{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:22:54Z","timestamp":1791300174549,"version":"4.1.0"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032626","name":"Unitaid","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100032626","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,12,2]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda and Zimbabwe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>15\u2009766\u2009women aged 25\u201354 years presenting at outpatient departments (Senegal only, general population) or at antiretroviral therapy clinics (all other countries, HIV-positive women only). Eligibility criteria followed national guidelines for cervical cancer screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>HPV testing was offered to eligible women as a primary screening for cervical cancer, and HPV-positive women were referred for visual inspection with acetic acid (VIA), and if lesions identified, received treatment or referral.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcomes were the proportion of HPV-positive women who received results and linked to VIA and the proportion of HPV-positive and VIA-positive women who received treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 15\u2009766\u2009women were screened and tested for HPV, among whom 14 564 (92%) had valid results and 4710\/14 564 (32%) were HPV positive. 13\u2009837 (95%) of valid results were returned to the clinic and 3376 (72%) of HPV-positive women received results. Of women receiving VIA (n=2735), 715 (26%) were VIA-positive and 622 (87%) received treatment, 75% on the same day as VIA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HPV testing was found to be feasible across the five study countries in a public health setting, although attrition was seen at several key points in the cascade of care, namely results return to women and linkage to VIA. Once women received VIA, if eligible, the availability of on-site cryotherapy and thermal ablation allowed for same-day treatment. With sufficient resources and supportive infrastructure to ensure linkage to treatment, use of HPV testing for cervical cancer screening as recommended by WHO is a promising model in low-income and middle-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-065074","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T11:28:10Z","timestamp":1673004490000},"page":"e065074","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3860-4673","authenticated-orcid":false,"given":"Jessica","family":"Joseph","sequence":"first","affiliation":[{"name":"Global Health Sciences, Clinton Health Access Initiative, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Demke","sequence":"additional","affiliation":[{"name":"Global Diagnostics Team, Clinton Health Access Initiative, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lola","family":"Ameyan","sequence":"additional","affiliation":[{"name":"Cervical Cancer, Clinton Health Access Initiative, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Bitilinyu-Bango","sequence":"additional","affiliation":[{"name":"National Laboratory Services, Ministry of Health, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandine","family":"Bourgoin","sequence":"additional","affiliation":[{"name":"Cervical Cancer, Clinton Health Access Initiative, Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamadou","family":"Diop","sequence":"additional","affiliation":[{"name":"Cancer Institute of Cheikh Anta Diop University, Aristide Le Dantec Hospital, Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babacar","family":"Gu\u00e8ye","sequence":"additional","affiliation":[{"name":"Disease Control, Minist\u00e8re de la Sant\u00e9 et de l\u2019Action Sociale, Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jibrin","family":"Kama","sequence":"additional","affiliation":[{"name":"Laboratory Access Program, Clinton Health Access Initiative, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin","family":"Lubega","sequence":"additional","affiliation":[{"name":"Laboratory Access Program, Clinton Health Access Initiative, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Madzima","sequence":"additional","affiliation":[{"name":"Family Health, Ministry of Health and Child Care, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatenda","family":"Maparo","sequence":"additional","affiliation":[{"name":"Laboratory Access Program, Clinton Health Access Initiative, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasimba","family":"Mhizha","sequence":"additional","affiliation":[{"name":"Laboratory Access Program, Clinton Health Access Initiative, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Musoke","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Nabadda","sequence":"additional","affiliation":[{"name":"National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Twambilire","family":"Phiri","sequence":"additional","affiliation":[{"name":"Reproductive Health, Ministry of Health, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Tchereni","sequence":"additional","affiliation":[{"name":"Sexual, Reproductive, Maternal and Newborn Health, Clinton Health Access Initiative, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owens","family":"Wiwa","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Hariharan","sequence":"additional","affiliation":[{"name":"Global Cervical Cancer and Nutrition, Clinton Health Access Initiative, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Peter","sequence":"additional","affiliation":[{"name":"Global Diagnostics Team, Clinton Health Access Initiative, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaukat","family":"Khan","sequence":"additional","affiliation":[{"name":"Global Diagnostics Team, Clinton Health Access Initiative, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"2025121509114876000_13.1.e065074.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.100836","article-title":"Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis","volume":"34","author":"Dorji","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025121509114876000_13.1.e065074.2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29210"},{"key":"2025121509114876000_13.1.e065074.3","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F"},{"key":"2025121509114876000_13.1.e065074.4","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn036"},{"key":"2025121509114876000_13.1.e065074.5","unstructured":"WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. WHO Guidelines Approved by the Guidelines Review Committee. Geneva 2021."},{"key":"2025121509114876000_13.1.e065074.6","unstructured":"WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: Use of mRNA tests for human papillomavirus (HPV). WHO Guidelines Approved by the Guidelines Review Committee. Geneva 2021."},{"key":"2025121509114876000_13.1.e065074.7","doi-asserted-by":"publisher","DOI":"10.1177\/0956462413491735"},{"key":"2025121509114876000_13.1.e065074.8","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/QAD.0000000000001765","article-title":"HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer","volume":"32","author":"Liu","year":"2018","journal-title":"AIDS"},{"key":"2025121509114876000_13.1.e065074.9","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2021039","article-title":"Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review","volume":"43","author":"Okoye","year":"2021","journal-title":"Epidemiol Health"},{"key":"2025121509114876000_13.1.e065074.10","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000005"},{"key":"2025121509114876000_13.1.e065074.11","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.ijid.2020.02.051","article-title":"Human papillomavirus prevalence and risk factors among HIV-negative and HIV-positive women residing in rural Eastern Cape, South Africa","volume":"95","author":"Taku","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2025121509114876000_13.1.e065074.12","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.20115"},{"key":"2025121509114876000_13.1.e065074.13","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1002\/ijgo.12415","article-title":"Cervical cancer screening through human papillomavirus testing in community health campaigns versus health facilities in rural Western Kenya","volume":"141","author":"Huchko","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121509114876000_13.1.e065074.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003528","article-title":"Diagnostic accuracy of cervical cancer screening and screening-triage strategies among women living with HIV-1 in Burkina Faso and South Africa: a cohort study","volume":"18","author":"Kelly","year":"2021","journal-title":"PLoS Med"},{"key":"2025121509114876000_13.1.e065074.15","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1002\/cam4.1089","article-title":"Cervical cancer screening in a low-resource setting: a pilot study on an HPV-based screen-and-treat approach","volume":"6","author":"Kunckler","year":"2017","journal-title":"Cancer Med"},{"key":"2025121509114876000_13.1.e065074.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.ypmed.2020.106076","article-title":"Introduction of HPV testing for cervical cancer screening in Central America: the scale-up project","volume":"135","author":"Holme","year":"2020","journal-title":"Prev Med"},{"key":"2025121509114876000_13.1.e065074.17","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25677","article-title":"Point-of-care testing can achieve same-day diagnosis for infants and rapid ART initiation: results from government programmes across six African countries","volume":"24","author":"Boeke","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"2025121509114876000_13.1.e065074.18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S2055-6640(20)30062-5","article-title":"Health service delivery models for scaling use of point-of-care HPV 'test and treat' strategies in high-burden, low-income settings","volume":"5","author":"Vallely","year":"2019","journal-title":"J Virus Erad"},{"key":"2025121509114876000_13.1.e065074.19","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1097\/QAD.0000000000003031","article-title":"Feasibility and impact of near-point-of-care integrated tuberculosis\/HIV testing in Malawi and Zimbabwe","volume":"35","author":"Wang","year":"2021","journal-title":"AIDS"},{"key":"2025121509114876000_13.1.e065074.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-022-09202-2","article-title":"Acceptability and safety of thermal ablation to prevent cervical cancer in sub-Saharan Africa","volume":"22","author":"Metaxas","year":"2022","journal-title":"BMC Cancer"},{"key":"2025121509114876000_13.1.e065074.21","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2016-052609"},{"key":"2025121509114876000_13.1.e065074.22","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/ijgo.12025","article-title":"Costs of integrating cervical cancer screening at an HIV clinic in Kenya","volume":"136","author":"Vodicka","year":"2017","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121509114876000_13.1.e065074.23","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1093\/heapol\/czw182","article-title":"Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting","volume":"32","author":"Campos","year":"2017","journal-title":"Health Policy Plan"},{"key":"2025121509114876000_13.1.e065074.24","unstructured":"Diagnostic pricing database, 2021. Available: https:\/\/aslm.org\/resource\/diagnostic-pricing-database\/"},{"key":"2025121509114876000_13.1.e065074.25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0248832","article-title":"Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: the HPV in Africa Research Partnership (HARP) study","volume":"16","author":"Devine","year":"2021","journal-title":"PLoS One"},{"key":"2025121509114876000_13.1.e065074.26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02722.x"},{"key":"2025121509114876000_13.1.e065074.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001351"}],"updated-by":[{"DOI":"10.1136\/bmjopen-2022-065074corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000}}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-065074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:11:57Z","timestamp":1765818717000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-065074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,6]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2022-065074"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-065074","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}