HPV self-sampling for cervical cancer screening during wartime: a pilot implementation study from a conflict-affected region of Ukraine

Structured AbstractO_ST_ABSIntroductionC_ST_ABSCervical cancer screening is difficult to initiate and sustain during war due to disrupted health services, population displacement and limited clinical capacity. Evidence on whether human papillomavirus (HPV)-based screening using self-sampling can function as a screening pathway during armed conflict is unknown. This study evaluated the feasibility, acceptability and operational performance of HPV self-sampling for cervical cancer screening in a war-affected region of Ukraine. MethodsWomen aged 30-60 years living in Zaporizhzhia Oblast, Ukraine, were offered HPV testing using self-collected cervicovaginal samples distributed through outpatient clinics, community outreach activities and refugee centres. Samples were analysed locally using PCR-based HPV assays with external laboratory quality assurance. Women positive for HPV16/18 were referred directly for colposcopic evaluation. Primary outcomes included screening uptake, kit return rate, HPV positivity and follow-up completion among HPV16/18-positive women. Secondary outcomes included turnaround times, HPV positivity by age and sampling setting, and participant feedback. ResultsBetween April and December 2025, 593 women were offered HPV self-sampling; only four (0.67%) declined participation. Of 589 distributed kits, 572 samples were returned and analysed (attendance rate 96.46%, 572/596), with non-return occurring only in refugee centres. Overall, 52/572 women (9.1%) tested positive for targeted HPV types, including 22 (3.8%) positive for HPV16/18 and 30 (5.2%) positive for HPV31/33/35/45/52/58. All women testing positive for HPV16/18 were contacted and referred for specialist follow-up; among those completing follow-up, all were assessed within two months. Median turnaround time from self-sampling to results was 6.3 days. All recorded participant feedback was positive. ConclusionHPV self-sampling-based cervical cancer screening can be initiated and maintained during active war with high uptake, timely laboratory processing and effective referral of women at highest risk. Simplified, low-contact screening pathways may support cervical cancer prevention under wartime conditions. Trial registrationClinicalTrials.gov identifier: NCT07275333. What is already known on this topicO_LIHPV-based screening is the most effective method for cervical cancer prevention and is recommended globally. C_LIO_LIHPV self-sampling increases participation and acceptability in stable healthcare settings. C_LIO_LIWhether cervical cancer screening can be implemented during an active armed conflict is unknown. C_LI What this study addsO_LIDemonstrates that HPV self-sampling-based screening can be initiated and sustained during active war. C_LIO_LIShows high uptake, timely laboratory processing and effective referral of HPV16/18-positive women under severe operational constraints. C_LIO_LIIdentifies distribution models that minimise sample loss in highly mobile and displaced populations. C_LI How this study might affect research, practice or policyO_LISupports inclusion of HPV self-sampling in cervical cancer prevention strategies for conflict-affected settings. C_LIO_LIInforms programme design choices, favouring simplified, single-visit screening pathways when population mobility is high. C_LIO_LIProvides implementation evidence relevant for countries rebuilding screening programmes during or after military conflicts. C_LI