The Possibilities of Pooled Procurement to Accelerate HPV Testing  

Cervical cancer elimination is an achievable goal that hinges on getting women access to proven prevention interventions: human papillomavirus (HPV) vaccination, high-performance screening, and timely treatment. But access itself depends heavily on the affordability and availability of these interventions.

Molecular diagnostics testing for the presence of HPV has proven to be far more accurate than the more common visual methods, such as cytology and visual inspection with acetic acid, while also requiring less frequent screening and reducing the burden on health practitioners. This is especially true when HPV testing is done through self-sampling by women themselves. However, this newer technology has seen slow uptake in low-resource settings in part due to the high need for investment in testing platforms and the relatively high price of individual tests.

The case for pooled procurement for HPV tests

Pooled procurement mechanisms have been essential to negotiating reduced prices and expanding the supply of global health commodities on behalf of low- and middle-income countries. Cervical cancer elimination efforts have greatly benefited from the pooled procurement of HPV vaccines by UNICEF on behalf of Gavi, the Vaccine Alliance, reducing vaccine prices to a fraction of those in high-income countries and ensuring their widespread global introduction and distribution. Such investments will protect today’s young women from cervical cancer and other HPV-related cancers, particularly in countries most impacted by cervical cancer deaths.

It’s just as critical to ensure that adult women today have access to lifesaving screening that can give those at highest risk a pathway to necessary care.

To understand how pooled procurement might be leveraged to reduce the cost of HPV tests in low- and middle-income countries, TogetHER for Health undertook a formative research project that combined desk research with interviews of stakeholders representing HPV diagnostics manufacturers, cervical cancer program implementers, and organizations specializing in global health procurement.

Considerations for increasing uptake of HPV tests

Some key insights from the project’s final report:

• Sustainable, predictable funding is key to any successful pooled procurement, providing the necessary incentive for suppliers to commit volumes of health commodities and in turn to negotiate price reductions.
• Reliable demand forecasting is critical to substantiating the case for pooling resources and ensuring the necessary supply.
• Given the effort and investment needed to launch a new pooled mechanism, expanding the eligibility of pre-existing pooled mechanisms to include HPV diagnostics may be preferable to the creation of one dedicated solely to their purchase.
• Reducing the price of HPV tests and increasing their supply can amplify the impact of investments and support higher cervical cancer screening rates, but ultimately these only represent one part of a complex process necessary to screen and, if necessary, treat women.

TogetHER for Health hopes this new publication — as well as this brief  Executive Summary — proves useful in generating awareness and sparking meaningful dialogue towards making HPV tests more widely affordable and accessible.

We are indebted to the stakeholders who provided their time and perspectives to generate this piece, and to the reviewers who added essential insight and guidance. We look forward to supporting decisive action to broaden access to high-performance screening for women around the world.