AFJOG

GUIDELINES included any more as a preferred option. Due to the high rate of HIV infection in South Africa, possible stigmatisation, as well as practical and logistic considerations of different screening strategies, it was decided to recommend a universal screening strategy for women living with HIV and women at lower risk for cervical cancer. HPV-testing is the only universally appropriate screening test available at present. These guidelines recommend a liquid-based collection from the cervical transformation zone taken by a health care worker as the most preferable. This makes HPV testing and reflex cytology, if needed, possible on one sample. The implementation of self-sampling in this screening algorithm is possible, which may improve uptake and coverage of screening. In that case a second visit is implied when cytology is needed for triage, which will increase loss-to-follow-up. Screening interval HPV-screening requires less frequent screening than cytology, and the recommended interval is stated as five to ten years. The frequency of screening can be varied within this window depending on the individual's risk profile, previous test results and available resources. HIV-positivity and previous HPV-positivity are the most important risk factors requiring a shorter screening interval. Screening algorithm All women 25 years and older: Primary HPV screening test every 5 to 10 years Negative Next screening in 5 to 10 years HPV16,18 POS (Add 45 if included in result) Treat directly (can do colposcopy with biopsy first) 40y+ and HIV NEG Treat directly < HSIL: Follow-up HPV test in 12 months Any HPV POS: Colposcopy to consider treatment <40y or HIV POS: Reflex cytology ASC-H/HSIL: Treat Follow-up HPV test in 12 months Follow-up HPV test in 12 months Negative: Next screening in 5 years Any HPV+: Colposcopy to consider re-treat Other high risk HPV POS African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 38