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Original research
The Mulher Study: cervical cancer screening with primary HPV testing in Mozambique
  1. Mila Pontremoli Salcedo1,
  2. Eva Lathrop2,
  3. Nafissa Osman3,
  4. Andrea Neves4,
  5. Ricardina Rangeiro5,
  6. Arlete A N Mariano6,
  7. Jean Claude Nkundabatware7,
  8. Guilhermina Tivir8,
  9. Carla Carrilho3,
  10. Eliane C S Monteiro6,
  11. Robert Burny9,
  12. Joseph P Thomas10,
  13. Jennifer Carns11,
  14. Viviane Andrade12,
  15. Celda Mavume13,
  16. Rosita Paulo Mugolo13,
  17. Hira Atif13,
  18. Hannah Hoover2,
  19. Edson Chivambo8,
  20. Marcos Chissano8,
  21. Cristina Oliveira14,
  22. Jessica Milan1,
  23. Melissa Lopez Varon1,
  24. Bryan M Fellman15,
  25. Ellen Baker1,
  26. José Jeronimo16,
  27. Philip E Castle16,
  28. Rebecca Richards-Kortum11,
  29. Kathleen M Schmeler1 and
  30. Cesaltina Lorenzoni17
  1. 1 Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Population Services International, Washington, District of Columbia, USA
  3. 3 Universidade Eduardo Mondlane, Maputo, Mozambique
  4. 4 Hospital Geral e Centro de Saúde José Macamo, Maputo, Mozambique
  5. 5 Hospital Central de Maputo, Maputo, Mozambique
  6. 6 Hospital Geral e Centro de Saúde de Mavalane, Maputo, Mozambique
  7. 7 Hospital Provincial de Xai-Xai, Xai-Xai, Mozambique
  8. 8 Population Services International, Maputo, Mozambique
  9. 9 APOPO TB project, Maputo, Mozambique
  10. 10 Oncology Care & Research IS, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  11. 11 Department of Bioengineering, Rice University, Houston, Texas, USA
  12. 12 ICON plc, São Paulo, Brazil
  13. 13 Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
  14. 14 Dasa, São Paulo, Brazil
  15. 15 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  16. 16 National Cancer Institute, Bethesda, Maryland, USA
  17. 17 Ministry of Health, Maputo, Mozambique
  1. Correspondence to Dr Kathleen M Schmeler, Gynecologic Oncology, M.D. Anderson Cancer Center, Houston, TX 77030, USA; KSchmele{at}mdanderson.org

Abstract

Objective To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally.

Methods Women aged 30–49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected.

Results Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30–49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology.

Conclusion It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.

  • Cervical Cancer

Data availability statement

Data are available upon reasonable request. De-identified datasets, the study protocol, and informed consent form are available upon reasonable request and subject to approval by the ethics committees overseeing the study.

https://doi.org/10.1136/ijgc-2023-004958

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    Data availability statement

    Data are available upon reasonable request. De-identified datasets, the study protocol, and informed consent form are available upon reasonable request and subject to approval by the ethics committees overseeing the study.

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    Footnotes

    • KMS and CL are joint senior authors.

    • Twitter @MilaPSalcedo

    • Presented at The preliminary results of this study were presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer, Phoenix, Arizona, USA, March 2022 and at the International Gynecologic Cancer Society (IGCS) Annual Global Meeting, New York, New York, USA, September 2022.

    • Contributors Conception and design: MPS, EL, CL, and KMS.,Administrative support: MPS, EB, EL, HH, CL, and KMS. Provision of study material or patients: NO, AN, RR, AANM, JCN, CL, and GT. Collection and assembly of data: MPS, VA, MC, BMF, and KMS. Data analysis and interpretation: MPS, VA, PEC, BMF, EC, MC, and KMS. Manuscript writing: all authors. All authors had access to all the data, contributed to the interpretation of the data, and revised, edited, and approved the final version of the manuscript before submission. All authors had final responsibility for the decision to submit for publication. Guarantor of the manuscript: KMS.

    • Funding This research was primarily supported by the American people through the United States Agency for International Development (USAID) and was prepared under Cooperative Agreement AID-OAA-A-11-00012, USAID-Partnerships for Enhanced Engagement in Research (PEER) Program/NASEM. Additional support was provided from the United States National Cancer Institute through the MD Anderson Cancer Center Support Grant (P30CA016672) as well as philanthropic funds from the Barberito, Giles-O’Malley, and Joe families.

    • Competing interests Cepheid loaned the study team GeneXpert machines for the project and provided the HPV testing cartridges at a reduced rate. The authors declare no competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.