Scaling HPV Self-Sampling in Low-Resource Settings: From Evidence to Sustainable Implementation

Abstract: Profound global inequities in cervical cancer burden persist, with nearly 90% of deaths occurring in low- and middle-income countries (LMICs). High-performance human papillomavirus (HPV) testing is the recommended primary screening method, but its scale-up remains constrained by resource and infrastructure limitations. HPV self-sampling optimizes health system resources by eliminating universal speculum examinations during primary screening, yet a critical implementation gap remains regarding how programs transition from pilot projects to routine national practice. To examine this transition, a literature search was conducted through May 2026, focusing on implementation of cervical screening using vaginal self-sampling and molecular DNA amplification techniques within resource-limited settings. While policy endorsement in LMICs expanded from 10 countries in 2020 to 29 in 2026—with 23 recommending self-sampling for all women—real-world implementation lags significantly, as reflected in an estimated five-year HPV-based screening coverage of only 2% in LMICs in 2022. Selected country case studies illustrate diverse delivery models and varying stages of implementation scale, ranging from localized research projects and regional campaigns to scaled national programs: community health worker home visits increased screening uptake four-fold in Argentina, digital health platforms and electronic registries are supporting national scale-up in Malaysia and Rwanda, and single-day near-point-of-care projects achieved very high follow-up rates in remote Amazonian populations. Beyond these country experiences, the review evaluates key considerations along the clinical care cascade, highlighting the importance of triage and treatment capacity, active tracing strategies to minimize loss to follow-up, and supply chain management. Ultimately, self-sampling serves as a promising equity strategy whose success relies on sustained political, financial, and structural commitment across the full clinical pathway. Keywords: cervical cancer screening, HPV testing, self-sampling, LMIC, implementation, health systems strengthening