TY - JOUR
T1 - The Mulher Study
T2 - cervical cancer screening with primary HPV testing in Mozambique
AU - Salcedo, Mila Pontremoli
AU - Lathrop, Eva
AU - Osman, Nafissa
AU - Neves, Andrea
AU - Rangeiro, Ricardina
AU - Mariano, Arlete A.N.
AU - Nkundabatware, Jean Claude
AU - Tivir, Guilhermina
AU - Carrilho, Carla
AU - Monteiro, Eliane C.S.
AU - Burny, Robert
AU - Thomas, Joseph P.
AU - Carns, Jennifer
AU - Andrade, Viviane
AU - Mavume, Celda
AU - Paulo Mugolo, Rosita
AU - Atif, Hira
AU - Hoover, Hannah
AU - Chivambo, Edson
AU - Chissano, Marcos
AU - Oliveira, Cristina
AU - Milan, Jessica
AU - Lopez Varon, Melissa
AU - Fellman, Bryan M.
AU - Baker, Ellen
AU - Jeronimo, José
AU - Castle, Philip E.
AU - Richards-Kortum, Rebecca
AU - Schmeler, Kathleen M.
AU - Lorenzoni, Cesaltina
N1 - Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/10/31
Y1 - 2023/10/31
N2 - Objective To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally. Methods Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected. Results Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology. Conclusion It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.
AB - Objective To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally. Methods Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected. Results Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology. Conclusion It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.
KW - Cervical Cancer
UR - http://www.scopus.com/inward/record.url?scp=85178016875&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85178016875&partnerID=8YFLogxK
U2 - 10.1136/ijgc-2023-004958
DO - 10.1136/ijgc-2023-004958
M3 - Article
C2 - 37907263
AN - SCOPUS:85178016875
SN - 1048-891X
VL - 33
SP - 1869
EP - 1874
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 12
ER -