Exploring strategies for cervical cancer control in Burundi

Thesis abstract

The project is about the performance of OncoE6 rapid HPV test to detect cervical lesions in HIV positive women. This group of women is at a higher risk of cervical cancer: the incidence of cervical intraepithelial neoplasia (CIN) is 4 - 5 times higher in HIV-infected compared to HIV-uninfected women with a risk of invasive cervical cancer 5 - 8 times higher. Burundian women don’t have access to cervical cancer screening. This is due to many factors including lack of infrastructure, lack of qualified staff and financial resources for pap smears, biopsies and colposcopy. Decision makers are preparing to start a demonstration project of HPV vaccination in 2016 as a strategy to control cervical cancer. It is known that high proportions of women harbour already HPV infection and thus, are at risk of developing cervical cancer despite the vaccination. The impact of HPV vaccination will not be fully realized until several decades after a vaccination programme is instituted. Therefore, the HPV vaccine does not replace cervical screening which is crucial. Immunization can be ineffective due to missing follow up doses and cost. Moreover, the currently available vaccines do not cover all oncogenic HPV. Furthermore, it remains challenging to guarantee sufficient coverage and ensure all girls of appropriate age to be vaccinated. Novel rapid HPV screening tests have been developed and these tests do not require highly equipped laboratory or high qualified technicians to run the tests. It can therefore be used as a good triage test for cervical lesions in high risk groups, especially in HIV women. Results can be available in 2.5 hours and treatment can be initiated afterwards in a screen and treat strategy in a health centre. WHO recommends Visual Inspection as a strategy for cervical screening in developing countries? Our research question is “Could HPV rapid test (OncoE6) be a screening alternative for cervical lesions in Burundian HIV positive women?”