Establishment of a cytopathology unit and implementation of HPV genotyping for cervical cancer screening at the University Hospital Complex “Le Bon Samaritain”, N’Djamena, Chad

Cervical cancer remains one of the leading causes of death among women in Sub-Saharan Africa, particularly in Chad, where access to screening and qualified personnel is limited. This study aimed to describe the implementation process of a cytopathology unit and human papillomavirus (HPV) genotyping dedicated to the screening of cervical (pre)cancerous lesions at the “Le Bon Samaritain” University Hospital Complex (CHU-BS) in N’Djamena, Chad, as well as the challenges faced and the lessons learned. The intervention followed four phases: needs assessment, procurement and installation of essential equipment, intensive training of local staff, and a pilot screening campaign. Telecytology was integrated to support remote validation by external experts. In parallel, a qualitative HPV genotyping protocol was implemented using the BioPerfectus real-time polymerase chain reaction (PCR) kit (BioPerfectus Technologies Co., Ltd.). A functional two-room cytology unit was established, and local staff were trained to independently prepare and stain smears. Telecytology enables rapid validation and capacity building. During a 10-day campaign, 284 women were screened. Among the 47 slides reviewed, 14 showed cytological abnormalities. HPV genotyping was performed on six samples, of which two tested positive, identifying seven high-risk genotypes (HPV16, 35, 45, 52, 58, 66, 68), one low-risk genotype (HPV6), and multiple infections. The main challenges faced were limited equipment and supply shortages, which were successfully addressed through adaptive solutions and collaborative efforts. This experience demonstrates that establishing a functional cytopathology service and implementing HPV genotyping is feasible in resource-limited settings through collaboration, tailored training, and adaptive use of available resources. The CHU-BS model provides a practical cancer screening service in Chad and similar Sahelian contexts.