Short-term reproducibility and comparative screening performance of paired cervical HPV DNA tests among women in Senegal

Cervical cancer remains a major public health challenge in sub-Saharan Africa, where access to effective screening programs remains limited. Human papillomavirus (HPV) DNA testing has emerged as a highly sensitive screening strategy for cervical precancer and cancer, although less is known about the short-term reproducibility of repeat HPV testing in high-burden settings. This analytic observational study used secondary data from two Senegalese cohort studies conducted between 1998 and 2006 to evaluate the reproducibility and screening performance of paired cervical swab HPV DNA tests collected within 119 days of one another among 768 women. Agreement between the first and second swab HPV DNA tests was evaluated using percent agreement and Cohens kappa ({kappa}) for overall high-risk HPV (hrHPV), low-risk HPV, and genotype-specific detection. Screening performance analyses compared four paired testing strategies, and exploratory logistic regression analyses examined factors associated with discordant paired hrHPV results. Reproducibility for any hrHPV detection was substantial ({kappa} = 0.74, 95% CI: 0.69-0.79), with almost perfect agreement observed for HPV16 ({kappa} = 0.85, 95% CI: 0.79-0.91). Agreement remained substantial across age, HIV status, education level, marital status, lifetime number of sexual partners, parity, contraceptive use, and cervical disease categories. Discordance was more likely when samples were collected 30-59 days apart than within 0-29 days and was less common among women with CIN2+, ICC, or HIV infection. Compared with a single swab strategy, classifying either swab as positive increased sensitivity for detection of both cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and invasive cervical cancer (ICC) by approximately 7-8%. This study demonstrates that paired cervical hrHPV DNA testing has substantial short-term reproducibility among women in Senegal, particularly for carcinogenic HPV types associated with cervical cancer. The findings support single hrHPV DNA testing as a reliable screening strategy in this high-burden setting while highlighting the importance of cautious interpretation of discordant repeat results, particularly among women without high-grade cervical disease.