Abstract Background: Cervical cancer remains a significant health burden in China. National policies now allow HPV DNA as a primary screening test, but many health resource-limited counties have not adopted it because programmes cannot fund reagents or laboratory platforms. We conducted a multicentre study in ten pilot counties where HPV DNA screening was introduced with project-supported reagents, platforms and training. Methods: We analysed data from 10 pilot counties designated by the National Cervical-Cancer Prevention Programme. 63,223 women aged 35-64 years were screened with three strategies: (1) cytology alone, (2) HPV DNA testing with cytology triage, and (3) HPV DNA testing with VIA/VILI triage. Key indicators included screen positivity rate, colposcopy rate, CIN2+ detection, positive predictive value (PPV), and number needed to refer (NNR). Inverse probability weighting (IPW) was used to adjust for loss to follow-up. Results: HPV-based strategies were superior to cytology across all indicators. CIN2+ detection was 2-3 times higher, with the highest PPV in the HPV + cytology group (21.9%) and the lowest NNR (5.73), indicating higher referral efficiency. Loss to follow-up rate was also significantly reduced under the HPV + VIA/VILI strategy. These advantages were most prominent among women aged ≥ 45 years. Conclusions: Within the first year of implementation, HPV DNA-based screening is feasible and more effective in health resource-limited areas of China and flexible triage models can be adapted. Impact: The findings support the integration of HPV DNA testing into national cervical cancer screening programmes and highlight needs for robust follow-up systems in underserved populations.
Jia et al. (Fri,) studied this question.