Nationwide implementation and evaluation of an external quality assessment program for HPV screening in Peru
In the global effort to eliminate cervical cancer, high-quality Human Papillomavirus (HPV) testing is essential, especially in Peru where vaccination coverage remains incomplete. To ensure consistent nationwide test performance, the Peruvian HPV National Reference Laboratory (NRL), in collaboration with the International HPV Reference Center (IHRC), launched the first nationwide External Quality Assessment (EQA) program for all screening laboratories. In 2024, 19 screening laboratories, including regional reference centers and tertiary hospitals, participated in the EQA program. Proficiency panels of 13 blinded samples with defined HPV types and viral loads were validated by IHRC and distributed by the NRL. Laboratories analyzed the samples using the Cobas 4800 HPV assay. Eighteen laboratories (94.7%) met proficiency criteria, correctly detecting all required HPV types, including low viral load samples. One laboratory reported false positives in a negative and a low-concentration HPV 18 sample. This program shows the feasibility of nationwide EQA in Peru, with full participation and reporting. Annual assessments will sustain quality assurance and equitable access to reliable HPV testing. From 2026, the Peruvian HPV NRL will coordinate the program independently, expand participation to additional laboratories, and enable local panel production-an important step toward strengthening cervical cancer screening quality.