços de rastreamento de câncer, ainda que não relacionada diretamente à curva de casos, mas sim às decisões em saúde urgentes que foram tomadas para conter o avanço do vírus, também puderam ser observadas em países como Holanda, Alemanha, Reino Unido e Polônia, que registraram uma redução nos diagnósticos de câncer durante a pandemia, segundo a OMS (Poljak et al, 2021).…”

Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer

“…19 In a recent report, 63% of the 57 surveyed HPV reference and screening laboratories in both high- and low- to middle-income countries reported temporary suspensions of routine cervical cancer screening due to COVID-19. 17 …”

“…Furthermore, self-sampling is a method to reach never- or underscreened women. 14 , 15 Self-sampling offers a unique opportunity for expansion to hard-to-reach populations, 16 , 17 and is one of the most feasible strategies for mid- and postpandemic catch-up screening. With these advantages, self-sampling will in the future play an important part in improving the global coverage of cervical cancer screening with highly accurate HPV-testing, which — followed by treatment of detected high-grade cervical lesions — is a prerequisite to the global goal of cervical cancer elimination, together with HPV vaccination.…”