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Desai KT, Ajenifuja KO, Banjo A, et al. Design and feasibility of a novel program of cervical screening in Nigeria: self-sampled HPV testing paired with visual triage. Infect Agent Cancer. 2020;15:60doi: 10.1186/s13027-020-00324-5.
Desai, K. T., Ajenifuja, K. O., Banjo, A., Adepiti, C. A., Novetsky, A., Sebag, C., Einstein, M. H., Oyinloye, T., Litwin, T. R., Horning, M., Olanrewaju, F. O., Oripelaye, M. M., Afolabi, E., Odujoko, O. O., Castle, P. E., Antani, S., Wilson, B., Hu, L., Mehanian, C., Demarco, M., Gage, J. C., Xue, Z., Long, L. R., Cheung, L., Egemen, D., Wentzensen, N., & Schiffman, M. (2020). Design and feasibility of a novel program of cervical screening in Nigeria: self-sampled HPV testing paired with visual triage. Infectious agents and cancer, 1560. https://doi.org/10.1186/s13027-020-00324-5
Desai, Kanan T, et al. "Design and feasibility of a novel program of cervical screening in Nigeria: self-sampled HPV testing paired with visual triage." Infectious agents and cancer vol. 15 (2020): 60. doi: https://doi.org/10.1186/s13027-020-00324-5
Desai KT, Ajenifuja KO, Banjo A, Adepiti CA, Novetsky A, Sebag C, Einstein MH, Oyinloye T, Litwin TR, Horning M, Olanrewaju FO, Oripelaye MM, Afolabi E, Odujoko OO, Castle PE, Antani S, Wilson B, Hu L, Mehanian C, Demarco M, Gage JC, Xue Z, Long LR, Cheung L, Egemen D, Wentzensen N, Schiffman M. Design and feasibility of a novel program of cervical screening in Nigeria: self-sampled HPV testing paired with visual triage. Infect Agent Cancer. 2020 Oct 14;15:60. doi: 10.1186/s13027-020-00324-5. eCollection 2020. PMID: 33072178; PMCID: PMC7556552.
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Infect Agent Cancer. 2020 Oct 14;15:60. doi: 10.1186/s13027-020-00324-5. eCollection 2020.

Design and feasibility of a novel program of cervical screening in Nigeria: self-sampled HPV testing paired with visual triage.

Infectious agents and cancer

Kanan T Desai, Kayode O Ajenifuja, Adekunbiola Banjo, Clement A Adepiti, Akiva Novetsky, Cathy Sebag, Mark H Einstein, Temitope Oyinloye, Tamara R Litwin, Matt Horning, Fatai Olatunde Olanrewaju, Mufutau Muphy Oripelaye, Esther Afolabi, Oluwole O Odujoko, Philip E Castle, Sameer Antani, Ben Wilson, Liming Hu, Courosh Mehanian, Maria Demarco, Julia C Gage, Zhiyun Xue, Leonard R Long, Li Cheung, Didem Egemen, Nicolas Wentzensen, Mark Schiffman

Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, USA.
  2. Oak Ridge Institute of Science and Education, Oak Ridge, USA.
  3. Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria.
  4. Lagos University Teaching Hospital, Lagos, Nigeria.
  5. Rutgers New Jersey Medical School and Cancer Institute of New Jersey (CINJ), Newark, USA.
  6. Hela Health, Tel Aviv, Israel.
  7. Global Health Labs, Bellevue, USA.
  8. Albert Einstein College of Medicine, New York City, USA.
  9. National Library of Medicine, NIH, Bethesda, USA.

PMID: 33072178 PMCID: PMC7556552 DOI: 10.1186/s13027-020-00324-5

Abstract

BACKGROUND: Accelerated global control of cervical cancer would require primary prevention with human papillomavirus (HPV) vaccination in addition to novel screening program strategies that are simple, inexpensive, and effective. We present the feasibility and outcome of a community-based HPV self-sampled screening program.

METHODS: In Ile Ife, Nigeria, 9406 women aged 30-49 years collected vaginal self-samples, which were tested for HPV in the local study laboratory using Hybrid Capture-2 (HC2) (Qiagen). HPV-positive women were referred to the colposcopy clinic. Gynecologist colposcopic impression dictated immediate management; biopsies were taken when definite acetowhitening was present to produce a histopathologic reference standard of precancer (and to determine final clinical management). Retrospective linkage to the medical records identified 442 of 9406 women living with HIV (WLWH).

RESULTS: With self-sampling, it was possible to screen more than 100 women per day per clinic. Following an audio-visual presentation and in-person instructions, overall acceptability of self-sampling was very high (81.2% women preferring self-sampling over clinician collection). HPV positivity was found in 17.3% of women. Intensive follow-up contributed to 85.9% attendance at the colposcopy clinic. Of those referred, 8.2% were initially treated with thermal ablation and 5.6% with large loop excision of transformation zone (LLETZ). Full visibility of the squamocolumnar junction, necessary for optimal visual triage and ablation, declined from 68.5% at age 30 to 35.4% at age 49. CIN2+ and CIN3+ (CIN- Cervical intraepithelial neoplasia), including five cancers, were identified by histology in 5.9 and 3.2% of the HPV-positive women, respectively (0.9 and 0.5% of the total screening population), leading to additional treatment as indicated. The prevalences of HPV infection and CIN2+ were substantially higher (40.5 and 2.5%, respectively) among WLWH. Colposcopic impression led to over- and under-treatment compared to the histopathology reference standard.

CONCLUSION: A cervical cancer screening program using self-sampled HPV testing, with colposcopic immediate management of women positive for HPV, proved feasible in Nigeria. Based on the collected specimens and images, we are now evaluating the use of a combination of partial HPV typing and automated visual evaluation (AVE) of cervical images to improve the accuracy of the screening program.

© The Author(s) 2020.

Keywords: Automated visual evaluation; Cervical screening; HPV; Self-sampling; Triage

Conflict of interest statement

Competing interestsThe HC2 test kits were donated by Qiagen. The OncoE6 test kits were donated by Arborvitae. The MobileODT EVA system devices and data management software were donated by MobileODT. N

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