HARP Project

Two main research hypotheses will be addressed by HARP:

1. The use of simplified point of care diagnostic tests to detect high-risk HPV genotypes, which have never before been evaluated in Africa, alone or combination with other tests, has the potential to improve the coverage of cervical cancer screening in high-risk populations, and that it may form the basis a cost-effective cervical cancer prevention intervention; and Representation of HPV virus (each blue cluster)
2. Immune restoration and control of HIV replication through antiretroviral therapy (ART) or ART initiation may improve clearance of HPV infection among high-risk HPV infected women, which could slow the development or progression of cervical precursor lesions.

The Project will enroll 1,200 HIV positive women aged between 25 and 50 years (half on ART or about to start ART; and half with high CD4 count >350 cells/mm3 and not in need of ART) in Burkina Faso and South Africa in a cross-sectional evaluation of cervical cancer screening strategies, from which about 1100 HIV-infected women without CIN2+ and 100 with CIN2+ (who will have been treated) will be followed at 18 months to detect incident CIN2+ and persistence, incidence and clearance of oncogenic HPV. Costing and modelling studies will determine the cost-effectiveness of triage strategies and impact on cervical cancer among HIV+ women.

The HARP Consortium will evaluate the cost-effectiveness of various screening strategies leading to earlier detection and management of cervical cancer in these high-risk populations, and model its long term impact on cancer reduction and lives saved. Moreover, HARP will enhance the local capacity of front line health workers, policy makers and communities in tackling cancer prevention. The HARP Consortium will disseminate best practice in cervical cancer screening in Africa and promote evidence for effective decision-making.