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1. WHO recommends using HPV DNA detection as the primary screening test rather than VIA or cytology in screening and treatment approaches among both the general population of women and women living with HIV.
Remarks: Existing programmes with quality-assured cytology as the primary screening test should be continued until HPV DNA testing is operational; existing programmes using VIA as the primary screening test should transition rapidly because of the inherent challenges with quality assurance.
| Strong recommendation, moderate-certainty evidence |
21. WHO recommends using HPV DNA detection as the primary screening test rather than VIA or cytology in screening and treatment approaches among both the general population of women and women living with HIV.
Remarks: Existing programmes with quality-assured cytology as the primary screening test should be continued until HPV DNA testing is operational; existing programmes using VIA as the primary screening test should transition rapidly because of the inherent challenges with quality assurance.
| Strong recommendation, moderate certainty of evidence |
| 2. WHO suggests using an HPV DNA primary screening test either with triage or without triage to prevent cervical cancer among the general population of women. | Conditional recommendation, moderate-certainty evidence | 22. WHO suggests using an HPV DNA primary screening test with triage rather than without triage to prevent cervical cancer among women living with HIV. | Conditional recommendation, moderate certainty of evidence |
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3a. In a screen-and-treat approach using HPV DNA detection as the primary screening test, WHO suggests treating women who test positive for HPV DNA among the general population of women.
3b. In a screen, triage and treat approach using HPV DNA detection as the primary screening test among the general population of women, WHO suggests using partial genotyping, colposcopy, VIA or cytology to triage women after a positive HPV DNA test (Annex 4).
Remarks: The benefits, harms and programmatic costs of the triage options are similar; therefore, the choice of triage method will be dependent on feasibility, training, programme quality assurance and resources in countries. HPV16/18 genotyping could be integrated into the HPV DNA test (refer to
Annex 4
for specific details of the algorithms).
| Conditional recommendation, moderate-certainty evidence |
23. In a screen, triage and treat approach using HPV DNA detection as the primary screening test among women living with HIV, WHO suggests using partial genotyping, colposcopy, VIA or cytology to triage women after a positive HPV DNA test (Annex 4).
Remarks: The benefits, harms and programmatic costs of the triage options are similar; therefore, the choice of triage method will be dependent on feasibility, training, programme quality assurance and resources in countries. HPV16/18 genotyping could be integrated into the HPV DNA test (refer to
Annex 4
for specific details of the algorithms).
| Conditional recommendation, moderate-certainty evidence |
| 4. When providing HPV DNA testing, WHO suggests using either samples taken by a health-care provider or self-collected samples among both the general population of women and women living with HIV. | Conditional recommendation, low-certainty evidence | 24. When providing HPV DNA testing, WHO suggests using either samples taken by a health-care provider or self-collected samples among both the general population of women and women living with HIV. | Conditional recommendation, low-certainty evidence |
| 5. WHO recommends starting regular cervical cancer screening at the age of 30 years among the general population of women. | Strong recommendation, moderate-certainty evidence |
25. WHO suggests starting regular cervical cancer screening at the age of 25 years among women living with HIV.
Remarks: Low-certainty evidence found that there are likely to be small numbers of women living with HIV with cervical cancer who are below the age of 25. This recommendation applies to women living with HIV regardless of when they first tested positive for HIV.
| Conditional recommendation, low-certainty evidence |
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6. After the age of 50 years, WHO suggests screening is stopped after two consecutive negative screening results consistent with the recommended regular screening intervals among both the general population of women and women living with HIV.
Remarks: Neither VIA nor ablative treatment are suitable for screening or treatment of women in whom the transformation zone is not visible. Inadequate visualization is typical after the menopause.
| Conditional recommendation, low-certainty evidence |
26. After the age of 50 years, WHO suggests screening is stopped after two consecutive negative screening results consistent with the recommended regular screening intervals among both the general population of women and women living with HIV.
Remarks: Neither VIA nor ablative treatment are suitable for screening or treatment of women in whom the transformation zone is not visible. Inadequate visualization is typical after the menopause.
| Conditional recommendation, very low-certainty evidence |
| 7. Priority should be given to screening women aged 30–49 years in the general population of women. When tools are available to manage women aged 50–65 years, those in that age bracket who have never been screened should also be prioritized. | Good practice statement | 27. Priority should be given to screening women living with HIV aged 25–49 years. When tools are available to manage women living with HIV aged 50–65 years, those in that age bracket who have never been screened should also be prioritized. | Good practice statement |
| 8. WHO suggests a regular screening interval of every 5 to 10 years when using HPV DNA detection as the primary screening test among the general population of women. | Conditional recommendation, low-certainty evidence | 28. WHO suggests a regular screening interval of every 3 to 5 years when using HPV DNA detection as the primary screening test among women living with HIV. | Conditional recommendation, low-certainty evidence |
| 9. Where HPV DNA testing is not yet operational, WHO suggests a regular screening interval of every 3 years when using VIA or cytology as the primary screening test, among both the general population of women and women living with HIV. | Conditional recommendation, low-certainty evidence | 29. Where HPV DNA testing is not yet operational, WHO suggests a regular screening interval of every 3 years when using VIA or cytology as the primary screening test, among both the general population of women and women living with HIV. | Conditional recommendation, low-certainty evidence |
| 10. While transitioning to a programme with a recommended regular screening interval, screening even just twice in a lifetime is beneficial among both the general population of women and women living with HIV. | Good practice statement | 30. While transitioning to a programme with a recommended regular screening interval, screening even just twice in a lifetime is beneficial among both the general population of women and women living with HIV. | Good practice statement |
| 11. WHO suggests that the general population of women who have screened positive on an HPV DNA primary screening test and then negative on a triage test are retested with HPV DNA testing at 24 months and, if negative, move to the recommended regular screening interval. | Conditional recommendation, low-certainty evidence | 31. WHO suggests that women living with HIV who have screened positive on an HPV DNA primary screening test and then negative on a triage test, are retested with HPV DNA testing at 12 months and, if negative, move to the recommended regular screening interval. | Conditional recommendation, low-certainty evidence |
| 12. WHO suggests that women from the general population and women living with HIV who have screened positive on a cytology primary screening test and then have normal results on colposcopy are retested with HPV DNA testing at 12 months and, if negative, move to the recommended regular screening interval. | Conditional recommendation, low-certainty evidence | 32. WHO suggests that women from the general population and women living with HIV who have screened positive on a cytology primary screening test and then have normal results on colposcopy are retested with HPV DNA testing at 12 months and, if negative, move to the recommended regular screening interval. | Conditional recommendation, low-certainty evidence |
| 13. WHO suggests that women from the general population who have been treated for histologically confirmed CIN2/3 or adenocarcinoma in situ (AIS), or treated as a result of a positive screening test are retested at 12 months with HPV DNA testing when available, rather than with cytology or VIA or co-testing, and, if negative, move to the recommended regular screening interval. | Conditional recommendation, low-certainty evidence | 33. WHO suggests that women living with HIV who have been treated for histologically confirmed CIN2/3 or adenocarcinoma in situ (AIS), or treated as a result of a positive screening test are retested at 12 months with HPV DNA testing when available, rather than with cytology or VIA or co-testing, and, if negative, are retested again at 12 months and, if negative again, move to the recommended regular screening interval. | Conditional recommendation, low-certainty evidence |
| 14. As programmes introduce HPV DNA testing, use this test at the woman’s next routine screening date regardless of the test that was used at prior screening. In existing programmes with cytology or VIA as the primary screening test, rescreening with the same test should be continued until HPV DNA testing is operational among both the general population of women and women living with HIV. | Good practice statement | 34. As programmes introduce HPV DNA testing, use this test at the woman’s next routine screening date regardless of the test that was used at prior screening. In existing programmes with cytology or VIA as the primary screening test, rescreening with the same test should be continued until HPV DNA testing is operational among both the general population of women and women living with HIV. | Good practice statement |
