Table 1.

General challenges in introducing HPV tests to laboratories across LICs.

Infrastructure challenges	HPV test-associated challenges
	Sample collection
Many labs are not physically suitable to run nucleic acid–based tests	There are a confusing number of collection brushes and swabs
Equipment for high throughput assays takes up considerable space and is usually expensive or dependent on purchase of guaranteed numbers of tests	Sample transport media may be proprietary and designed for cytology, with high alcohol or formaldehyde content and large volume
Lack of local agents makes access to technical support and maintenance difficult and impacts on regular delivery of supplies	Sample transport may need temperature control and limited storage before testing
Disposal of clinical waste and associated plastics can be problematic	HPV test
Temperature control and transportation of samples to testing laboratories can be difficult	HPV tests often have several manual steps, leading to cross contamination and other errors
IT systems may be limited and Internet connectivity intermittent	Internal quality control and external quality assurance are additional issues, especially for small runs where the proportionate cost of controls can be high
Lab staff may not be knowledgeable nor trained to deliver molecular tests; even when staff have had training, there is often not the resource for regular competence assessment	Turnaround times greater than 2 h render many HPV tests unsuitable for point-of-care use and therefore for use in ‘screen and treat’ programmes
	Reproducibility in specific setting needs to be tested, and information on failure rates is essential

HPV: human papillomavirus; LIC: low-income countries; IT: information technology.