The African HPV-Related Cancers (AHRC) Initiative: An Innovative Solution for Cervical Cancer Self-Screening in Kenya

East Africa has the highest incidence and mortality from cervical cancer in the world, where the mortality rate is 50%. Screening programs have been successful in high-income countries based on pap smear testing. There exist several barriers to the uptake of screening in Kenya, namely access to a clinic, access to personnel that can interpret the samples, as well as the cultural and social barriers to cervical exams. Currently less than 4% of at-risk women in Kenya are undergoing screening. We have developed an innovative tool to make self-screening for cervical cancer possible. The assay uses self-administered cervicovaginal swabs to detect oncogenic HPV, the virus that causes cervical cancer, via a new process called droplet digital polymerase chain reaction. Other tests developed to detect HPV lack appropriate sensitivity to be used as a screening test. In our center, we demonstrated unprecedented 96% sensitivity and specificity for oncogenic HPV, which is the most sensitive test developed. This assay is easy to perform, costs less than a pap smear, can be performed by a woman in her own home, and does not require a pathologist for interpretation. Our proposed solution involves a pilot study in Canada to further validate the technology, followed by an implementation study in Nairobi. We hope to set up a laboratory in partnership with AMREF Kenya, and perform a screening study to determine the validity, and acceptability of our assay for cervical screening in Nairobi.