Cervical cancer is a major public health issue in Uganda, with high incidence due to limited screening especially in rural areas. In 2019, HPV DNA testing using GeneXpert was rolled out to improve screening access. Assessing progress and challenges since its introduction is important. To determine genotype distribution and explore health worker experiences with HPV screening using GeneXpert in Uganda. We conducted a retrospective cohort study where HPV screening data from 66 GeneXpert labs from March 2021-May 2023 country wide was analyzed. We used descriptive statistics to provide percentages and proportions from the data. Seven focus group discussions and five interviews were done with health workers to understand experiences. We extracted 24,497 HPV tests that were done, and 39.1% were HPV positive. Other high-risk HPV genotypes were the most common at 65%, followed by HPV 16 (17%) and HPV 18/45 (18%). 15% of the HPV positive cases had more than one genotype. Qualitative findings showed inconsistent health worker knowledge, high workload, and complex care seeking behaviors as main challenges. It also revealed low community awareness, care seeking from traditional healers, HPV DNA testing has been expanding since its rollout, but the yield of HPV cases is lower than expected, signaling need to address supply-side challenges. Limited information on HPV among health workers especially community health workers, demand-side barriers like myths, medical pluralism and social norms must also be tackled through trainings of health workers and awareness campaigns engaging communities. Although access to GeneXpert services has increased, health system weaknesses pose bottlenecks to screening HPV. Targeted interventions are required to strengthen HPV diagnosis, prevent cervical cancer and save lives.

中文翻译：

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乌干达卫生工作者使用 Genexpert 筛查人乳头瘤病毒的阳性率、趋势和经验：一项为期三年的回顾性队列研究

宫颈癌是乌干达的一个主要公共卫生问题，由于筛查有限，尤其是在农村地区，宫颈癌的发病率很高。 2019 年，推出了使用 GeneXpert 的 HPV DNA 检测，以改善筛查机会。评估自推出以来的进展和挑战非常重要。确定基因型分布并探索乌干达卫生工作者使用 GeneXpert 进行 HPV 筛查的经验。我们进行了一项回顾性队列研究，分析了 2021 年 3 月至 2023 年 5 月全国 66 个 GeneXpert 实验室的 HPV 筛查数据。我们使用描述性统计来提供数据的百分比和比例。与卫生工作者进行了七次焦点小组讨论和五次访谈，以了解经验。我们提取了 24,497 份已完成的 HPV 检测，其中 39.1% 为 HPV 阳性。其他高危 HPV 基因型最常见，占 65%，其次是 HPV 16 (17%) 和 HPV 18/45 (18%)。 15% 的 HPV 阳性病例有不止一种基因型。定性研究结果显示，卫生工作者知识不一致、工作量大和复杂的就医行为是主要挑战。它还揭示了社区意识低下、传统治疗师寻求护理、HPV DNA 检测自推出以来一直在扩大，但 HPV 病例的产量低于预期，这表明需要解决供应方的挑战。卫生工作者尤其是社区卫生工作者关于 HPV 的信息有限，还必须通过对卫生工作者的培训和社区参与的宣传活动来解决诸如神话、医疗多元化和社会规范等需求方障碍。尽管 GeneXpert 服务的普及率有所增加，但卫生系统的薄弱环节给 HPV 筛查带来了瓶颈。需要有针对性的干预措施来加强 HPV 诊断、预防宫颈癌并挽救生命。