title: Implementing human papillomavirus testing in a public health hospital: challenges and opportunities.
abstract: OBJECTIVE
  Robust evidence now supports human papillomavirus (HPV) testing as a more effective option to screening and as more sensitive than cytology in detecting high-grade cervical intraepithelial neoplasia . Our goal was to analyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecological examination at a public health hospital as part of the evaluation of HPV screening as an alternative or complement to cytology.
  
  
  METHODS
  This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared.
  
  
  RESULTS
  The analysis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of the HC2 assay versus cytology (84.5 vs. 69.7%; p < 0.0001) but a lower specificity (49.90 vs. 88.78%; p < 0.0001).
  
  
  CONCLUSIONS
  The combination of both methods seems to be useful in improving detection of cervical lesions.
authors.affiliation: Departments of Obstetrics and Gynecology, Clinics Hospital, School of Medicine, University of São Paulo, Brazil.
authors.forename: Mariana Carmezim
authors.initials: MC
authors.lastname: Beldi
authors.forename: Maricy
authors.initials: M
authors.lastname: Tacla
authors.forename: Helio
authors.initials: H
authors.lastname: Caiaffa-Filho
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ab'saber
authors.forename: Sheila
authors.initials: S
authors.lastname: Siqueira
authors.forename: Edmund Chada
authors.initials: EC
authors.lastname: Baracat
authors.forename: Venancio Avancini Ferreira
authors.initials: VA
authors.lastname: Alves
authors.forename: Adhemar
authors.initials: A
authors.lastname: Longatto-Filho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002277:Carcinoma / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006779:Hospitals, Public / Q000639:trends; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000473:pathology*; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000379:methods; D055815:Young Adult