PATH's Cervical Cancer Prevention Action Planner

Lessons specific to HPV DNA testing

HPV DNA testing has been available in wealthier countries for years. PATH worked with two medical equipment companies (Digene, which later was bought by QIAGEN) to adapt technology from a laboratory-based, rather expensive HPV DNA test called Hybrid Capture II™ and to create a more "field-friendly" test, called careHPV™. The lessons below relate primarily to careHPV™, though some also are relevant to other molecular tests.

HPV DNA testing has been endorsed as a primary screening method by the World Health Organization, the International Federation of Gynecology and Obstetrics, the United Nations Population Program (UNFPA), the ACCP, the Cervical Cancer Action coalition, PATH, and many other organizations.

The WHO Comprehensive Cervical Cancer Control: A guide to essential practice is an excellent, detailed resource on HPV DNA use.

Client- and provider-perceived benefits of HPV DNA testing

  • HPV DNA testing is much more sensitive than VIA or Pap.
  • CareHPV™ provides good results with either cervical or vaginal specimens (though sensitivity when using cervical samples is slightly higher).
  • In cases where it would be culturally appropriate, clients can be taught to collect a vaginal sample themselves, in a private space at the clinic or at home.
  • HPV DNA and other molecular tests are more objective than VIA or Pap.
  • CareHPV™ results are available much more rapidly than Pap results.
  • Client- and provider-perceived drawbacks of HPV DNA testing
  • At the time of writing, no molecular tests are commercially available at the low prices needed for broad introduction. However, careHPV™ is slated for commercial distribution in 2013.
  • Because careHPV™ detects HPV infection rather than lesions, and infection can resolve spontaneously, use of HPV DNA testing may lead to some unnecessary treatment, especially if the test is used wih women under 30 years of age.
  • Even if the cost of the tests plummets, because the test format is optimized for multiple samples to be run at the same time (90 samples in the case of careHPV™), HPV DNA testing could still be expensive for low-volume screening. On the other hand, waiting to gather enough samples for the test to be cost-effective may delay delivery of results.
  • Because the test requires two to three hours to produce results, and because samples likely will be batched for testing to save money, HPV DNA is less amenable than VIA to same-day screen and treat strategies.
  • Because the evidence supporting HPV DNA testing is relatively new, health professionals in lower-resource settings may not be aware of the data and may not readily accept it. They may perceive HPV DNA testing as inappropriate or too high-tech for their setting.

Strategies appropriate for HPV DNA testing

  • Develop a VIA-based screening platform now, then introduce HPV DNA or other molecular tests when they become affordable (and use VIA for treatment selection).

Messaging specific for HPV DNA testing

  • The new test (careHPV™) works much better than the old test (Pap).
  • It only takes a few minutes to take the sample, and the process is not painful.
  • Results will be available later in the day, or the next few days [or whenever appropriate given your program].
  • You can choose to have the test sample taken by a provider or you can do it yourself, in private [if the program offers self-sampling].
Photo: PATH

Additional resources

Print version: Cervical cancer screening and treatment in low-resource settings (PDF, RHO Cervical Cancer website)

Watch videoScreening and Treatment of Precancerous Lesions video and transcript

Screening and treatment (RHO Cervical Cancer website)

World Health Organization: Comprehensive Cervical Cancer Control: A guide to essential practice (PDF)

Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers (PDF)

Evidence-Based, Alternative Cervical Cancer Screening Approaches in Low-Resource Settings

Strategic Plan for Cervical Cancer Prevention and Control in Uganda (PDF)

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