Using Human Papillomavirus (HPV) detection tests for cervical cancer screening and managing HPV-positive women – a practical guide / Activity 6

The success of a cervical cancer screening programme depends on appropriate management of screen-positive women. Because HPV positivity by itself does not indicate the presence of cervical premalignant or malignant lesions, a triage test is usually recommended. Women who test positive on the triage test are then referred for colposcopy or are directly assessed for treatment.

The tests used for triage can be VIA, HPV16/18 genotyping, cytology (or liquid-based cytology), a combination of these, or colposcopy.

In low-resource settings with limited or non-existent colposcopy and histopathology services, WHO recommends a more realistic approach of offering treatment to all HPV-positive women. This is known as the screen-and-treat approach, in which treatment is offered to screen-positive women directly without verification of disease by colposcopy or histopathology. The screen-and-treat approach has the potential to improve the efficiency of a screening programme because it increases compliance of screen-positive women with treatment and reduces referral for colposcopy.

In women living with HIV, the HPV positivity rate may be very high. For these women, WHO recommends using any of the triage tests and not applying a screen-and-treat strategy.