Considerations for HPV primary screening in lower-middle income countries.

The accumulated scientific evidence now provides ample support for HPV primary screening as a superior method for detecting cervical precancer and preventing cervical cancer. Approximately half of the global burden of cervical cancer could be reduced in lower-middle income countries where attempts to implement traditional cytology-based programs have not experienced successes. In these countries screening programs have struggled with poor screening and diagnostic test sensitivity, difficulties maintaining quality control and adequate population coverage. HPV testing is not only more accurate and reliable, but also requires less training, quality assurance and expensive personnel. Because these countries are especially vulnerable to economic, political and societal instabilities, HPV tests must become more affordable and accessible in order to enable Ministries of Health to make long-term resource commitments.