An Overview of HPV Screening Tests to Improve Access to Cervical Cancer Screening Amongst Underserved Populations: From Development to Implementation.
An Overview of HPV Screening Tests to Improve Access to Cervical Cancer Screening Amongst Underserved Populations: From Development to Implementation.
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DOI：
10.2147/rmhp.s296914
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发表时间：
2022
影响因子：
3.5
通讯作者：
Oluwole, Ayodeji A.
中科院分区：
文献类型：
--
作者：
Okunade, Kehinde S.;Adejimi, Adebola A.;John-Olabode, Sarah O.;Oshodi, Yusuf A.;Oluwole, Ayodeji A.
宫颈癌是最常见的人类乳头瘤病毒(HPV)相关疾病。了解宫颈癌的自然历史和病因学知识为预防宫颈癌提供了独特的机会，而开发HPV筛查测试是最有效的策略之一。目前的HPV诊断方法使用基于分子的技术来检测宫颈/阴道样本中的HPVDNA或E6/E7mRNA。HPV筛查试验比细胞学检查或以醋酸(VIA)为主要筛查方法的目视检查更敏感，作为一种杂交试验，在诊断轻度细胞学异常方面甚至更有临床价值。由于技术和实验室资源在边缘化或服务不足的环境中极为有限，因此需要妇女长途跋涉进行筛查和治疗。基于HPV的筛查方案的实际实施可能面临许多挑战，应采取措施克服这些挑战，而不影响疾病检测。这些措施可能包括利用世卫组织在35岁和45岁提供HPV筛查检测的全球战略减少筛查频率，采用高通量检测技术，以及改善偏远地区或不愿接受妇科检查的妇女获得阴道HPV自我采样筛查检测的机会。另一项重要战略是使用需要实验室技术人员有限技能的护理点平台，实施“看一看、看一看”的方法。此外，对于服务不足的环境，应优先开发和大规模采用更具体的HPV检测技术，这些技术比目前可用的选择更便宜、更容易在非实验室环境中使用。同时，有必要开发和开始实施一种负担得起的、容易获得的中间或二次检测，具有最佳的特异性，用于对临床上不重要的不需要阴道镜检查的HPV感染进行分类或分离。
Cervical cancer is the most common human papillomavirus (HPV)-related disease. Knowledge of the natural history and aetiology of cervical cancer offers unique opportunities for its prevention, and the development of HPV screening tests is one of the most effective strategies. The current HPV diagnostics detect HPV DNA or E6/E7 mRNA in cervical/vaginal samples using molecular-based technologies. HPV screening tests are more sensitive than cytology or visual inspection with acetic acid (VIA) as a primary screening method and are even more clinically valuable in triaging mild cytological abnormalities as a hybrid test. As technical and laboratory resources are grossly limited in marginalized or underserved settings which thus require that women travel long distances for screening and treatment. The practical implementation of an HPV-based screening programme may face many challenges and measures should be instituted to overcome these challenges without compromising disease detection. These measures may include a reduction in screening frequency using the WHO global strategy of offering HPV screening tests at 35 and 45 years of age, adoption of a high throughput testing technology, and improved access to vaginal HPV self-sampling screening tests to women in remote settings or those who are reluctant to undergo gynecologic examination. Another important strategy is the implementation of a “see-and-treat” approach using a point-of-care platform that requires limited skills of laboratory technicians. In addition, the development and large-scale incorporation of more specific HPV testing technologies that are much cheaper and easier to use in non-laboratory settings than the currently available options should be prioritized for underserved settings. At the same time, there is a need to develop and commence the implementation of an affordable and readily available intermediate or secondary test with optimal specificity for triaging or segregating clinically unimportant HPV infections that do not require colposcopy.