Indonesia Expands HPV DNA Screening in Drive to Eliminate Cervical Cancer by 2030

A nationwide screening push confronts late diagnosis

Indonesia is moving to roll out HPV DNA testing nationwide in 2025 for women aged 30 to 69, making more sensitive screening a central part of its effort to eliminate cervical cancer as a major public health threat by 2030. The programme combines testing for the virus that causes most cervical cancers with an existing visual examination, while expanding vaccination and access to treatment.

The need is substantial. The International Agency for Research on Cancer (IARC) estimated approximately 36,000 new cervical cancer cases and 21,000 deaths in Indonesia in 2022. Cervical cancer is the second most common cancer among Indonesian women after breast cancer, and the country's rates of new cases and deaths, adjusted for differences in population age, are among the highest in Southeast Asia.

About 70% of cases are detected at advanced stages, when treatment is less effective. In 2020, fewer than 10% of women aged 30 to 50 underwent the free screening available to them. Expanding testing therefore means reaching many women who have had little contact with preventive services.

Indonesia's National Cervical Cancer Elimination Plan for 2023 to 2030 and National Cancer Action Plan for 2024 to 2034 bring screening, vaccination and treatment into the same strategy. As of June 18, 2025, the programme combines a planned national expansion with the practical challenge of delivering services across a vast country where access differs between cities, rural communities and remote areas.

What changes when screening looks for HPV DNA?

Persistent infection with high risk types of human papillomavirus, or HPV, is the main cause of cervical cancer. HPV is transmitted through sexual contact. DNA testing searches a cervical sample for genetic material from these virus types, helping identify women at risk before cancer develops.

Indonesia has mainly relied on visual inspection with acetic acid, known as VIA. A healthcare worker applies acetic acid to the cervix and looks for abnormal changes. The method is inexpensive and relatively easy to provide in rural settings, but its limits in sensitivity and specificity can lead to missed abnormalities or unnecessary follow-up examinations.

Sensitivity describes how well a test finds the condition it is looking for. Specificity describes how well it identifies people without that condition. HPV DNA testing offers greater accuracy in identifying women at risk, supporting earlier intervention and reducing the chance that disease progresses unnoticed.

The Ministry of Health plans to use HPV DNA testing as the primary screening tool for women aged 30 to 69, together with VIA. Using both methods is called co-testing. The combination adds molecular testing to the visual examination already familiar to many health facilities.

Siti Nadia Tarmizi, Director of Noncommunicable Diseases Prevention and Control at the Ministry of Health, described the planned expansion at a press briefing:

We will begin to roll out HPV DNA co-testing with VIA nationwide starting in 2025.

The announcement followed pilot programmes in Greater Jakarta and an expansion during 2024 to 25 regencies and cities across 16 provinces. Early results found HPV infections in about 2.5% of women screened through co-testing.

Earlier detection and fewer screening visits

HPV DNA testing looks for infection before visible or microscopic abnormalities appear. VIA looks for visible changes, while a Pap smear examines cells for abnormalities. Detecting the virus earlier gives health services an opportunity to identify risk before those changes develop into cancer.

A negative HPV DNA result can provide reassurance for five to 10 years, compared with a screening interval of three years for Pap smears. Longer intervals can reduce how often women need to arrange visits, an advantage where travel, time and access to services make repeated appointments difficult.

Less invasive sampling could also help increase participation. Self-collected vaginal samples and urine sampling offer possible alternatives for women who are uncomfortable with a pelvic examination. Embarrassment, discomfort and social stigma are among the reasons women avoid existing screening services.

Indonesia's strategy therefore involves both changing the test and making screening easier to accept. More accurate testing can find women at risk, while convenient sampling and accessible services can help bring more women into the programme.

What the 2030 targets require

Indonesia's plans align with the World Health Organization's 90-70-90 targets for 2030. The three numbers cover different parts of prevention and care, from protecting girls before infection to treating women who already have disease.

• 90% of girls should be fully vaccinated against HPV by age 15.
• 70% of women should receive screening with a high performance test by ages 35 and 45.
• 90% of women with precancerous changes should receive treatment, and 90% of women with invasive cancer should have their disease managed.

The global strategy seeks to reduce cervical cancer incidence to fewer than four cases per 100,000 women. Indonesia's elimination objective is tied to this public health threshold, with vaccination, screening and treatment each contributing to fewer cases and deaths.

The national cervical cancer plan and the broader cancer action plan prioritise expanding all three services across the country. Stronger health infrastructure, partnerships and equitable access are part of that work. A screening programme needs treatment services alongside it so that women with abnormal findings can receive care.

Vaccination expands from selected cities to a national programme

Indonesia introduced HPV immunisation in 2016, initially in selected cities. In 2023, it expanded the programme nationwide for girls aged 11 to 12, in fifth and sixth grade, through the School Children Immunization Month programme, known as BIAS.

Coverage with two doses has surpassed 90%, with nearly two million girls immunised against a target of 2.15 million. Vaccination is the most effective way to prevent cervical cancer, making the school programme a central part of protecting the next generation.

The government plans to introduce a single dose for girls in fifth grade, following WHO recommendations that one dose offers protection comparable to two doses. It also plans catch-up immunisation for girls younger than 15 who missed earlier doses.

Vaccination could extend to boys as early as 2026. The aim is to reduce HPV transmission and accelerate progress towards herd immunity, the protection that develops when enough people are immunised to limit a virus's spread.

Dr. N. Paranietharan, WHO Representative to Indonesia, welcomed the national programme and the planned change in vaccination schedule:

Indonesia's national HPV vaccine rollout represents a significant commitment to public health and gender equity. The single-dose schedule will bring greater efficiency, lower costs and accelerate protection for Indonesian girls and women, advancing our shared goal of eliminating cervical cancer.

A schedule requiring one dose would reduce the number of vaccination appointments needed to deliver protection. Catch-up vaccination would reach girls missed by earlier rounds, while the proposed expansion to boys would broaden prevention beyond the current schoolgirl programme.

How the programme has developed

Indonesia's current plans build on several years of vaccination and screening expansion. The main dates show how the country has moved from programmes in selected locations towards national delivery.

• 2016: HPV immunisation began in selected cities.
• 2020: Fewer than 10% of women aged 30 to 50 used available free screening.
• 2022: IARC estimated approximately 36,000 new cervical cancer cases and 21,000 deaths.
• 2023: HPV vaccination expanded nationally for girls aged 11 to 12, and the 2023 to 2030 cervical cancer elimination plan began.
• 2024: HPV DNA co-testing expanded to 25 regencies and cities in 16 provinces. The broader cancer action plan covers 2024 to 2034.
• 2025: Nationwide rollout of HPV DNA co-testing with VIA is planned.
• 2026: Vaccination could extend to boys as early as this year.
• 2030: Indonesia aims to meet cervical cancer elimination goals aligned with WHO targets.

The expansion to boys remains a proposal with a possible start in 2026. The nationwide screening announcement gives 2025 as the rollout year, without a more detailed timetable for individual locations.

Why free services still struggle to reach women

Many women and families lack information about HPV, cervical cancer and the benefits of vaccination and screening. Cultural taboos around sexual health can make conversations difficult, while internal examinations may be viewed as embarrassing or inappropriate.

Family support also affects whether women seek care. Encouragement from husbands and other relatives can help women attend screening, while a lack of support can become another obstacle. These pressures sit alongside differences in education, income and access to reliable health information.

Research in urban Jakarta found generally positive attitudes towards prevention, but only about 30% of women reported favourable preventive behaviours. Vaccination uptake remained low outside government programmes. Knowledge, attitudes and practices were shaped by social and demographic factors, including parental support, particularly from mothers.

Government screening and vaccination may be free, yet costs paid directly by patients for follow-up care or private services can still be prohibitive for families with low incomes. Socioeconomic constraints can prevent women from seeking preventive care even when an initial test is available.

Indonesia's geography adds another layer of difficulty. Shortages of trained healthcare workers, limited laboratory capacity and uneven service distribution leave rural and remote communities with fewer options than urban areas. Public education and community engagement need to accompany the expansion of clinical services.

Local diagnostic tools and less invasive testing

Nusantics, an Indonesian biotechnology company, has developed the PathoScan hrHPV qPCR Kit to detect 14 high risk HPV types with high sensitivity. The company is also piloting HPV DNA tests using urine, offering a potentially less invasive option for women uncomfortable with traditional sampling.

Urine testing and self-collected vaginal samples address one of the programme's practical problems: some women avoid screening because of the examination itself. Making sample collection more acceptable could help health services reach women who have previously stayed away.

Artificial intelligence tools such as Cerviray A.I. are also being evaluated. These tools can help healthcare workers interpret screening results and support remote consultations through telemedicine, potentially extending specialist assistance to underserved areas.

The technologies are still under evaluation. Their proposed role is to widen access and improve diagnostic accuracy, alongside the healthcare workers, laboratories and treatment services needed to deliver the national programme.

Bringing screening into routine health care

The government plans to include HPV DNA screening in President Prabowo Subianto's flagship free birthday checkups for women aged 30 to 69. Adding cervical screening to a broader preventive health programme creates another opportunity for eligible women to receive testing.

The Ministry of Health is also repurposing laboratory equipment from the COVID-19 response, including RT-PCR and GeneXpert machines, to support HPV testing. Using existing equipment is part of the effort to increase molecular testing capacity across the health system.

WHO and the United Nations Population Fund (UNFPA) support the strategy through technical assistance, training for healthcare workers and guidance on protocols grounded in evidence. Indonesia's National Cancer Action Plan also calls for stronger infrastructure and wider partnerships.

Routine checkups, laboratory equipment and trained staff need to connect with follow-up care. Women identified through screening must be able to reach assessment and treatment, including outside major cities. Integration with universal health coverage is part of sustaining that access.

Shared challenges across Asia

A review in The Lancet found that only a handful of Asian countries had achieved high coverage for HPV vaccination and cervical screening. Most still relied on VIA or cytology, which examines cells for abnormalities, rather than DNA testing.

Affordability, vaccine supply shortages and limited awareness are common barriers across the region and in countries with low and middle incomes. Indonesia's shift towards more effective screening reflects a wider effort to improve prevention in health systems facing these constraints.

Indonesia's commitment to WHO targets, rapid vaccination expansion and adoption of more accurate screening methods place it among regional leaders in cervical cancer elimination efforts. Its experience also shows the role of political commitment, cooperation across sectors and community participation in extending services.

For Indonesian women, the concrete measure of progress will be access: whether vaccination reaches girls who missed it, whether screening is available beyond urban centres, and whether an abnormal result leads to timely care.

Turning national targets into sustained care

Indonesia needs enough laboratory capacity to make HPV DNA testing available and affordable nationwide, including in rural and remote areas. Training and retaining healthcare workers is equally central to providing screening, explaining results and arranging follow-up treatment.

Public education must address low awareness, embarrassment and cultural barriers that keep women away from care. Community involvement and family support can help translate positive attitudes towards prevention into actual screening and vaccination.

Long term funding, reliable disease surveillance and integration with universal health coverage are needed to sustain progress. Surveillance systems help track the disease burden and the reach of services, allowing the programme to measure movement towards its targets.

Self-sampling, artificial intelligence and digital health platforms offer opportunities to close gaps in access and quality. Partnerships involving local industry, civil society and international agencies will support delivery, but the programme ultimately depends on connecting prevention, detection and treatment for women across the country.

Key Points

• Indonesia plans nationwide HPV DNA co-testing with VIA in 2025 for women aged 30 to 69.
• IARC estimated approximately 36,000 new cervical cancer cases and 21,000 deaths in Indonesia in 2022.
• About 70% of cases are detected at advanced stages, while fewer than 10% of women aged 30 to 50 used available free screening in 2020.
• HPV vaccination coverage with two doses has surpassed 90%, reaching nearly two million girls against a target of 2.15 million.
• Plans include a single vaccine dose for girls in fifth grade, catch-up vaccination for girls under 15 and possible vaccination of boys from 2026.
• Free birthday checkups, repurposed laboratory equipment and new sampling methods are intended to widen access.
• Indonesia's 2030 goals depend on expanding vaccination, screening and treatment while addressing financial, cultural and geographic barriers.