S10.3 Point-of-care HPV testing and treatment for cervical cancer screening and elimination in Papua New Guinea

Papua New Guinea (PNG) has among the highest estimated burdens of cervical cancer globally, but lacks national programs for cervical screening or human papillomavirus (HPV) vaccination. Following the disappointing performance of visual inspection of the cervix with acetic acid (VIA) for cervical screening in this setting, we evaluated a novel same-day ‘test-and-treat’ screening model based on point-of-care HPV-DNA testing of self-collected vaginal specimens followed by same-day thermal ablation of the cervix. Self-collected specimens tested at point-of-care on the GeneXpert platform (Xpert HPV; Cepheid, Sunnyvale, CA) had comparable performance to laboratory-based assays both for the detection of high-risk oncogenic HPV types and for detection of underlying pre-cancer and cancer. This strategy was highly acceptable among women and health care workers; highly cost-effective compared to screening based on VIA or Pap test cytology; and with suitable training and support, feasible to implement in routine primary care facilities in this setting. We further showed that if 70% of women aged 30–54 years were screened twice in their lifetime as recommended by WHO, this point-of-care ‘test and treat’ model could reduce both cervical cancer incidence and mortality in PNG by more than 50%. This approach represents a promising new model for cervical screening in PNG and other high-burden, low-income countries embarking on a path towards cervical cancer elimination.