Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Toliman, Pamela J; Kaldor, John; Badman, Steven G; Gabuzzi, Josephine; Silim, Selina; Kumbia, Antonia; Kombuk, Benny; Kombati, Zure; Munnull, Gloria; Guy, Rebecca; Vallely, Lisa M; Kelly‐Hanku, Angela; Wand, Handan; Ryan, Claire; Tan, Grace Hwei Ching; Brotherton, Julia; Saville, Marion; Mola, Glen; Garland, Suzanne M.; Tabrizi, Sepehr N.; Vallely, Andrew

doi:10.1016/j.pvr.2018.10.009

Cited by 36 publications

(60 citation statements)

References 29 publications

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“…However, an important fraction (4 out of 10) careHPV-positive hHSIL+ seen at visit 2 were also triaged to no treatment, so that hHSIL+ sensitivity for careHPV+VIA triage dropped to 35%. These findings confirm those of similar studies in which a HPV + VIA triage algorithm was associated with sensitivity of only 33% for cervical intraepithelial neoplasia (CIN)2+ in Cameroon [ 7 ] and 34% for cHSIL+ in Papua New Guinea [ 29 ]. In other settings, the proportion of HPV-positive CIN2+ triaged to no treatment have been reported as 75% [ 6 ], 34% [ 8 ] or, estimated in the presence of verification bias due to lack of systematic biopsies, 18% [ 30 ].…”

Section: Discussionsupporting

confidence: 88%

“…In summary, our data send a warning against the real-world utility of a 2-visit approach to VIA-triage of HPV-positive women as an algorithm for cervical cancer screening [ 6 – 8 , 29 ]. Indeed, it appears that investment in HPV-testing to identify women at highest risk of hHSIL+ needs to be coupled with systematic treatment (where possible, in a single visit), to obtain the long term prevention of CIN2+ observed for HPV screen-and-treat approaches in prevention trials [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda

et al. 2018

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BackgroundA pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat.Methods764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+ HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o’clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches.ResultsIn a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment.ConclusionsCareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.Electronic supplementary materialThe online version of this article (10.1186/s12905-018-0549-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda

et al. 2018

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“…Evidence suggests that triaging with either Pap or VIA effectively nullifies the gain in sensitivity of testing with HPV for primary screening [17]. Cost-effectiveness models suggest that a screen-and-treat approach, in which all HPV-positive women are treated and VIA is used only to determine treatment eligibility (rather than to triage women), would be the most effective and costeffective strategy for Nicaragua [18] and other countries in the region [19].…”

Section: Discussionmentioning

confidence: 99%

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Holme

Galindo²,

Martinez-Granera³

et al. 2020

BMC Public Health

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Background: In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. Methods: We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self-vs. provider-collected sampling. Results: Forty-four thousand six hundred thirty-five women were screened with HPV testing; 96.6% of women used self-sampling. Six thousand seven hundred seventy-six women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04-0.08, p < 0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29. Conclusions: Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of selfsampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.

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“…Evidence suggests that triaging with either Pap or VIA effectively nullifies the gain in sensitivity of testing with HPV for primary screening. 17 Cost-effectiveness models suggest that a screen-and-treat approach, in which all HPV-positive women are treated and VIA is used only to determine treatment eligibility (rather than to triage women), would be the most effective and cost-effective strategy for Nicaragua 18 and other countries in the region. 19 Alternatively, emerging evidence indicates that machine learning algorithms , which are currently under evaluation, could dramatically improve the quality of the visual triage step using digital images of the cervix, 20 enabling providers to better "seeand-treat" with less overtreatment than we currently observe in an "HPV test-and-treat" algorithm.…”

Section: Discussionmentioning

confidence: 99%

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Holme¹,

Galindo²,

Martinez-Granera³

et al. 2020

Preprint

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Background: In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. Methods: We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self- vs. provider-collected sampling.Results: 44,635 women were screened with HPV testing; 96.6% of women used self-sampling. 6,776 women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04–0.08, p<0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29.. Conclusions: Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of self-sampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.Trial registration :Not applicable.

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Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Cited by 36 publications

References 29 publications

Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda

Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

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