There is now little dispute about the value of HPV primary screening to identify women at risk of cervical disease and cancer. This talk will cover the practical issues which influence feasibility and cost of introducing HPV testing in LMIC and which differ from those in HIC.
There is a plethora of HPV assays available commercially mostly designed for HIC. Relatively few HPV assays can be described as ‘low resource’ whether in terms of kit and equipment costs, trained personnel or compatible laboratory and clinic infrastructures to ensure accurate and speedy transport of samples and results. HPV assays are relatively expensive and tend to use difficult-to-dispose-of ‘disposables’. Furthermore, only those assays with a quick turn-around are suited to a ‘screen and treat’ single visit programme, while high throughput platforms require to be centralised and lead to 'two visit' programmes. These are different issues from those faced in HIC, but continue to influence the feasibility of introducing HPV testing.
In high income countries, the major stumbling block to introduction of HPV primary screening is the speed at which the juggernaut of population-based cytology-based screening programmes can be turned round. In sharp contrast, low and middle income countries have little or no cytology; what does exist is not accessible to the majority of women and theoretically, HPV-based programmes should be easier to introduce. Cost remains an issue and visual inspection with acetic acid (VIA) has been implemented as a low technology deliverable programme in a number of countries. However, unless treatment is available for observed lesions, such screening programmes will achieve little. Furthermore, quality assurance, a major element in the success of cytology based programmes is often not considered when other screening modalities are introduced. QA for HPV assays should reach similar standards to cytology QA, adding a further cost dimension, particularly difficult for LMIC. The introduction of national HPV vaccine programmes, largely in HIC and where there is high coverage, will impact on the type of HPV assays required and lead to dramatic changes in screening programmes. Self-sampling is increasingly considered, as evidence mounts that it is as/almost as effective as physician taken samples. This has implications for public health, staffing and follow-up which exist in both HIC and LMIC. However more self-sampling studies are required in LMIC to provide robust evidence of the quality of samples which are then submitted and of successful communication of HPV results.
n/a
n/a
n/a
n/a