<![CDATA[Background: Cervical cancer remains a major global health challenge, particularly in low- and middle-income countries where screening uptake is limited. Clinician-collected cervical HPV testing is the current reference standard, yet conventional sampling procedures are often invasive, uncomfortable, and stigmatized, reducing acceptability among under-screened women. Urine-based HPV DNA testing has therefore emerged as a promising non-invasive alternative. Purpose: To critically synthesize and appraise existing evidence on the diagnostic accuracy of urine-based HPV DNA testing—specifically its sensitivity, specificity, and concordance—as well as the methodological factors influencing these metrics, in comparison with clinician-collected cervical HPV DNA samples for cervical cancer screening. Method: This systematic review, conducted in accordance with PRISMA 2020 guidelines, synthesized evidence from PubMed, Scopus, and ScienceDirect published between 2016 and 2026. Thirty eligible studies were included from 455 identified records, all evaluating the diagnostic accuracy of urine-based HPV DNA testing compared with clinician-collected cervical samples. Results: Findings revealed moderate-to-high concordance, with sensitivity ranging from 44% to over 95% and consistently high specificity. Superior diagnostic performance was observed in studies employing first-void urine collection and validated PCR-based assays, while methodological heterogeneity in collection procedures, preservation methods, and assay platforms remained evident. Conclusion: Urine-based HPV DNA testing offers a feasible, non-invasive approach to expand cervical cancer screening, particularly for under-screened populations. However, methodological standardization and large-scale validation are essential before adoption as a primary screening strategy.]]>
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