<![CDATA[The concept of HPV tests adapted to emerging economies]]>

Is HPV testing in self-collected vaginal samples really a game-changer in cervical cancer screening?It is certainly a game-changer, HPV testing in self-collected vaginal samples is the only option for breaking some of the barriers for increasing coverage of screening, and HPV testing is the only screening test that can be run using those samples. The other screening tests require a pelvic examination which is not acceptable in many cultural groups. In most places women have a very busy schedule and many other competing obligations, and they do not have time to visit a health facility for a pelvic examination. There is a great experience in Argentina showing that self-collection increased the coverage of screening four times compared with Pap screening. Additionally, multiple studies have shown that HPV testing using self-collected vaginal samples is more sensitive than Pap smear for detecting pre-cancer.

But is self-collection of vaginal samples acceptable by women?This is great question because there is always some uncertainty about the acceptability of self-sampling by women. In my own experience in several studies in India, Uganda and Central America, self-collecting a vaginal sample is highly acceptable by women from multiple different continents, cultures or beliefs. I also found that the medical community underestimates the acceptability of self-sampling by women in their communities, and also underestimate the proficiency of women for collecting those samples. I participated in several interventions using vaginal self-sampling in almost 100,000 women in multiple countries, and in all of them self-sampling was highly acceptable, and easy to understand and perform by women.

Are the HPV current tests suitable for developing countries?There is always the tendency to wait until we have the “perfect test” to start implementing HPV testing in developing countries, but the HPV test is just one of the several components we need for screening and treating pre-cancerous lesions. We are using careHPV in the national programs of several countries and the test is working very well. It has been mentioned that the problem with careHPV, or any other batch testing, is that we need to have 90 samples to run the test, but in many places there is the need for screening thousands of women, and we have also a limited number of lab technicians. Therefore, being able to run 90 samples in a 3-hour period makes a more efficient use of the limited lab tech capacity. Delaying implementation of this technology has a huge impact in human life, to be more specific, hundreds of thousands of women die every year due to cervical cancer, and thousands of those lives can be prevented if we do not delay the implementation of the technologies currently available. If any new and better technology comes later, it could be easily incorporated if the other components of the prevention program are already in place.

What could we do for speeding up the reduction of cervical cancer in developing countries?We do not need more pilots for cervical cancer prevention; we already have multiple good options for primary and secondary prevention. Now it is the time to think out-of-the-box for planning new options for delivering the services. We need to scale-up the implementation of services in more than 100 developing countries in a short period of time, one or two decades at the most. Therefore, we need innovative options for training health care providers in all regions, to make HPV testing available to countries with the higher burden of disease, and to make new treatment options available for those in need. It is urgent to evaluate new strategies for one-in-alifetime interventions, strategies such as the HPV Faster approach to do screening and vaccination in one visit. Millions of women will die if we do not act fast within the next few years.

Indigenous laboratory technician running careHPV in Chimaltenango Province, Guatemala.

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INTERVIEW WITH
Dr. Jose Jeronimo, MD
Senior Advisor for Women’s Cancers PATH, Seattle, USA
jjeronimo@path.org

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