Resource-Adapted Triage Strategies for Women Testing HPV Positive With Self-Collected Vaginal Samples in Cameroon

Sep 23, 2026

Uploaded by dhado

WHO recommends HPV-DNA testing as a primary cervical cancer screening approach in low- and middle-income countries, but triage guidance for HPV-positive women remains limited, especially when extended HPV genotyping is not incorporated into existing recommendations. Using retrospective 3T study data from Cameroon (2018–2022) in women aged 30–49 with self-sampling and VIA triage, the study assessed 35 risk-based strategies to manage CIN3+ risk under varying resource availability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

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Introduction

Abstract

International Journal of Cancer RESEARCH ARTICLE OPEN ACCESS Cancer Epidemiology Resource-Adapted Triage Strategies for Women Testing HPV Positive With Self-Collected Vaginal Samples in Cameroon Micol Murtas1 | Pierre Vassilakos1,2 | Ania Wisniak1,3 | Ketty Hu1 | Marc Arbyn4,5 | Gilles W. Tankeu Happi6 | Esther Abatsong6 | François Marcel Ndam Nsangou6 | Jean-Christophe Tille7 | Essia Saiji7 | Bruno Kenfack8 | Patrick Petignat1 1Gynecologic Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva, University of Geneva, Geneva, Switzerland | 2Geneva Foundation for Medical Education and Research, Geneva, Switzerland | 3Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland | 4Unit of Cancer Epidemiology, Belgian Cancer Centre, Brussels, Belgium | 5Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium | 6Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon | 7Division of Clinical Pathology, Diagnostic Department Geneva University Hospitals, Geneva, Switzerland | 8Department of Obstetrics and Gynaecology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon Correspondence: Micol Murtas ([micol.murtas@hug.ch](micol.murtas@hug.ch)) Received: 21 November 2025 | Revised: 13 May 2026 | Accepted: 21 May 2026 Keywords: cervical cancer screening | extended genotyping | human papillomavirus | resource-adapted strategies | risk-based management ABSTRACT The World Health Organization (WHO) recommends HPV-DNA testing as the primary screening method for cervical cancer in low-and middle-income countries (LMICs), yet guidance on how to triage HPV-positive women remains limited. The 2021 WHO guidelines for LMICs do not incorporate extended HPV genotyping, despite its potential to improve risk stratification and support scalable management strategies. This study evaluated screening strategies based on locally available resources for management of HPV-positive women. We retrospectively analyzed data from the 3T study (Test, Triage, and Treat), conducted between 2018 and 2022, which included HPV self-sampling and VIA triage among women aged 30–49years. For all HPV-positive participants, HPV testing (stratified into five genotype-based risk groups), cytology, VIA, cervical-biopsy, and endocervical-brush histopathology were available. Thirty-five screening and triage strategies integrating HPV extended genotyping alone or in combination with VIA or cytology were assessed using CIN3+ risk as a guiding principle. Among 868 HPV-positive women, 9% had CIN3+ lesions. HPV types 31/33/35/52/58 were most prevalent, whereas HPV16 and HPV18/45 carried the highest CIN3+ risks. Strategies combining extended genotyping with cytology demonstrated the best balance of sensitivity and specificity. In settings without access to cytology or VIA, direct treatment of the eight highest-risk HPV types, 16/18/45/31/33/35/52/58, showed the best balance between sensitivity and specificity. When cytology or VIA was available, immediate treatment for HPV16 and reflex triage, cytology (treating ≥ASCUS lesions), or VIA for HPV18/45/31/33/35/52/58 showed the best trade-off. The proposed screening strategies enable risk-adapted triage and guide management decisions based on available resources. | Abbreviations: AI, artificial intelligence; ASC-US+, atypical squamous cells of undetermined significance or worse; CC, cervical cancer; CI, confidence interval; CIN2+, cervical intraepithelial neoplasia grade 2 or worse; CIN3+, cervical intraepithelial neoplasia grade 3 or worse; cNPV, complementary negative predictive value; DNA, deoxyribonucleic acid; ECB, endocervical brushing; HIV, human immunodeficiency virus; HPV, human papillomavirus; IARC, lnternational Agency for Research on Cancer; LLETZ, large loop excision of the transformation zone; LMI

FAQs

What screening and triage strategies were evaluated in the study?

The study assessed 35 strategies integrating extended HPV genotyping alone or with VIA or cytology, using CIN3+ risk as the guiding principle.

Which HPV types were most associated with CIN3+ lesions?

HPV types 31/33/35/52/58 were most prevalent, while HPV16 and HPV18/45 carried the highest CIN3+ risks.

Which strategy performed best depending on available resources?

Extended genotyping combined with cytology offered the best sensitivity–specificity balance overall. Without cytology or VIA, direct treatment of the eight highest-risk HPV types provided the best balance; with cytology or VIA, immediate treatment for HPV16 and reflex triage using cytology or VIA for specified high-risk types showed the best trade-offs.

Sep 23, 2026

Uploaded by dhado