Title : Assessing feasibility of integrating hrHPV testing on m2000 for cervical cancer screening among HIV-1 infected women in Malawi
Abstract:
Introduction: Cervical Cancer remains a public health concern in Malawi and the disease burden is unacceptably high. The WHO recommends HPV DNA testing as a high performance screening method for cervical cancer.
Main Objective: To assess feasibility of hrHPV DNA testing on m2000 for cervical cancer screening among HIV-1 infected women.
Methods: Cross-section study conducted at 2 ART sites in Blantyre, southern Malawi and 500 HIV-1 infected women aged 25 to 49, who came to access ART services. First-void urine [Colli-Pee], vaginal-self-collected, Vaginal-provider-collected and cervical sample were collected and laboratory testing was done on Abbott M2000.
Results: Positivity of hrHPV was comparable in cervical and vaginal self-collected samples (37% and 38% respectively. VIA correctly identified 16 out of 24 CIN2+cases, and missed detection of 8 cases, while hrHPV DNA test correctly identified 23 CIN2+ cases and missed 1 case. The agreement between high risk HPV DNA results from vaginal self- and HCW-collected samples was almost perfect (92%, kappa 0.88). Vast majority of women had positive experiences with vaginal self-sampling, and nearly all women would recommend vaginal and urine self-sampling to friends. 80% of women would prefer self-sampling, compared to 15% who would prefer vaginal or cervical sampling done by a HCW in a clinical setting.
Conclusion: High risk HPV testing on m2000 for cervical cancer screening among HIV-1 infected is feasible in Malawi. To reduce the high burden of cervical cancer in Malawi, there is need to increase detection of pre-invasive lesions using high performance test such as HPV testing on m2000. Further research should focus on evaluation of cost-effectiveness of m2000 and other diagnostic platforms.
Funding: This study was conducted with financial support from Abbott Laboratories
