Mathias Dzobo

Human papillomavirus (HPV35) is globally associated with only 2% of invasive cervical cancers (ICC) but demonstrates a disproportionately higher prevalence in sub‐Saharan Africa, reaching up to 10% in previous reports. In this review, we provide updated data from multiple African countries, revealing high HPV35 prevalence rates in women with precancerous and ICC lesions. Among women with ICC, the highest prevalence of HPV35 was observed in Mozambique (30% and 19%), Kenya (26% and 22%), South Africa (17%), Burkina Faso (13.7%), Zimbabwe (11%), and Tanzania (11.2%). Similarly, in women with precancerous lesions (LSIL/HSIL/CIN1‐3), the highest rates were recorded in Tanzania (26%) and Botswana (23% and 20%). These findings highlight a significant and underappreciated burden of HPV35‐associated cervical disease in African populations, particularly among women with precancerous and invasive lesions. The findings call for an urgent re‐evaluation of current HPV vaccination strategies to consider the inclusion of HPV35, which could profoundly enhance the effectiveness of cervical cancer prevention programs in sub‐Saharan Africa.

Objectives The objective of this scoping review was to map evidence on the acceptability of self-sampling for human papillomavirus testing (HPVSS) for cervical cancer screening among women in the sub-Saharan Africa region. Design Scoping review. Methods Using Arksey and O’Malley’s framework, we searched Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the acceptability of HPVSS among women aged 25 years and older published between January 2011 and July 2021. We included studies that reported evidence on the acceptability of HPVSS for cervical cancer screening. Review articles and protocols were excluded. We also searched for evidence from grey literature sources such as dissertations/theses, conference proceedings, websites of international organisations such as WHO and relevant government reports. Two reviewers independently performed the extraction using a pre-designed Excel spreadsheet and emerging themes were narratively summarised. Results The initial search retrieved 1018 articles. Of these, 19 articles were eligible and included in the review. The following themes emerged from the included articles: acceptability of HPVSS; lack of self-efficacy to perform HPVSS, complications when performing HPVSS, preferences for provider sampling or assistance; setting of HPVSS; HPVSS by vulnerable populations. Conclusion Evidence shows that HPVSS is highly acceptable for cervical cancer screening in sub-Saharan Africa. Further research exploring the acceptability of HPVSS among women residing in rural areas is required, as well as studies to determine women’s preferences for HPVSS intervention including the preferred type of sampling devices. Knowledge on the acceptability and preferences for HPVSS is important in designing women-centred interventions that have the potential to increase screening coverage and participation in cervical cancer screening programmes.

Public Health Genomics (PHG) is a relatively new field. The wide application of genomic technologies played a pivotal role in elucidating the full genomic sequence of the SARS‐CoV‐2 virus. This breakthrough proved to be the starting point in the manufacture of diagnostic kits and the subsequent making of vaccines. Beyond the COVID‐19 pandemic, many African countries can take advantage of the various investments in genomic technologies to introduce and intensify the use of genomics for public health gain. Public Health Genomics effectively monitors, prevents, and manages non‐communicable and infectious diseases. However, there are several challenges to implementing PHG in Africa. In this perspective article, we discuss the utilization of PHG during the COVID‐19 pandemic, the lessons learned from using PHG to manage and contain the COVID‐19 pandemic, as well as potential challenges Africa may face when putting PHG into practice compared to challenges of other regions. We also discuss our recommendations for overcoming these challenges.

Background: Sexually transmitted infections (STIs) are a major global healthcare burden, disproportionately affecting women. Self-sampling interventions for diagnostic purposes have the potential to improve STI healthcare management and expand STI services. However, there is currently no published evidence of the global use of self-sampling interventions to diagnose STIs in women. The main aim of this scoping review was to map evidence on the use of self-sampling interventions to diagnose STIs in women. Methodology: The methodology of this scoping review was guided by Arksey and O’Malley and Levac. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Medline (EBSCO), ProQuest, and Cochrane. For grey literature, a search was conducted in Open Grey, World Health Organization, Google, and conference proceedings and dissertations. All search results were screened and assessed for eligibility. Thereafter data from eligible studies was extracted and analysed. The quality of these studies was appraised using the Mixed Methods Appraisal Tool 2018 version. Results: A total of 770 articles were retrieved from databases and grey literature sources. A total of 44 studies were eligible for data extraction following title, abstract and full-text screening. Of the included studies, 63% presented evidence of research conducted in high-income countries and 37% presented evidence in low- and middle-income countries. Studies presented evidence on the following: feasibility of self-sampling in remote areas; acceptance and ease of use of self-sampling interventions; types of self-sampled specimens; pooled samples for diagnosing STIs; laboratory diagnostic assays for STI using self-sampled specimens; and self-testing of self-sampled specimens. Conclusions: Self-sampling interventions are feasible and easy to use and, therefore, can improve STI management and treatment in women across various age groups and various access levels to good-quality healthcare. Despite this, there is a lack of evidence of self-sampling interventions designed according to user preferences. We recommend studies to collaborate with women to co-develop user-friendly self-sampling interventions to diagnose STIs in women.

In this article, the authors discuss the problem of high prevalences of active syphilis amongst key populations (KPs) in Zimbabwe, in combination with low testing rates, partly because of a difficult legal and social environment for these populations. The article highlights the need to develop strategies to address the high prevalence of syphilis amongst KPs. The authors discuss requirements for addressing deficits in existing clinical services, predominantly primary care settings, in providing primary healthcare, including sexually transmitted infection (STI) management, to Zimbabwe's KP communities and utility of point-of-care testing and self-testing and other innovations to improve testing uptake.

Introduction: Evidence shows that women in sub-Saharan Africa have high rates of cervical cancer (CC) mortality compared with women in high-income countries. Effective screening programmes have significantly reduced the burden of CC in high-income countries. Self-sampling for human papillomavirus testing (HPVSS) has been reported to increase the participation and engagement of women in CC screening. Before HPVSS can be introduced for CC screening there is a need to establish its acceptability among end-users to ensure the increase in CC screening rates. Here, we outline a protocol for a scoping review aimed at mapping literature on the use and acceptability of HPVSS for screening CC in sub-Saharan Africa to reveal gaps to guide future research and practice. Method: The scoping review protocol was developed according to Arksey and O’Malley and Levac et al , and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We will search Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the use and acceptability of HPVSS published between January 2011 and July 2021. We will also search grey literature in the form of dissertations/theses, conference proceedings, websites of international organisations such as the WHO, and relevant government reports reporting evidence on HPVSS programmes for screening CC among women in sub-Saharan Africa. Ethics and dissemination: No ethical approval is needed for the study as it will not include animals or human participants. The results of the proposed scoping review will be disseminated electronically in peer-reviewed journals, in print and through conference presentations.