Accuracy of triage strategies for human papillomavirus DNA-positive women in low-resource settings:A cross-sectional study in China

Objective: Care HPV is a human papillomavirus(HPV) DNA test for low-resource settings(LRS).This study assesses optimum triage strategies for care HPV-positive women in LRS.Methods: A total of 2,530 Chinese women were concurrently screened for cervical cancer with visual inspection with acetic acid(VIA),liquid-based cytology and HPV testing by physician-and self-collected care HPV,and physician-collected Hybrid Capture 2(HC2).Screen-positive women were referred to colposcopy with biopsy and endocervical curettage as necessary.HPV-positivity was defined as ≥1.0 relative light units/cutoff(RLU/CO) for both care HPV and HC2.Primary physician-HC2,physician-care HPV and self-care HPV and in sequential screening with cytology,VIA,or increased HPV test-positivity performance,stratified by age,were assessed for cervical intraepithelial neoplasia(CIN) grade 2/3 or worse(CIN2/3+) detection.Results: The sensitivities and specificities of primary HPV testing for CIN2+ were: 83.8%,88.1% for physiciancare HPV; 72.1%,88.2% for self-care HPV; and 97.1%,86.0% for HC2.Physician-care HPV test-positive women with VIA triage had a sensitivity of 30.9% for CIN2+ versus 80.9% with cytology triage.Self-care HPV testpositive women with VIA triage was 26.5% versus 66.2% with cytology triage.The sensitivity of HC2 test-positive women with VIA triage was 38.2% versus 92.6% with cytology triage.The sensitivity of physician-care HPV testing for CIN2+ decreased from 83.8% at ≥1.0 RLU/CO to 72.1% at ≥10.00 RLU/CO,while the sensitivity of selfcare HPV testing decreased from 72.1% at ≥1.0 RLU/CO to 32.4% at ≥10.00 RLU/CO; similar trends were seen with age-stratification.Conclusions: VIA and cytology triage improved specificity for CIN2/3 than no triage.Sensitivity with VIA triage was unsuitable for a mass-screening program.VIA provider training might improve this strategy.Cytology triage could be feasible where a high-quality cytology program exists.Triage of HPV test-positive women by increased test positivity cutoff adds another LRS triage option.