OC 12-05CERVICAL SCREENING IN RURAL MALAWI USING XPERT® HPV AND SELF-TAKEN VAGINAL SAMPLES

32. Low resource settings
H. Cubie 1, E. Kawonga 2, M. Mautanga 2, I. Mwenitete 2, B. Kabota 3, D. Morton 3, R. Ter Haar 3, C. Campbell 4, G. Stanczuk 5.
1Global Health Academy, University of Edinburgh (United Kingdom), 2Nkhoma Hospital Laboratory, Nkhoma, Malawi (Malawi), 3Nkhoma CCAP Hospital, Nkhoma, Malawi (Malawi), 4Usher Institute for Populations Health Sciences and Informatics, University of Edinburgh (United Kingdom), 5NHS Highland and GHA, University of Edinburgh (United Kingdom)

Background / Objectives

To test whether self-taken vaginal specimens could be used with Xpert® HPV for primary screening prior to visual inspection with acetic acid (VIA) in Malawi

To compare HPV prevalence in self-taken versus clinician-collected cervical samples using Xpert® HPV.


Methods

Self-taken samples were obtained from women attending routine VIA clinics in Nkhoma Hospital, using cotton swabs suspended in 5ml of PreservCyt® solution. All samples were tested in the local laboratory using the Xpert HPV assay. Results were compared with Xpert® HPV results from 750 clinician-collected LBC samples in PreservCyt®, obtained from women attending the same clinics in the preceding year.  


Results

Overall HPV positivity in the LBC samples was 19.9%, compared with 24.5% in the self-taken samples. Of positive detections, HPV 16 and HPV 18/45 accounted for 24.2% each and HR-HPV ‘others’  for 64.4% in LBC, compared with 17.7%, 26.5% and 76.1% respectively in the self-taken samples. Multiple infections were also more frequently detected in self-taken samples. HPV prevalence in known HIV positive women was comparable (43.4% in LBC ; 45% in vaginal samples).  


Conclusion

Self-taken vaginal samples using cotton swabs gave valid results with Xpert HPV and showed higher HPV positivity than clinician-collected cervical samples. HPV 16 was less frequently detected in vaginal samples, while HPV 18/45, ‘others’ and multiple infections were more common.  Self-sampling was well accepted and satisfactorily collected by women. Sending only HR-HPV positive women to VIA would significantly reduce the burden on clinical staffing resources and skills.


References