Point-of-care testing with Xpert HPV for single-visit, screen-and-treat for cervical cancer prevention: a demonstration study in South Africa

Sep 24, 2026

Uploaded by Stanley

Human papillomavirus (HPV)-based screen-and-treat (SAT) is recommended for cervical cancer prevention, but implementation in real primary health care settings is operationally challenging. A research site in Khayelitsha, South Africa, implemented HPV-SAT, screening 3062 women aged 30–65, largely receiving same-day point-of-care Xpert HPV results and ablative treatment when eligible. At 12 months, many treated women cleared HPV, while some test-positive women ineligible for treatment showed CIN2+ outcomes. The study highlights program trade-offs between overtreatment and delayed or absent care and underscores the need to improve treatment modalities.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Results

Study population

Operational fidelity to the screen-and-treat cascade

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Point‑of‑care testing with Xpert HPV for single‑visit, screen‑and‑treat for cervical cancer prevention: a demonstration study in South Africa Lynette Denny1,2, Rakiya Saidu1,2, Rosalind Boa1,2, Nomonde Mbatani1,2, Delivette Castor3,4, Jennifer Moodley2,5 & Louise Kuhn3,6* Human papillomavirus (HPV)‑based screen‑and‑treat (SAT) is recommended but implementation presents operational challenges. We implemented HPV‑SAT at a research site in Khayelitsha, South Africa, screening 3062 women aged 30–65 years (44% women living with HIV [WHIV]). All were screened using point‑of‑care Xpert HPV and almost all received their HPV results on the same day. HPV‑positivity occurred in 41.5% ofWHIV and 17.4% of women without HIV (WNoH) reducing to 26.2% in WHIV and 10.4% in WNoH applying treatment eligibility criteria based on high viral load in the channels detecting HPV16, 18, 45, 16, 18, 31, 33, 35, 52, 58. Among those eligible for treatment, 91.3% were considered suitable for ablative therapy, and 94.6% underwent thermal ablation on the same day, with no serious adverse events. Twelve months later, 39.0% ofWHIV and 65.2% ofWNoH treated with ablative therapy were clear of HPV. In women who were HPV‑positive but ineligible for treatment, 19.1% and 12.9% had histologically‑confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) at 12 months. SAT programs need to weigh trade‑offs between overtreatment versus delayed or no treatment for women who test positive for HPV. Treatment modalities for precancerous lesions need to be improved. Cervical cancer is one of the most preventable cancers due to the possibility of detecting and treating during the precancerous phase before the development of invasive disease. Yet, global inequality in access to quality healthcare has resulted in a highly-skewed prevalence, incidence, and mortality from cervical cancer1. Strengthening cervical cancer screening programs in Low and Middle Income Countries (LMICs) is essential to address global inequity2. Weak linkage between the screening test and follow-up treatment threatens the goals of the World Health Organization (WHO) elimination of cervical cancer as a public health problem agenda. Recognizing this critical gap in program efficiencies, WHO endorsed a simplified approach to screening called screen-and-treat (SAT) . In SAT, a positive screening test result, a human papillomavirus (HPV) test, or visual inspection with acetic acid (VIA), identifies those at highest risk of precursor lesions that can be treated immediately—reducing attrition introduced by referral to colposcopy and histological confirmation. Although known to be safe and effective, including in women living with HIV (WHIV)3–6, much remains unknown about the implementation and scale-up HPV-SAT in real-world primary health care settings. Some have questioned the desirability of HPV-SAT for populations with high HIV prevalence. WHIV have high rates of HPV co-infection, but not all will progress to cancer. Treating all WHIV who are HPV co-infected 1Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of CapeTown, CapeTown, South Africa. 2Department Obstetrics and Gynaecology, South African Medical Research Council, Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 3Department Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA. 4Division of Infectious Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA. 5Cancer Research Initiative and School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 6Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 630 W 168th Street, New

FAQs

What approach did the study implement for cervical cancer prevention?

The study implemented a single-visit HPV-based screen-and-treat approach using point-of-care Xpert HPV, with same-day eligibility-based ablative treatment.

How were eligibility and treatment determined for women who tested HPV-positive?

Eligibility for treatment was determined using modified interpretation of Xpert HPV that applied treatment criteria based on high viral load across specific HPV-detecting channels.

What outcomes were observed after 12 months?

Among those treated with ablative therapy, a substantial proportion were clear of HPV at 12 months. Women HPV-positive but ineligible for treatment had histologically confirmed CIN2+ in a minority.

Sep 24, 2026

Uploaded by Stanley