Mario Raviglione

Detection of human papillomavirus in fresh and dried urine through an automated system for cervical cancer screening in low‐ and middle‐income countries

AbstractThe majority of cervical cancer cases and associated deaths occur in low‐ and middle‐income countries (LMICs), where sociocultural barriers, poor access to prevention and care, and technical and practical difficulties hinder screening coverage improvement. Using urine specimens for human papillomaviruses (HPV) molecular screening through automated testing platforms can help to overcome these problems. We evaluated the high‐risk (HR) HPV detection performance of the Xpert® HPV test on GeneXpert® System (Cepheid), on fresh and dried urine (Dried Urine Spot [DUS]) samples as compared to an in‐house polymerase chain reaction (PCR) genotyping assay. Forty‐five concentrated urine samples collected from women with known cytological and HPV infection status, determined through in‐house PCR and genotyping assays, were tested “as is” and as DUS with the Xpert® HPV test. This system detected HR‐HPV in 86.4% of fresh and in 77.3% of dried urine samples collected from HPV+ women, correctly identifying HR‐HPV infection in 100% of women with low‐ and high‐grade lesions. High concordance (91.4%, k = 0.82) was found between PCR test and Xpert® HPV Test from urine. Urine‐based Xpert® HPV test seems to be a suitable screening test for detection of HR‐HPV infections associated with low‐ and high‐grade lesions requiring follow‐up monitoring or treatment. This methodology, relying on noninvasively collected samples and on available rapid testing platforms, could facilitate large, at‐scale screening programs, particularly in LMICs and rural areas, thus reducing adverse outcomes of HPV infection and facilitating achievement of the WHO cervical cancer elimination goal.

Participation in cervical cancer screening among migrants and non-migrants in primary healthcare in Lisbon: a register-based study

Introduction Cervical cancer screening is a critical preventive measure to reduce the burden of cervical cancer. Yet, disparities persist worldwide, particularly among migrant populations. This study examined cervical cancer screening participation among migrant and non-migrant women enrolled in the primary healthcare centres in the Lisbon district. Methods This cross-sectional study analysed healthcare records from 88 278 women aged 25–60 years. Participation was assessed based on documented screening within nationally recommended timeframes. Migrants were classified by nationality into Portuguese-speaking and non-Portuguese-speaking groups. Screening participation was compared between groups, adjusting for age, family doctor assignment, primary healthcare unit type and provider gender. Logistic regression identified factors influencing participation. Results Migrants showed lower uptake of cervical cancer screening: 19.6% for non-Portuguese-speaking and 31.9% for Portuguese-speaking migrants, compared with 43.7% in non-migrants. After adjusting for confounders, non-Portuguese-speaking migrants had significantly lower odds of participation (OR 0.46, 95% CI 0.43 to 0.50, p<0.01), while Portuguese-speaking migrants had participation rates similar to non-migrants (p=0.29). Key healthcare factors that were associated with higher participation include enrolment in Family Health Units (FHUs) (OR=3.55, 95% CI 3.41 to 3.70, p<0.01) and having an assigned female family doctor (OR 1.43, 95% CI 1.37 to 1.50, p<0.01). Conclusions Migrant women face unique barriers to cervical cancer screening, particularly language and cultural differences. These findings highlight the need for tailored screening programmes incorporating multilingual support, cultural mediation and self-sampling for human papillomavirus testing as an alternative screening method. Enhancing healthcare delivery through training, improved access to family doctors and more incentive-driven FHUs could significantly improve screening uptake. Addressing these disparities is crucial for advancing health equity and enhancing cervical cancer prevention.