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November 19, 2024
COMMUNITY AND GLOBAL HEALTH
Article
HPV Testing in South African Clinic May Prevent Cervical Cancer
Cervical cancer is the second most common cancer diagnosed in South African women, yet it is one of the most preventable cancers. The illness is caused by infection of the cervix (opening of the womb) by a very common virus known as human papillomavirus (HPV). While the majority of women infected by HPV are able to clear the infection through their own immunity, some women will develop cancer because of this infection.
A community clinic for disadvantaged women in South Africa, demonstrated HPV testing and treatment in one visit was feasible using Cepheid GeneXpert® point-of-care testing, helping patients reduce their risk of developing cancer.
Women living in disadvantaged communities in South Africa face many barriers to accessing quality health services, including HPV testing. Historically, prevention of cervical cancer required women to undergo a Pap smear. However, for many women, the Pap smear was neither available nor accessible and could often take as long as 6 weeks to get a result. During this waiting period, positive individuals may be lost to follow-up and be a risk for transmission to others through skin-to-skin contact, including sexual activity.
Khayelitsha Township, in Cape Town, is an underprivileged area where there are relatively high rates of undiagnosed HPV infection. Previously for a woman to be tested for HPV at the Khayelitsha Township community clinic, patient samples (Pap smears) had to be sent out to a lab. It took about six weeks for the results to come back to the clinic. The more time that went by, the harder it became for the clinic to get in touch with the women to give them their results. Many patients never returned to the clinic after their initial visit, meaning they didn't get the treatment they may have needed.
Yet, once detected and appropriately treated, women who test positive for HPV are extremely unlikely to develop cervical cancer.
The new point-of-care model of testing has condensed the test-and-treat pathway at the South African clinic from two appointments six weeks apart to a single visit.
It is now possible to take a sample from the cervix and immediately run the Xpert HPV test* on the GeneXpert system, located on-site, eliminating the need to transport the specimens to an off-site lab. Instead, within an hour, the system provides a result, enabling healthcare workers at the clinic to determine the best treatment for the patient the same day they are tested.
"The rates of HPV are quite high in this community,” explained Dr. Rakiya Saidu, University of Cape Town, doctor in obstetrics and gynaecology.
According to Saidu, the rapid HPV test takes away two of the main obstacles to preventing cervical cancer in low-income countries.
“One is women lost to follow-up. If we take a sample and the woman has to come back, she may never come back. It has also taken away the waiting to get treatment. Now a woman comes and gets the test done, gets the results and she gets treated if she needs it. That is very important," said Saidu.
More than 3,000 women have received same-day results for HPV at the clinic, potentially protecting them from developing cervical cancer in the future. Over 95% of women were happy to wait an hour to receive their results and treatment plan.
Watch to learn how point-of-care testing is speeding up the diagnostics pathway for HPV in community health clinics in South Africa.
Transcript
Ncumisa Sonwabo: “My name is Ncumisa Sonwabo. I'm 41 years old and I have four lovely boys—three biological and one adopted. I live in Khayelitsha, one of the biggest townships in Cape Town.”
Rakiya Saidu, M.D.: “Khayelitsha is a diverse community with many health challenges, especially in semi-urban areas like this. The high rate of unemployment and violence, particularly against women, makes it difficult for women to negotiate condom use, putting them at risk for infections like HPV and HIV. These infections are prevalent and very real in this community.”
Lynette Denny, M.D, Ph.D: “These community health clinics were a brilliant idea. They offer diverse services to any woman who comes in seeking help. We also invite them to join our research projects focused on preventing cervical cancer. That's our main work.”
Ncumisa Sonwabo: “I never knew anything about cervical cancer until the clinic taught us about it and asked us to participate in the study. I was interested in doing it.”
Rakiya Saidu, M.D.: “This particular study started in 2015, and we have been recruiting patients through word of mouth. Women tell their neighbors and daughters, so we get a lot of patients. Over the last 1.5 years, we recruited over 3,000 women.”
Ncumisa Sonwabo: “When I go there, everything is fine. The staff is friendly and welcoming, and everything is easy. They have a playground for the kids, and they are welcome because they also give the kids some juices and stuff. It’s very nice to take your kids there.”
Dixy Zweni: “When a woman walks in, she goes to the waiting room where we provide health education about what is going to happen.”
Ncumisa Sonwabo: “I was scared but willing to test because I just wanted to stay safe. They say it's better to know beforehand.”
Dixy Zweni: “After placing the woman on the examination bed, we take a sample from the cervix and put it in a thin prep, which we take upstairs to the technician to test for HPV.”
Vathiswa Kamkam: “We use the GeneXpert® machine to determine which HPV type the patient has. When we get the specimens from the nurse, we prepare them and then put them in the GeneXpert machine, which takes an hour to prepare and get results.
Lynette Denny, M.D, Ph.D: “It's incredibly brilliant technology. You screen a woman and treat her during the same visit.”
Dixy Zweni: “Previously, we had to do a Pap smear and wait six weeks for the results, which was challenging because patients often didn't come back for their results, requiring us to trace and track them.”
Rakiya Saidu, M.D.: “The Rapid HPV Test removes two main obstacles in preventing cervical cancer in low-income countries: loss to follow-up and waiting for treatment. If a woman has to come back for results, she may never return. This test eliminates that issue and allows for treatment on the same day. The woman gets tested, receives her results, and gets treated if needed—all in one visit. This is very important.”
Dixy Zweni: “Patients are excited to be treated on the same day because they know a problem was detected and addressed immediately. This is beneficial for both us and the patients.”
Ncumisa Sonwabo: “Being in this small clinic has helped me a lot. I get to know the doctors and learn more about HPV. They teach us everything we need to know to take care of and protect ourselves. I like visiting there.”
Lynette Denny, M.D, Ph.D: “We've shown that screen and treat works. It prevents conditions that can lead to cancer. Now we need to implement it outside the comfort of this kind of building.”
Rakiya Saidu, M.D.: “It's a blessing to be a woman. Women face many issues, but somehow we cope with them all. As a doctor, I feel very honored to help other women.”
References:
- WHO. Cervical cancer health topics. Accessed 9/16/2024. https://www.who.int/health-topics/cervical-cancer#tab=tab_1
- Cancer Research U.K. About Cancer. Access 9/16/2-24. https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/infections-eg-hpv-and-cancer/does-hpv-cause-cancer
- WHO Factsheet; Human papillomavirus (HPV) and cervical cancer https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer
CE-IVD. In Vitro Diagnostic Medical Device. May not be available in all countries. Not available in the United States.
*Xpert HPV ENGLISH Package Insert 301-2585 Rev E Intended Use states that the Xpert HPV Assay is a qualitative in vitro test for the detection of the E6/E7 region of the viral DNA genome from high-risk Human Papillomavirus (HPV) in patient specimens. Indications for Xpert HPV includes: The Xpert HPV Assay can be used with a Pap specimen to assess the presence or absence of high-risk HPV types. This information, together with the physician’s assessment of the patient’s medical history, other risk factors, and professional guidelines, may be used to guide patient management. • The Xpert HPV Assay can be used with a Pap specimen to assess the presence or absence of HPV genotypes 16 and 18/45. This information, together with the physician’s assessment of the patient’s medical history, other risk factors, and professional guidelines, may be used to guide patient management.
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