title: HPV prevalence in women attending cervical screening in rural Malawi using the cartridge-based Xpert®HPV assay.
abstract: Early 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.
  
  
  
  Liquid-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.
  
  
  
  Valid 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%).
  
  
  
  HR-HPV testing using Xpert®HPV was practical in a small rural laboratory. The rapid turnaround (within 2h) 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.
authors.affiliation: Global Health Academy, University of Edinburgh, 1 George Sq, Edinburgh EH8 9JZ, United Kingdom. Electronic address: Heather.Cubie@ed.ac.uk.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Cubie
authors.affiliation: Nkhoma CCAP Hospital, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: David
authors.initials: D
authors.lastname: Morton
authors.affiliation: Nkhoma Hospital Laboratory, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Edson
authors.initials: E
authors.lastname: Kawonga
authors.affiliation: Nkhoma Hospital Laboratory, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Mike
authors.initials: M
authors.lastname: Mautanga
authors.affiliation: Nkhoma Hospital Laboratory, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Ipyana
authors.initials: I
authors.lastname: Mwenitete
authors.affiliation: Nkhoma Hospital Laboratory, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Ngari
authors.initials: N
authors.lastname: Teakle
authors.affiliation: University of Malawi-The Polytechnic, Department of Community Health, Chichiri, Blantyre 3, Malawi.
authors.forename: Bagrey
authors.initials: B
authors.lastname: Ngwira
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Walker
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom.
authors.forename: Graeme
authors.initials: G
authors.lastname: Walker
authors.affiliation: Nkhoma CCAP Hospital, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Savel
authors.initials: S
authors.lastname: Kafwafwa
authors.affiliation: Nkhoma CCAP Hospital, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kabota
authors.affiliation: Nkhoma CCAP Hospital, PO Box 48, Nkhoma, Central Malawi, Malawi.
authors.forename: Reynier
authors.initials: R
authors.lastname: Ter Haar
authors.affiliation: Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005838:Genotype; D060005:Genotyping Techniques; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology*; D015995:Prevalence; D012424:Rural Population; D013997:Time Factors; D055815:Young Adult
keywords: HPV prevalence; Low and middle income countries (LMICs); Xpert(®) HPV