Epidemiology of HPV infection in rural settings is more difficult to investigate than in more accessible urban areas. A comprehensive impression and information on HPV prevalence also in such locations is important. Self-sampling may be a more acceptable method for material collection and less trained personnel could support it. HPV testing on cervicovaginal brush samples should result in data on circulating HPV genotypes, age of highest prevalence, mean prevalence and should be correlated to risk for disease.
2000 women between the age of 18 and 65 years from rural communities in the North Tongu District in Ghana, representatively selected from the geographical area and socioeconomical setting, self-collected cervico-vaginal samples using the Evalyn brush device. Samples were transported in the absence of collection media to the lab within 7 days, transferred into methanol-based cell preservation medium and kept at 4°C. From the cell suspension Arbor Vita OncoE6™ Cervical Test, a molecular lateral flow assay for detection of HPV16 and 18 E6 protein, was performed followed by full genotyping using GP5+/6+ PCR with Luminex read-out.
Sample collection in rural communities was highly successful. 2000 samples were collected by Evalyn brush and acceptability was very high. The median age of women screened was 30 years. The OncoE6 Cervical test results revealed a positivity rate of 2% (41/1988) with 5 HPV16+, 11 HPV18+ and 25 HPV16/18+ samples. Initial results present much higher positivity by HPV genotype testing. Concordance with HPV genotyping results and clinical confirmation will be evaluated once all results are available. Follow-up of the patients will be done by PAP smear and colposcopy where indicated due to HPV positivity.
The initial results imply that a molecular triage test may be important to reduce referrals after HPV testing especially in settings with limited resources.