Abstract
BackgroundVaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women’s experiences, concerns and the acceptability of such tests in low-resource settings remain unknown.MethodsIn India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women’s and providers’ experiences with self-sampling, women’s opinions of sampling at home, and their future needs.ResultsAmong surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn’t mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%).ConclusionSelf-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women’s preference for self-sampling.
Highlights
Vaginal self-sampling with Human papillomavirus (HPV)-DNA tests is a promising primary screening method for cervical cancer
Survey participants were asked closed-ended questions about their opinions, attitudes, health-seeking behaviors, potential barriers related to cervical cancer screening and self-collection procedures, and about their experiences participating in the study
A total of 20 providers and 82 women enrolled in the study participated in the semi-structured qualitative interviews (SSIs) and focus group discussions (FGDs) (Table 1)
Summary
Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. It is the third most common cancer among women worldwide, and poses a public health problem in developing countries where 85% of the global deaths due to cervical cancer occur [1]. Cervical cancer-related deaths have decreased significantly in developed countries due to widespread screening based on Pap smear testing. Similar initiatives in developing countries have not had the same success due to the complexity of the elements required. The success of Pap smear testing depends on repeat testing and high-quality laboratories, which drive up costs [2]. The lack of trained personnel who can adequately read cytology samples leads to a long waiting time (1 to 3 months) for receiving test results, causing high loss to follow-up [3]
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