ADVANCING THE FUTURE OF CERVICAL CANCER SCREENING IN SINGAPORE WITH HPV EXTENDED GENOTYPING AND SELF-SAMPLING

Abstract

Cervical cancer screening (CCS) remains suboptimal in Singapore, due to the lack of awareness and motivation for screening. However, the poor CCS uptake is not attributed to patients alone and a deeper understanding of factors related to healthcare providers (HCPs) and the health system is necessary. Further, emerging evidence has suggested for a revision of human papillomavirus (HPV) screening algorithms to monitor more HPV genotypes, and highlighted the role of self-sampling to improve CCS uptake. Systematic evaluations are required to ensure the cost-effectiveness implementation of these CCS advancements. Therefore, in this thesis we achieved the following: (1) captured the perspectives of HCPs on CCS delivery, HPV extended genotyping (XGT) and self-sampling (2) demonstrated that XGT was cost-effectiveness compared to HPV partial genotyping in the national CCS program (3) demonstrated self-sampling recruitment strategies were cost-effective compared to routine screening invitations at primary care clinics within the national CCS program.