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Clifford GM, Baussano I, Heideman DAM, Tshering S, Choden T, Lazzarato F, Tenet V, Franceschi S, Darragh TM, Tobgay T, Tshomo U. Human papillomavirus testing on self-collected samples to detect high-grade cervical lesions in rural Bhutan: The REACH-Bhutan study. Cancer Med 2023; 12:11828-11837. [PMID: 36999740 PMCID: PMC10619475 DOI: 10.1002/cam4.5851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND "REACH-Bhutan" aimed to evaluate the feasibility and clinical performance of a community-based screening program for cervical cancer in rural Bhutan using self-collected samples for high-risk human papillomavirus (HR-HPV) testing. METHODS In April/May 2016, 2590 women aged 30-60 years were screened across rural Bhutan by providing a self-collected sample for careHPV testing. All careHPV-positive women, plus a random sample of careHPV-negative women, were recalled for colposcopy and biopsy. Self-samples also underwent GP5+/6+ polymerase chain reaction (PCR)-based HR-HPV DNA detection and genotyping. Cross-sectional screening indices were estimated against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), including imputation of hHSIL+ in women without colposcopy. RESULTS HR-HPV positivity was 10.2% by careHPV and 14.8% by GP5+/6+ PCR. Twenty-two cases of hHSIL+ were histologically diagnosed, including one invasive cancer; an additional 7 hHSIL+ were imputed in women without colposcopy. HR-HPV testing by GP5+/6+ showed higher sensitivity for hHSIL+ (89.7%, 95% CI 72.6-97.8) than careHPV (75.9%, 95% CI 56.5-89.7). Negative predictive value was also slightly higher for GP5+/6+ (99.9%, 95% CI 99.6-100) than careHPV (99.7%, 95% CI 99.4-99.9). Specificity, however, was lower for GP5+/6+ (86.1%, 95% CI 84.6-87.4) than careHPV (90.6%, 95% CI 89.4-91.7), as was positive predictive value (6.9%, 95% CI 4.5-9.9 vs. 8.5%, 95% CI 5.4-12.6). Of 377 HR-HPV-positive women by GP5+/6+, 173 (45.9%) were careHPV-positive, including 54.7% HPV16-positive and 30.2% HPV18-positive women. CONCLUSIONS The final REACH-Bhutan results show that screening for cervical cancer with self-collection of samples and HR-HPV testing, in addition to our previous report of achieving high participation, can also perform well to detect women with hHSIL+.
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Affiliation(s)
- Gary M. Clifford
- Early Detection, Prevention and Infections BranchInternational Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Iacopo Baussano
- Early Detection, Prevention and Infections BranchInternational Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Daniëlle A. M. Heideman
- Department of PathologyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center Amsterdam, Imaging and BiomarkersAmsterdamThe Netherlands
| | - Sangay Tshering
- Department of Obstetrics & GynaecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Tashi Choden
- Department of Pathology & Laboratory MedicineJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Fulvio Lazzarato
- Cancer Epidemiology Unit“Città della Salute e della Scienza” HospitalTurinItaly
| | - Vanessa Tenet
- Early Detection, Prevention and Infections BranchInternational Agency for Research on Cancer (IARC/WHO)LyonFrance
| | | | | | - Tashi Tobgay
- Department of Pathology & Laboratory MedicineJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Ugyen Tshomo
- Department of Obstetrics & GynaecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
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Baena A, De Vuyst H, Mesher D, Kasubi M, Yuma S, Mwaiselage J, Zouiouich S, Mlay P, Kahesa C, Landoulsi S, de la Luz Hernandez M, Lucas E, Herrero R, Almonte M, Broutet N. Reproducibility of a Rapid Human Papillomavirus Test at Different Levels of the Healthcare System in Tanzania: The AISHA Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2261-2268. [PMID: 32856600 DOI: 10.1158/1055-9965.epi-20-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/23/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To inform policy makers in Tanzania if and how best to implement rapid HPV testing, we assessed the interobserver reproducibility of careHPV test at three different levels of the healthcare system in an urban and a rural region of Tanzania. METHODS Women aged 30 to 50 years were screened by careHPV testing in two primary healthcare centers (PHC), two district hospitals (DiH), and two regional hospitals (ReH). Aliquots were retested at regional (ReH) and national referral laboratories (NRL). Reproducibility was evaluated using agreement and kappa index measures. Intralaboratory reproducibility was also evaluated in a set of 10 positive and 10 negative samples. RESULTS Samples from 1,134 women were locally tested and retested at ReH and/or NRL. Test results from Dar es Salaam ReH and Kilimanjaro PHC showed clear quality problems including suspicion of contamination during testing or aliquoting. After excluding these samples, 18.8% of 743 women were HPV positive at clinic level. The resulting careHPV reproducibility at different levels of the healthcare system was very good [agreement 95.7%, 95% confidence interval (CI), 94.0-96.9; kappa, 0.86, 95% CI, 0.81-0.91]. Intralaboratory agreement was also very good across four different experiments, with Fleiss' kappa between 0.87 (95% CI, 0.61-1.00) and 1.00 (0.75-1.00). CONCLUSIONS Rapid HPV testing was highly reproducible between lower and higher levels of the healthcare system in Tanzania; however, performance seems to be operator dependent. IMPACT The careHPV test seems to be a feasible option for cervical cancer screening in an organized, decentralized system and in limited-resource settings if quality assurance measures are in place.
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Affiliation(s)
- Armando Baena
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Hugo De Vuyst
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.
| | - David Mesher
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.,Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, United Kingdom
| | - Mabula Kasubi
- Department of Microbiology/Immunology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Safina Yuma
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Julius Mwaiselage
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Semi Zouiouich
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pendo Mlay
- Department of Gynecology and Obstetrics, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Crispin Kahesa
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sihem Landoulsi
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Maria de la Luz Hernandez
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Holme F, Jeronimo J, Maldonado F, Camel C, Sandoval M, Martinez-Granera B, Montenegro M, Figueroa J, Slavkovsky R, Thomson KA, de Sanjose S. Introduction of HPV testing for cervical cancer screening in Central America: The Scale-Up project. Prev Med 2020; 135:106076. [PMID: 32247010 PMCID: PMC7218710 DOI: 10.1016/j.ypmed.2020.106076] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/30/2020] [Accepted: 03/28/2020] [Indexed: 01/02/2023]
Abstract
The Scale-Up project introduced vaginal self-sampling and low-cost human papillomavirus (HPV) testing as the primary approach for cervical cancer screening in selected public health centers in Guatemala, Honduras, and Nicaragua. We evaluate the country-specific accomplishments in screening: target-coverage, triage, and treatment. Between 2015 and 2018, cervical cancer screening was offered to women at least 30 years of age. Triage of HPV-positive women was based on visual inspection with acetic acid or Pap. Aggregated data included total women screened, use of self-sampling, age, time elapsed since last screening, HPV results, triage tests, triage results, and treatment. A total of 231,741 women were screened for HPV, representing 85.8% of the target populations within the project. HPV positivity was lower in Guatemala (12.4%) compared to Honduras and Nicaragua (14.5% and 14.2%, respectively, p < 0.05). A follow-up triage test was completed for 84.2%, 85.8%, and 50.1% of HPV-positive women in Guatemala, Nicaragua, and Honduras, respectively. Of those with a positive triage test, 84.7%, 67.1%, and 58.8% were treated in Guatemala, Nicaragua, and Honduras, respectively. First-time screening was highest in Nicaragua (55.8%) where self-sampling was also widely used (97.1%). The Scale-Up project demonstrated that large-scale cervical cancer screening and treatment intervention in a high-burden, low-resource setting can be achieved. Self-sampling and ablative treatment were key to the project's achievements. Data monitoring, loss to follow-up, and triage methods of screen- positive women remain critical to full success.
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Affiliation(s)
| | | | | | - Claudia Camel
- Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Manuel Sandoval
- Asociación Hondureña de Planificación de Familia, Tegucigalpa, Honduras.
| | | | - Mirna Montenegro
- Instancia por la Salud y el Desarrollo de las Mujeres, Guatemala City, Guatemala
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