Enhancing cervical cancer prevention in South African women : primary HPV mRNA screening with different genotype combinations

dc.contributor.authorSorbye, Sveinung Wergeland
dc.contributor.authorFalang, Bente Marie
dc.contributor.authorBotha, Matthys H.
dc.contributor.authorSnyman, Leon Cornelius
dc.contributor.authorVan der Merwe, Haynes
dc.contributor.authorVisser, Cathy
dc.contributor.authorRichter, Karin Louise
dc.contributor.authorDreyer, Greta
dc.contributor.emailleon.snyman@up.ac.zaen_US
dc.date.accessioned2024-04-19T11:30:02Z
dc.date.available2024-04-19T11:30:02Z
dc.date.issued2023-11-17
dc.description.abstractBACKGROUND : Cervical cancer prevention in regions with limited access to screening and HPV vaccination necessitates innovative approaches. This study explored the potential of a test-and-treat strategy using mRNA HPV tests to impact cervical cancer prevention in a high-prevalence HIV population. METHODS : A cervical screening study was conducted at three South African hospitals involving 710 under-screened, non-pregnant women (25 to 65 years) without known cervical diseases. Cytology, HPV testing, colposcopy, and biopsies were performed concurrently. Histopathologists determined final histological diagnoses based on biopsy and LLETZ histology. mRNA-HPV-genotyping for 3 (16, 18, 45) to 8 (16, 18, 31, 33, 35, 45, 52, 58) high-risk types was performed on leftover liquid-based cytology material. The preventive potential of the test-and-treat approach was estimated based on published data, reporting the causative HPV types in cervical cancer tissue from South African women. Treatment was provided as needed. RESULTS : The HPV positivity rate more than doubled from 3-type (15.2%; 95% CI: 12.6–17.8) to 8-type mRNA (31.5%; 95% CI: 28.8–34.9) combinations, significantly higher among HIV-positive women. CIN3+ prevalence among HIV-positive women (26.4%) was double that of HIV-negative women (12.9%) (p < 0.01). The 6-type combination showed the best balance of sensitivity, specificity and treatment group size, and effectiveness to prevent cervical cancer. A 4-type combination (16, 18, 35, 45) could potentially prevent 77.6% (95% CI: 71.2–84.0) of cervical cancer burden by treating 20% and detecting 41.1% of CIN3 cases in the study group. Similarly, a 6-type combination (16, 18, 31, 33, 35, 45), treating 25% and including 62% of CIN3 cases, might prevent 85% of cervical cancer cases (95% CI: 79.6–90.6) among HIV-positive and negative women. CONCLUSION : Employing mRNA HPV tests within a test-and-treat approach holds huge promise for targeted cervical cancer prevention in under-screened populations. Testing for mRNA of the 6 highest-risk HPV types in this population and treating them all is projected to effectively prevent progression from CIN3 to invasive cervical cancer while reducing overtreatment in resource-constrained settings.en_US
dc.description.departmentMedical Virologyen_US
dc.description.departmentObstetrics and Gynaecologyen_US
dc.description.librarianam2024en_US
dc.description.sdgSDG-03:Good heatlh and well-beingen_US
dc.description.urihttps://www.mdpi.com/journal/cancersen_US
dc.identifier.citationSørbye, S.W.; Falang, B.M.; Botha, M.H.; Snyman, L.C.; van der Merwe, H.; Visser, C.; Richter, K.; Dreyer, G. Enhancing Cervical Cancer Prevention in South African Women: Primary HPV mRNA Screening with Different Genotype Combinations. Cancers 2023, 15, 5453. https://DOI.org/10.3390/cancers15225453.en_US
dc.identifier.issn2072-6694 (online)
dc.identifier.other10.3390/cancers15225453
dc.identifier.urihttp://hdl.handle.net/2263/95686
dc.language.isoenen_US
dc.publisherMDPIen_US
dc.rights© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.en_US
dc.subjectCervical canceren_US
dc.subjectHPV screeningen_US
dc.subjectPrevention strategiesen_US
dc.subjectHIV interactionen_US
dc.subjectNumber needed to treaten_US
dc.subjectPositive predictive valueen_US
dc.subjectNegative predictive valueen_US
dc.subjectRisk managementen_US
dc.subjectGlobal health challengesen_US
dc.subjectTest and treat approachen_US
dc.subjectHuman immunodeficiency virus (HIV)en_US
dc.subjectHuman papillomavirus (HPV)en_US
dc.subjectSDG-03: Good health and well-beingen_US
dc.titleEnhancing cervical cancer prevention in South African women : primary HPV mRNA screening with different genotype combinationsen_US
dc.typeArticleen_US

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