Feasibility and acceptability of HPV testing using GeneXpert for cervical cancer screening in Morocco

Abstract

Human papillomavirus (HPV) testing is increasingly recommended for cervical cancer screening. To evaluate the potential large-scale implementation of HPV testing in Morocco, we conducted a pilot study to assess its acceptability and feasibility in four provinces. This study involved 999 women aged 30 or 40 years. Face-to-face interviews were conducted, and HPV testing was performed via the GeneXpert system. Of the 1097 women invited, 91.1% were involved. Most participants (62.9%) were from urban areas, with age groups distributed between 30 s (46.0%) and 40 s (54.0%). The majority of the samples were received without issues affecting HPV testing. The mean time from sample collection to test results was 7.5 ± 6.1 days. On the GeneXpert workstation, 1.1% of the samples yielded invalid results. Among the remaining 972 samples, HPV DNA was detected in 4.8% of the samples, with HPV 16 being the most common type (27.7%). Among the HPV-positive patients, 21.3% refused colposcopy. Among those who underwent colposcopy, abnormal findings (51.4%) included TAG I, TAG II, and suspected invasive cancer. Biopsies revealed normal findings in 47.4%, CIN1 (21.1%), CIN2 (10.5%), CIN3 (15.8%), and carcinoma in situ (5.2%) patients. All patients were managed in accordance with the World Health Organization (WHO) guidelines for comprehensive cervical cancer control (WHO, 2014). HPV testing via the GeneXpert platform may be a reliable and user-friendly tool for the early detection of cervical lesions, with the potential to reduce the incidence and mortality of cervical cancer in Morocco.