Clinical evaluation of modifications to a human papillomavirus assay to optimise its utility for cervical cancer screening in low-resource settings: a diagnostic accuracy study

Publication date: February 2020Source: The Lancet Global Health, Volume 8, Issue 2Author(s): Louise Kuhn, Rakiya Saidu, Rosalind Boa, Ana Tergas, Jennifer Moodley, David Persing, Scott Campbell, Wei-Yann Tsai, Thomas C Wright, Lynette DennySummaryBackgroundHPV-based screen and treat is the recommended approach for cervical cancer screening in low-resource settings, but quite low specificity of human papillomavirus (HPV) testing, particularly in women living with HIV, leads to overtreatment. We evaluated whether HPV type restriction and more stringent cutoffs on Xpert HPV optimise performance characteristics of this assay for screen and treat.MethodsWe recruited HIV-negative and HIV-positive women aged 30–65 years from a primary care facility and a referral colposcopy clinic in Cape Town, South Africa. Women included had no history of any anogenital cancer or treatment for cervical dysplasia, had no hysterectomy, and were not pregnancy at the time of recruitment. All women had cervical samples collected for Xpert HPV (an assay that detects high-risk HPV types in five channels: HPV type 16; HPV types 18 or 45, or both; HPV types 31, 33, 35, 52, or 58, or more than one of these types; HPV types 51 or 59, or both; and HPV types 39, 56, 66, or 68, or more than one of these types) and underwent colposcopy and histological sampling with consensus pathology review. Logistic regression and receiver operating characteristic curves were used to evaluate improvements in specificity att...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research