Background: The SelfCerv Self-Collection Cervical Health Screening Kit (Ilex Medical Ltd., Johannesburg, South Africa) is an applicator tampon designed for self-collection of vaginal samples for the detection of human papillomavirus (HPV) deoxyribonucleic acid (DNA) and E6/E7 messenger ribonucleic acid (mRNA). The study aimed to evaluate the performance of the SelfCerv applicator tampon for the detection of hr-HPV for cervical cancer screening, and further to investigate women’s experiences and preferences regarding self-sampling. Methods: Vaginal samples were collected from 527 gynecology clinic attendees aged ≥18 years at a tertiary hospital in Gauteng Province, South Africa. Self-samples were collected using the SelfCerv kit, followed by endocervical samples collected by a healthcare professional using Cervex-Brush^® Combi. Participants completed a self-administered questionnaire on self-sampling experiences and preferences. Both samples were tested for 14 high-risk (hr) HPV types and E6/E7 mRNA using the Abbott RealTime HR-HPV and Aptima HR-HPV mRNA assays, respectively. Results: The overall agreement for hr-HPV typing between 527 paired samples was good (87.1%; κ =0.74) with high sensitivity (86.2%) and specificity (88.0%). HPV-16 (96.4%; κ = 0.83) had higher agreement rate than HPV-18 (96.8%; κ = 0.72) and the other 12 hr-HPVs (86.5%; κ = 0.72). Two hundred and eighty-five (285) sample pairs tested for E6/E7 mRNA showed fair agreement (70.2%; κ= 0.34). Furthermore, self-sampling was reported as comfortable (90.5%) and painless (86.7%), with 88.4% of women preferring self-collection. Conclusions: Self-collected samples had good agreement with the healthcare professional-collected samples for the detection of hr-HPV DNA and the procedure was highly preferred by women. Self-sampling using SelfCerv can be used as an alternative to healthcare professional sampling in clinic-based routine cervical cancer screening.

Cervical cancer remains a major health burden among women in sub-Saharan Africa, where screening is often limited. Persistent high-risk human papillomavirus (HR-HPV) infection is the principal cause, highlighting the need for accurate molecular diagnostics. This cross-sectional study evaluated the analytical performance of one mRNA assay, APTIMA^® HPV assay (APTIMA mRNA), and two DNA-based assays, the Abbott RealTime High Risk HPV assay (Abbott DNA) and Seegene Allplex™ II HPV28 assay (Seegene DNA), in 527 cervical samples from a South African tertiary hospital, focusing on 14 shared HR-HPV genotypes. Seegene DNA yielded the highest detection rate (53.7%), followed by Abbott DNA (48.2%) and APTIMA mRNA (45.2%). APTIMA mRNA showed a strong agreement with Abbott DNA (87.9%, κ = 0.80), 89.9% sensitivity, 91.2% NPV, and the highest accuracy (AUC = 0.8804 vs. 0.8681). The agreement between APTIMA mRNA and Seegene DNA was moderate (83.4%, κ = 0.70), reflecting target differences. Many DNA-positive/mRNA-negative cases likely represent transient infections, though some may be latent with reactivation potential, warranting a follow-up. In resource-constrained settings, prioritizing transcriptionally active infections through mRNA testing may enhance screening efficiency and reduce burden. Scalable, cost-effective assays with strong clinical utility are essential for broadening access and improving cervical cancer prevention. Further studies should assess the integration of mRNA testing into longitudinal screening algorithms.

Human papillomavirus (HPV) infection leading to cervical cancer remains one of the most urgent public health challenges worldwide. In 2022 alone, there were an estimated 662,301 new cervical cancer cases and 348,874 deaths globally, with the burden heavily affecting low-and middleincome countries (LMICs) where access to prevention, screening, and treatment remains limited (1,2). Persistent infection with high-risk HPV genotypes, especially types 16 and 18, underpins nearly all cases of cervical cancer, causing over 300,000 deaths each year (3). Despite significant scientific advances in HPV diagnostics and vaccine development over the past two decades, translating these innovations into equitable healthcare practices remains a major global challenge (4). A clearer understanding of how best to deliver evidence-based interventions in real-world settings is crucial to bridging the gap between research and actual health outcomes, especially in low-resource settings where vaccination uptake, screening coverage, sociocultural barriers, and health system limitations continue to pose challenges. HPV vaccination has proven highly effective in reducing cervical disease, yet uptake varies considerably, often reflecting underlying social and structural factors.vaccine uptake among women in Africa. Their analysis identifies persistent inequalities driven by misinformation, inadequate health education, limited health system capacity, and structural barriers such as distance and cost. The review emphasises that improving vaccination coverage requires multipronged approaches, policy alignment, community-based interventions, and targeted communication strategies.The social dimension of vaccination is further examined by Matsangaise et al., who analysed vaccine sentiment on South African social media prior to the COVID-19 pandemic. Their study reveals widespread mistrust and misinformation, highlighting that digital platforms play a significant role in shaping public perceptions of vaccination. These findings reflect global concerns about the profound and often overlooked impact of online discourse on vaccine confidence. These findings have significant implications for resource-limited settings, where cost and logistical barriers can hinder the completion of multi-dose regimens.Individually and collectively, the contributions in this research topic emphasise that scientific advances alone are insufficient to attain equitable HPV prevention. Effective integration demands attention to three overarching imperatives:Health systems should prioritise integrated models that bring screening, vaccination, and followup care into the same continuum to improve uptake and retention.As demonstrated by Matsangaise et al., communication challenges can undermine even the most robust scientific tools. Enhancing health literacy and combating misinformation must remain core components of national immunisation strategies.There is no single universal approach. Implementation must consider context-specific barriers, resource availability, and cultural norms to achieve meaningful and sustainable progress.While progress is evident, significant gaps persist, especially in strategies for engaging underserved populations, maintaining long-term vaccine confidence, and translating scientific evidence into national policy.The collective findings of these studies highlight that integrating diagnostics, vaccination, and women's health through an implementation science lens is essential to accelerating regional and global efforts to eliminate HPV. By placing implementation strategies, vaccine uptake, communication dynamics, and immunogenicity within broader health system and societal contexts, this collection enhances both scientific understanding and practical measures.Continued interdisciplinary collaboration will be key to ensuring that innovations lead to equitable and measurable reductions in HPV-related disease burden.

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Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women in sub-Saharan Africa, where screening access is limited. It is mainly caused by persistent high-risk human papillomavirus (HR-HPV) infection, making HPV testing in screening programs imperative. The widely used DNA-based assays cannot distinguish transient from active infections, thus reducing specificity and risking overtreatment. In contrast, mRNA-based assays like APTIMA® detect E6/E7 transcripts, markers of active, likely persistent infections and improve clinical relevance. This cross-sectional study compared mRNA and DNA assay performance and characterized circulating HPV genotypes in a South African population to inform screening approaches in resource-limited settings. 527 cervical samples collected from women at a South African tertiary hospital were tested for HPV infections using two DNA assays (Abbott RealTime High-Risk HPV, Seegene Allplex™ II HPV28) and one mRNA assay (APTIMA® HPV). APTIMA® had the highest specificity (86.2%) and sensitivity (89.9%), outperforming Seegene (81.6%, 82.3%) and demonstrating stronger agreement with Abbott (Cohen’s Kappa = 0.80 vs. 0.70). ROC analysis confirmed APTIMA’s improved discrimination (AUC 0.8804 vs. 0.8681). Although Seegene detected more infections, many were likely transient and clinically insignificant. Findings support mRNA-based testing to better target high-risk women and reduce unnecessary interventions in resource-limited, high-burden settings.