HPV prevalence in women attending cervical screening in rural Malawi using the cartridge-based Xpert® HPV assay

- High-risk HPV (HR-HPV) prevalence in screening clinics in rural Malawi is 19.9%.
- HR-HPV 'other' types (non HPV 16/18/45) predominate (63.8%) in screening specimens.
- HPV 31 and related types accounting for two-thirds of the detections of HR-HPV 'others'.
- Xpert® HPV from Cepheid is a robust and easy to use HPV test with short turnaround time.
- Xpert® HPV is expensive but otherwise suitable for use in low resourced settings.

Background and objectivesEarly experience with Cepheid Xpert® HPV assay (Xpert® HPV) suggests that its quick turnaround time and ease of application might make it a relevant contender for routine use in low and middle income countries (LMICs). In the context of a cervical screening service in rural Malawi, we aimed to assess practicalities of local laboratory testing with Xpert® HPV and provide preliminary high-risk HPV (HR-HPV) prevalence data.Study designLiquid-based cytology (LBC) specimens were collected from women attending cervical screening clinics in Nkhoma, Malawi. Xpert® HPV testing was carried out according to manufacturer's instructions. Partial genotyping results were obtained immediately (HPV 16, 18/45 and HR-HPV 'other'). Review of individual channel data provided further breakdown of other HR-HPV types into HPV 31 and related; HPV 51/59 and HPV 39 and related.ResultsValid HR-HPV results were obtained from 750/763 samples. Most samples were from previously unscreened women, with 92.3% aged between 20 and 60 years. Overall HR-HPV positivity was 19.9%, with HR-HPV 'other' being more than twice as frequent as HPV 16 or HPV 18/45 and HPV 31-related (HPV 31, 33, 35, 52 or 58) most prevalent. Known HIV status was low (7.3%), but HR-HPV positivity in this group was much higher (43.4%).ConclusionsHR-HPV testing using Xpert® HPV was practical in a small rural laboratory. The rapid turnaround (within 2 h) could facilitate a 'see and treat' programme. Partial genotyping allows assessment of risk beyond HPV 16/18. The high prevalence of HPV 31 and related types warrants further investigation.