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. 2023 Sep 27;13(1):16182.
doi: 10.1038/s41598-023-43467-2.

Point-of-care testing with Xpert HPV for single-visit, screen-and-treat for cervical cancer prevention: a demonstration study in South Africa

Lynette Denny  1   2 , Rakiya Saidu  1   2 , Rosalind Boa  1   2 , Nomonde Mbatani  1   2 , Delivette Castor  3   4 , Jennifer Moodley  2   5 , Louise Kuhn  6   7
Affiliations

Point-of-care testing with Xpert HPV for single-visit, screen-and-treat for cervical cancer prevention: a demonstration study in South Africa

Lynette Denny et al. Sci Rep. .

Abstract

Human papillomavirus (HPV)-based screen-and-treat (SAT) is recommended but implementation presents operational challenges. We implemented HPV-SAT at a research site in Khayelitsha, South Africa, screening 3062 women aged 30-65 years (44% women living with HIV [WHIV]). All were screened using point-of-care Xpert HPV and almost all received their HPV results on the same day. HPV-positivity occurred in 41.5% of WHIV and 17.4% of women without HIV (WNoH) reducing to 26.2% in WHIV and 10.4% in WNoH applying treatment eligibility criteria based on high viral load in the channels detecting HPV16, 18, 45, 16, 18, 31, 33, 35, 52, 58. Among those eligible for treatment, 91.3% were considered suitable for ablative therapy, and 94.6% underwent thermal ablation on the same day, with no serious adverse events. Twelve months later, 39.0% of WHIV and 65.2% of WNoH treated with ablative therapy were clear of HPV. In women who were HPV-positive but ineligible for treatment, 19.1% and 12.9% had histologically-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) at 12 months. SAT programs need to weigh trade-offs between overtreatment versus delayed or no treatment for women who test positive for HPV. Treatment modalities for precancerous lesions need to be improved.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Schematic of the HPV-based screen-and-treat algorithm utilizing a modified definition of a positive HPV test to define eligibility for treatment as well as the numbers of study participants moving through each step in the screening cascade.
Figure 2
Figure 2
Schematic of the design of the follow-up evaluation including the numbers of women seen at each follow-up visit by HIV status.
See this image and copyright information in PMC

References

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