Understanding the implementation and scale up of human papillomavirus testing using self-sampling techniques and point-of-care diagnostics for the screening of cervical cancer in Malawi

Background

Although cervical cancer is one of the most preventable malignancies worldwide, Malawi remains among the top five countries globally with the highest incidence and mortality rates from cervical cancer. The country’s screening programme is largely based on a screen-and-treat strategy using visual inspection with acetic acid (VIA) followed by cryotherapy or thermoablation. Despite nationwide roll-out, screening coverage remains low and inequitable. The World Health Organization (WHO) now recommends high-risk human papillomavirus (HR-HPV) DNA testing – which demonstrates superior diagnostic accuracy as opposed to VIA – as the preferred screening method. Emerging point-of-care (POC) HPV tests and self-sampling modalities have shown potential to transform screening accessibility in low-resource settings such as Malawi. This thesis explores the feasibility of integrating POC HPV DNA testing and self-sampling into the Malawian cervical cancer screening programme.