HPV testing for cervical cancer screening in Mozambique: Challenges and recommendations

Background Cervical cancer is the fourth most common cancer affecting women worldwide and is the leading cause of cancer and related deaths among women in Mozambique. The World Health Organization (WHO) recommends screening with human papillomavirus (HPV) testing, but it has not yet been implemented in many low- and middle-income countries (LMICs). We conducted a cervical cancer screening study in Mozambique using the careHPV test (QIAGEN, Germantown, MD, USA). This study aimed to describe our experience with HPV testing for cervical cancer screening in Maputo, Mozambique, including challenges and lessons learned. Methods We conducted a cervical cancer screening pilot demonstration project at the General Hospital of Mavalane in Maputo, Mozambique, from April 2018 to September 2019, using primary HPV testing with careHPV. We performed the direct observations and discussions with participating laboratory experts, technicians, nurses and physicians from Mozambique, Brazil and the United States. Results HPV testing was successfully implemented. The main challenges we experienced were inadequately equipped laboratory facilities, a lack of laboratory and clinical staff expertise, and difficulties procuring equipment, tests and laboratory supplies. These challenges were overcome by increasing the budget to better equip the laboratory, building relationships with procurement and importation specialists and training sessions for laboratory personnel and medical providers. Conclusions Our findings suggest that primary HPV testing is achievable in Mozambique. Several challenges were identified and are being addressed for a successful scale-up.