Overview

The HPV DNA test represents a potentially game-changing development for women at risk of cervical cancer given its high sensitivity, cost-effectiveness, accessibility, and WHO’s recommendation for use among both HIV-positive and negative women. It saves women and health care workers time and money as it can be carried out less frequently due to its high performance and can be delivered with shorter turnaround times. Its higher sensitivity can save lives by providing early signals of the need for further investigation and treatment. The HPV DNA test is particularly useful in resource-limited settings, where the use of cytology screening is limited and effective treatment of invasive cancer is not accessible for most women. To enable this tool to save countless lives, it is now necessary to gain the full support of governments and donors, as well as high-level advocacy on the part of implementing partners in order to introduce and scale up HPV DNA screening programs and to improve awareness about its benefits for all women.

Recommendations

In order to speed up the use of HPV DNA testing as the standard of practice in screening women for cervical cancer, the following steps should be taken as soon as possible:

Governments should:

Update national policies and plans on cervical cancer

• Rapidly align national policies on cervical cancer screening and treatment with the WHO recommendations from 2021 and any subsequent updates
• Prioritize prevention, screening, and treatment of cervical cancer within national strategic health plans
• Ensure that cervical cancer prevention, screening, and treatment are integrated into all relevant health care entry points, especially primary health care, sexual and reproductive health, and HIV services, and ensure proper training for health care workers in these settings

Secure funding

• Prioritize cervical cancer prevention, screening, and treatment in requests to donors, including related work by community-based organizations
• In national budgets, incorporate cervical cancer prevention, screening, and treatment, including related work by community-based organizations
• Provide free vaccinations, screening, and treatment for cervical cancer—with no out-of-pocket expenses for people living both with or without HIV—and support women in traveling to health care facilities

Scale up HPV DNA screening

• Ensure that HPV DNA testing, including via self collected samples, is available to all women at the ages recommended by the WHO guidelines
• Ensure that test results are delivered to all women in a timely manner, preferably during the same visit to enable immediate follow-up
• Ensure that HPV DNA testing needs are included in central laboratories and that POC testing plans are within a diagnostic network optimization approach
• Support community efforts to increase awareness of, demand for, and use of HPV DNA tests

Donors should:

Provide funding for cervical cancer, including HPV DNA testing

• Include funding for cervical cancer prevention, screening, and treatment within funding streams for universal health coverage and health systems strengthening, in addition to existing HIV program funding

Strengthen support for civil society and community-based organizations

• Support community-based organizations’ efforts to increase awareness of and demand for cervical cancer vaccination, screening, and treatment and to combat
  stigma and misconceptions around cervical cancer
• Support community-based organizations’ efforts to facilitate women’s access to HPV DNA testing, including via self-collection kits

Push for prices of HPV DNA tests to come down

• Work with private industry, large procurement agencies and countries, and civil society to seek additional decreases in costs for HPV DNA assays, especially for POC tests, through such methods as encouraging additional products to enter the market, volume-based global price reductions across instrument menus, and pooled procurement

Civil society should:

Improve awareness about cervical cancer and scale up demand

• Inform women about the lifesaving benefits of early screening and treatment and the benefits of using HPV DNA screening
• Provide community education about cervical cancer and address misconceptions

Support access to DNA testing and sample transportation in the community

• Facilitate women’s access to HPV DNA tests and inform women of the benefits of using self-collection kits
• Provide support for timely sample transportation to diagnostic sites
• Accompany women throughout the post-test process, including by encouraging them to find out their results and pursue treatment if needed

Call on governments to improve access to HPV DNA testing

• Call on governments to rapidly scale up HPV DNA screening and to devote greater resources to cancer treatment and management
• Call on governments to ensure that women receive test results in a timely manner