Lessons Learned From Evaluation of a Human Papillomavirus Screening Pilot in Uzbekistan

PURPOSE: In 2021, Ministry of Health conducted a pilot study to screen 50,000 women with human papillomavirus (HPV) testing in Uzbekistan and assess the feasibility of national implementation. The present article describes organization of the pilot, evaluation of the program using key performance indicators (KPIs), and lessons learned. METHODS: Women age 30-55 years were invited for HPV screening via a communication campaign at 11 polyclinics in Karakalpakstan province. Samples were collected and analyzed locally in nine polyclinics using GeneXpert test. HPV-positive women were triaged with colposcopy, although colposcopists were not trained to obtain biopsies or perform treatment. Abnormal results led to further diagnostic colposcopy and treatment. Pilot data were managed using an Excel database, with quality assurance through regular monitoring visits and estimation of KPIs. RESULTS: Over 10 months, 50,000 women were tested for HPV, with 98% yielding satisfactory results and a 6.8% positivity rate. Of the HPV-positive women, 93.9% underwent triaging colposcopy, revealing abnormalities in 32.5%, although results varied by district. Diagnostic colposcopy and histopathology data were available for 87.9% of referrals. Treatment adherence was not systematically tracked. An external review showed 64.6% agreement with local histopathology, and the correlation between diagnostic colposcopy and histopathology was 53.2%. CONCLUSION: The pilot successfully recruited a large number of women and ensured high participation of the HPV-positive women in triage and diagnostic evaluation. Key strengths were the use of existing health infrastructure, and decentralization of services. However, challenges were identified in HPV test procurement, referral pathways, quality of pathology and colposcopy, and adequate data collection. Addressing these issues is critical to the future success of cervical cancer screening in Uzbekistan.

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