A Systematic Review of the Role of HPV Testing in Cervical Cancer Screening in Africa translation missing: zh.hyrax.visibility.files_restricted.text

Stapleford, Liza (Summer 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/jw827c61n?locale=zh
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Abstract

OBJECTIVE: The purpose of this study was to conduct a systematic review of the effectiveness and implementation feasibility of human papillomavirus (HPV) detection in Africa as part of a solitary, sequential, or combined screening strategy in the context of a screen-and-treat approach. 

METHODS: A systematic literature review was performed of studies published between 1/1/2012 and 2/14/2019 that investigated the use of HPV as a screening test for cervical cancer in Africa. For analysis, studies were grouped into topical categories: acceptability and participation, the accuracy of HPV testing, the agreement of self-sampling and clinician-collected sampling, the feasibility of HPV testing, the performance of HPV testing in screen-and-treat approaches, and follow-up. 

RESULTS: We included 30 studies in this review, with studies taking place in twelve African countries. Study designs were predominantly cross-sectional (73%), but there were five randomized controlled trials (RCTs) (17%). HPV testing was performed in twenty-six studies (87%), and the sampling methods varied by the study: self-sampling alone (46%), clinician-collected sampling alone (15%), both (35%), randomization to either self-sampling or clinician-collected sampling (4%). Fifteen publications (50%) spanned only one topical category, 14 (47%) covered two or three, and one publication covered four categories. The acceptability and participation category had the most publications (n= 17), while follow-up had the least (n=1).

CONCLUSIONS: Despite considerable heterogeneity in the studies, a few common themes arose: convenience is a critical determinant of women’s screening uptake; community-based collection yields higher attendance and participation rates than facility-based collection; self-sampling for HPV testing is generally acceptable to women. Additional implementation research in Africa is needed to test the effectiveness of adopting approaches that have proven efficacious in randomized trials performed in other geographic locations.

Table of Contents

SECTION                                                                                                                           PAGE

CHAPTER 1. Introduction..........................................................................................................1

CHAPTER 2. Literature Review..................................................................................................6

           I. Cervical Cancer.............................................................................................................6

              A. Epidemiology............................................................................................................6

             B. Prevention & Screening.............................................................................................7

                  Primary Prevention....................................................................................................7

                  Secondary Prevention................................................................................................8

                  Screening Guidelines for LMIC................................................................................ 11

             C. Staging & Treatment................................................................................................12

             D. HPV Testing in Screening.........................................................................................14

                  Primary Screening....................................................................................................15

                  Secondary Screening (Triage)...................................................................................17

                  Screen-and-Treat......................................................................................................18

             E. Cervical Cancer and HIV............................................................................................19

             F. Critical Questions Remaining....................................................................................20

CHAPTER 3. Manuscript...........................................................................................................22

                  Introduction..............................................................................................................22

                  Methods....................................................................................................................24

                  Results......................................................................................................................29

                  Discussion.................................................................................................................41

CHAPTER 4. Discussion and Recommendations......................................................................46

TABLES & FIGURES..................................................................................................................58

REFERENCES............................................................................................................................75

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