A Pilot Study on the Feasibility and Integration of High-Risk Human Papillomavirus (HPV) Testing for Cervical Cancer Prevention in Trinidad and Tobago.

Background Globally, cervical cancer is one of the leading causes of cancer-related death among women. Persistent infection with high-risk human papillomavirus (hrHPV) is the predominant etiological factor for cervical cancer, underscoring the critical need for effective screening to enable early detection and reduce disease burden. However, in Trinidad and Tobago, liquid-based cytology is not available in the public healthcare system, and current screening efforts rely solely on conventional Pap smears. This limitation restricts the integration of hrHPV testing either as a standalone primary screening tool or as part of a co-testing strategy. Addressing these gaps through infrastructure investment and policy reform is essential for achieving comprehensive and equitable cervical cancer prevention. Objectives This study aimed to evaluate the feasibility of hrHPV testing within the public healthcare system of Trinidad and Tobago, identifying potential facilitators and barriers to nationwide implementation. Methods A descriptive cross-sectional study design was employed. Women aged 30-65 meeting specific inclusion criteria were recruited from 18 primary healthcare centers and a mobile unit between March 2019 and November 2019. HPV samples were collected, analyzed using the careHPV system, and categorized as positive or negative for high-risk HPV types. Patients with positive results underwent follow-up conventional cytology, with colposcopy referral as indicated by cytological findings. Results Out of 1241 women tested, 1201 were eligible. hrHPV positivity was detected in 140 women (11.7%), with the highest positivity rate observed in 75 women (15.7%) out of a cohort of 476 women in their 30s. Of those with positive results, 115 women (81.6%) were referred for cytology, revealing 12 cases of high-grade squamous intraepithelial lesions and a CIN 2/3 incidence of 46.7% (14 cases) among 30 women with concurrent positive HPV and abnormal cytology. Active call-and-recall mechanisms led to increased screening uptake by 33% within the target catchment area. Conclusion hrHPV testing demonstrated practical feasibility and improved sensitivity for detecting pre-invasive cervical lesions compared to cytology alone. Implementing a screening algorithm integrating HPV and cytology testing could optimize patient triage, alleviate colposcopy service demand, and enhance screening coverage. When combined with effective HPV vaccination campaigns, these measures present a viable path toward achieving the World Health Organization's cervical cancer elimination goals in Trinidad and Tobago.