Acceptability of self-sampling for high-risk HPV DNA testing for primary cervical cancer screening among women in Thyolo, Malawi: A qualitative study

Despite the roll-out of cervical cancer screening within routine health facilities, uptake of cervical cancer screening in Malawi remains low due to factors such as privacy concerns, stigma, and distance to health facility. Self-sampling for human papillomavirus (HPV) testing offers a viable alternative to provider-delivered sampling, resolving issues with accessibility and privacy related barriers. However, there is limited understanding of the acceptability of self-sampling among women in low-income settings. We aimed to assess women's perceptions, experiences, and acceptability of self-sampling for HPV testing for primary cervical cancer screening. We conducted a qualitative phenomenological study among ten purposively sampled women screening for cervical cancer at a rural hospital in Malawi. Data collection instruments and the thematic analytical approach were guided by the Theoretical Framework of Acceptability. Key constructs that were central to this analysis included affective attitude, burden, self-efficacy, intervention coherence, and perceived effectiveness. Self-sampling emerged as a culturally and socially acceptable diagnostic practice by the women, mediated by emic values of privacy, bodily autonomy, and convenience. Women valued the ability to autonomously collect samples, which allowed them to circumvent discomfort and perceived invasiveness linked to speculum use, especially by male clinicians. Sociocultural barriers such as limited literacy levels, poor access to transport, and a lack of spousal approval restricted broader acceptability. Facilitators of acceptability included comprehension of the intervention, confidence in the self-sampling process, and the potential of the intervention to increase screening uptake, reduce cervical cancer screening-related stigma and reduce healthcare worker burden. Self-sampling for cervical cancer screening is an acceptable and promising alternative for improving the uptake of screening among women in Malawi and similar low-income countries. Scale-up of this approach will require addressing socio-cultural barriers through optimising instructional materials, engaging male partners, and leveraging community health workers for scaled community implementation via task-sharing.

IntroductionHuman papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic...

Cervical cancer (CC) screening shifted from Pap-smear to human papillomavirus (HPV) testing HPV with and without a self-sampling HPV-test in Thailand. Few studies have reported the initial outcomes of such a transition. This study aims to explore CC screening rate, CC detection and compare the CC detection rate by HPV with and without self-sampling methods in Krabi, province. A retrospective study was conducted from 1st October 2023 to 30th September 2024. A total of 11,925 women's records were retrieved. Information on demographic, screening results and cancer diagnosis was retrieved from the Krabi provincial hospital. Different proportions of CC detections and self-test collection based on demographic features were tested using chi-square and Fisher's exact tests. Result: CC screening rate was 42.4%: 10,619 (89%) of women had an HPV test and 1,306 (11%) had a Pap-smear test. The screening rate was 30.2% in 2023 and 52.1% in 2024. With regard to age, occupation, and health insurance schemes there was a significant difference in the proportion of those taking the self- collection test. Religion showed non-significance difference in the proportion of self-sampling test in relation to religion. CC detection was 3% among women who underwent the Pap-smear test and 0.12% for those who performed the HPV test. There is a significant difference in CC detection between the HPV with and without a self-sampling test. CC screening with HPV testing, especially with self-sampling, showed a promising approach to increasing CC screening uptake in the population. The rate of CC detection through self-sampling was lower in the early years of implementation compared to non-self-sampling methods. Ensuring the correct performance of self-sampling should be carefully considered and monitored in the future.

Background: Cervical cancer (CC) remains a leading cause of morbidity and mortality of all cancers among women residing in low-income countries, including Ethiopia. In Ethiopia, although the standard method of CC screening is using Visual Inspection with Acetic Acid (VIA), service accessibility is limited and the uptake by eligible women is very low. Self-sampling for human papillomavirus (HPV) DNA testing might improve the uptake of targeted women for CC screening, especially for hard-to-reach population in Ethiopia. We investigated whether self-collection of cervicovaginal samples for HPV DNA tests would be associated with increased uptake of screening compared with VIA. Methods: A community-based randomized controlled trial has been conducted in Butajira, one of the Health and Demographic Surveillance Sites (HDSS) of Ethiopia. A total of 55 clusters comprising 2,356 women aged 30-49 were randomized in two arms. Community-based sensitization was conducted using the local community workers at their vicinity. Following the community mobilization women were invited to go to the local health post for self-collection-based HPV DNA testing (arm A) or to Butajira Hospital for VIA screening (arm B). We compared the uptake of screening between the two arms. Results: In the HPV arm, of the total 1,213 sensitized women, 1,020 (84.1%) (P<0.0001) accessed the health post for HPV screening. In the VIA arm, 575 of 1,143 (50.5%) visited the hospital. Among the women who accessed the health post for HPV DNA testing, 892 of 1,020 (87.5%) (p=0.0007) provided samples, while 466 of 575 (81%) underwent VIA screening. The residual was excluded due to eligibility criteria in both arms. Conclusion: This preliminary finding of the trial demonstrated better community acceptability and uptake of self-collection-based CC screening at the health post compared to VIA at the hospital. Self-collection-based CC screening can be done at the local health facility and may significantly improve the uptake of CC screening in Ethiopia. Citation Format: Muluken Gizaw, Friederike Ruddies, Adamu Addissie, Alemayehu Worku, Tamrat Abebe, Brhanu Teka, Andreas M. Kaufmann, Eva Kantelhardt. Community-based uptake of self-sampling for HPV DNA-based testing for cervical cancer screening in Ethiopia: Preliminary findings of a cluster randomized trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B103.

BACKGROUND: Cervical cancer currently ranks the commonest gynecological cancer in Nigeria. This could be attributed to poor performance of screening strategies due to economic and patient factors. HIV (human immunodeficiency virus) infection is associated with increased risk of cervical cancer and there is lack of sufficient data on cervical cancer screening among HIV positive patients in our setting. Inefficient cervical cancer screening is related to late diagnosis and increased mortality associated with cervical cancer in our setting. AIM: This study was to assess the uptake and attitude of HIV positive women in relation to cervical cancer screening. METHODOLOGY: This was a cross-sectional study of women diagnosed with HIV that presented for care at the department of obstetrics and gynecology of Federal Medical Centre Abeokuta. A total of 52 women were recruited from July, 2017 to June, 2018. Knowledge of Pap smear, HPV DNA test and colposcopy were tested among the participants. A pretested questionnaire was given to respondents to assess factors associated with uptake of cervical cancer screening and SPSS version 23 was used for cross tabulation and to perform logistic regression of the factors associated with cervical screening among the subjects. RESULTS: The mean age of the subjects was 36.5±6.8 years. Out a total of 52 respondents, only 15 (29%) were aware of at least one method of cervical cancer screening. Women with tertiary level of educational status comprised 11(78%) of the subjects that are aware of cervical cancer screening. Only 6 (12%) of the HIV positive subjects were aware of the increased risk of cervical cancer associated with HIV infection. Among the 15(29%) of subjects that are aware of cervical cancer screening, 9(17%) were screened because of symptoms and signs of lower genital tract condition. Women between 40 and 50 years of age (OR= 2.41), presence of gynecological symptoms (OR= 2.97), educational attainment (OR=2.54), duration of HIV diagnosis >5yrs (OR=2.99), were strong predictors of uptake of cervical cancer screening in our setting. CONCLUSION: The knowledge and uptake of cervical cancer screening was very poor among HIV positive patients in our setting despite the increased risk associated with HIV infection, incorporation of cervical cancer screening among health education and intervention to improve its uptake by the agencies involved in HIV care will lead to improved uptake and ultimately decrease mortality associated with cervical cancer REFERENCES 1. Zayyan MS, Akpa M, Dawotola DA, Oguntayo AO, Kolawole AO. Quality of life in patients with advanced cervical cancer in Nigeria. Sahel Med J 2018;21:61-9 Note: This abstract was not presented at the meeting. Citation Format: Chibuike F. Chukwunyere, David O. Awonuga. Uptake of cervical cancer screening among HIV positive women at a tertiary healthcare center in Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4002.

Several countries have implemented primary human papillomavirus (HPV) testing for cervical cancer screening. HPV testing enables home-based, self-collected sampling (self-sampling), which provides similar diagnostic accuracy as clinician-collected samples. We evaluated the impact and cost-effectiveness of switching an entire organized screening program to primary HPV self-sampling among cohorts of HPV vaccinated and unvaccinated Norwegian women. We conducted a model-based analysis to project long-term health and economic outcomes for birth cohorts with different HPV vaccine exposure, that is, preadolescent vaccination (2000- and 2008-cohorts), multiage cohort vaccination (1991-cohort) or no vaccination (1985-cohort). We compared the cost-effectiveness of switching current guidelines with clinician-collected HPV testing to HPV self-sampling for these cohorts and considered an additional 44 strategies involving either HPV self-sampling or clinician-collected HPV testing at different screening frequencies for the 2000- and 2008-cohorts. Given Norwegian benchmarks for cost-effectiveness, we considered a strategy with an additional cost per quality-adjusted life-year below $55 000 as cost-effective. HPV self-sampling strategies considerably reduced screening costs (ie, by 24%-40% across cohorts and alternative strategies) and were more cost-effective than clinician-collected HPV testing. For cohorts offered preadolescent vaccination, cost-effective strategies involved HPV self-sampling three times (2000-cohort) and twice (2008-cohort) per lifetime. In conclusion, we found that switching from clinician-collected to self-collected HPV testing in cervical screening may be cost-effective among both highly vaccinated and unvaccinated cohorts of Norwegian women.

Background: Cervical cancer is a public health problem affecting women all over the world. Persistent infection with high-risk types of human papillomavirus (HPV) is a key risk factor for the development of cervical cancer. Besides, HPV vaccines and cervical cancer screening have been established as the primary and secondary preventive measures, respectively, yet studies have documented low uptake of these preventive measures. This study was designed to identify factors associated with uptake of HPV vaccination and cervical cancer screening among female undergraduates in Obafemi Awolowo University, Ile-Ife, Nigeria. Methods: This is a cross-sectional descriptive study employing a semi-structured, self-administered questionnaire to elicit information from 240 female undergraduates on sociodemographics and factors associated with uptake of HPV vaccines and screening for prevention of cervical cancer. The data collected was analyzed using the statistical package for social sciences (SPSS) version 20.0. Descriptive statistics were used to present data in tables and frequencies. Results: Findings from the study revealed that 80% of the respondents have heard of cervical cancer; however, only 48.3% and 41.7% have information about HPV vaccination and cervical cancer screening, respectively. The key factors identified for low uptake of HPV vaccination and cervical cancer screening were inadequate information about HPV vaccines (96.7%) and lack of detailed information about cervical cancer screening (94.6%), respectively. However, the least identified factors for low uptake of the primary and secondary preventive measures were some of the respondents considered their age too young to receive HPV vaccines (15%) and lack of time (42.1%) for the uptake of cervical cancer screening. Conclusion: There is a high level of knowledge about cervical cancer, but does not translate to high uptake of the prevention services. Thus, there is a great need to put in place measures to improve the uptake of HPV vaccination and cervical cancer screening services among the target population.

Background: Screening can effectively identify precancerous lesions for early treatment to prevent cervical cancer. However, only 69% of Vietnamese immigrants in the U.S. reported screening in the past 3 years compared to 84% of non-Hispanic White women. Human papillomavirus (HPV) self-sampling is a novel cervical cancer screening approach that does not require women to visit healthcare providers and has been shown to increase screening uptake in several minority populations. Understanding the attitudes towards cervical cancer screening, including HPV self-sampling, among Vietnamese immigrants could inform strategies to improve their screening rates. Methods: We conducted two online semi-structured focus groups with a total of nine Vietnam-born women aged 50-65 living in Southern California, which has the largest Vietnamese community outside of Vietnam, to understand their awareness of, attitudes towards, and experiences with cervical cancer screening. Participants also watched two short videos on two cervical cancer screening methods (Papanicolaou "Pap" test and HPV self-sampling) and shared their thoughts on each method. Each focus group was recorded, transcribed, translated into English, and coded and analyzed using NVivo 14. Results: Three main themes emerged from the focus groups. First, participants showed a strong acceptance of cervical cancer screening despite poor knowledge of the disease and its prevention as well as logistic and psychosocial barriers associated with visiting healthcare providers for screening. Second, participants found HPV self-sampling to be highly acceptable, mentioning advantages like its convenience and the lack of embarrassment compared to visiting healthcare providers. However, there were some concerns regarding the mailing of the self-collected samples and the cost of the test. Third, participants described circumstances that may be immigrant-specific, such as a shift from making gynecologic appointments themselves in Vietnam to relying on family doctors as gatekeepers for such appointments in the U.S., a strong preference for Vietnamese- speaking providers, and the use of English as a Second Language (ESL) centers, community organizations, radio stations, and newspapers targeting Vietnamese communities to obtain healthcare information. Conclusions: HPV self-sampling has the potential to improve cervical cancer screening uptake in Vietnamese immigrants since it can overcome barriers associated with visiting healthcare providers for a Pap test. Education campaigns are needed to increase awareness of cervical cancer screening and address concerns related to HPV self-sampling. Engagement with healthcare providers, organizations, and media channels that serve Vietnamese communities may be effective since Vietnamese immigrants often receive health-related information from these sources. It is necessary to explore the perceptions of younger immigrants and U.S.-born Vietnamese women to inform efforts that can improve screening uptake in all Vietnamese women; focus groups and interviews of these women are underway. Citation Format: Minh T. Phung, Ivy Nguyen, Bethany Nguyen, Hailey Nguyen, Becky Nguyen, Dung Hua, Celeste L. Pearce, Alice W. Lee. Insight into cervical cancer screening and HPV self-sampling among Vietnamese immigrants in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A144.

Background: There is a paucity of studies exploring women living with HIV's (WLWH) experiences relating to human papillomavirus (HPV) self-sampling as cervical cancer (CC) screening approach, either at the clinic or at the home setting, using qualitative methods. Our study explored facilitators and barriers to HPV self-sampling as a CC screening approach among human immunodeficiency virus (HIV)-infected women, as supported by the new WHO guidelines of using the HPV test as a screening modality. Methods: The study was guided by the health promotion model (HPM), which helps individuals achieve higher levels of well-being. The phenomenology design was used to explore the deeper facilitators and barriers of women regarding self-sampling, either at home or in clinical settings, at Luweero District Hospital, Uganda. The in-depth interview (IDI) guide was translated from English to Luganda. Qualitative data analysis was guided by content analysis techniques. The transcripts were coded in NVivo 20.7.0. The coded text was used to generate categories of analytically meaningful data that guided the formation of themes, the interpretation of results, and the final write-up. Results: WLWH were motivated to screen for HPV using the clinic-based approach because of perceived early diagnosis and treatment, visualization of the cervix, and free service, while reduced distance, privacy and the smooth sample collection kit were motivators for the home-based approach. A barrier that cut across the two HPV self-sampling approaches was a lack of knowledge about HPV. The barriers to clinic-based HPV self-sampling screening included lack of privacy, perceived painful procedures for visual inception under acetic acid (VIA), and fear of finding the disease. Stigma and discrimination were reported as the major barriers to the home-based HPV self-sampling approach. The major reasons why some WLWH refused to screen were fear of finding the disease, stress, and financial disruptions related to being diagnosed with CC disease. Conclusions: Therefore, early diagnosis for HPV and CC enhances clinic-based HPV self-sampling, while privacy enhances the home-based HPV self-sampling approach. However, fear of finding a disease and the lack of knowledge of HPV and CC hinders HPV self-sampling. Finally, designing pre- and post-testing counselling programs in HIV care is likely to increase the demand for HPV self-sampling.

Cervical cancer screening program in Uganda is opportunistic and focuses mainly on women aged 25-49 years. Female sex workers (FSWs) are at increased risk of developing invasive cervical cancer. There is limited data regarding the uptake and acceptability of cervical cancer screening among FSWs in Uganda. This study aimed at identifying factors associated with uptake and acceptability of cervical cancer screening among FSWs in Eastern Uganda. This was a cross-sectional study conducted among 423 FSWs aged 18-49 years attending care at six health facilities serving Key Populations (FSWs, Men who have sex with men, transgender people, people who inject drugs and people in prisons) in the Teso sub-region. Data was collected using structured investigator administered questionnaire and analyzed using Stata statistical software version 15.0 (Stata Corp, Texas, USA). The primary outcome was uptake of cervical cancer screening measured as the proportion of female sex workers who have ever been screened for cervical cancer. Chi-square test was used to compare the differences in uptake of cervical cancer screening by HIV status. Modified Poisson regression model with a robust variance estimator was used to determine association between the outcome variables and selected independent variables including demographic characteristics. Prevalence ratios (PR) with accompanying 95% confidence intervals have been reported. Statistical significance was considered at two-sided p-values ≤ 0.05. The mean age of the participants was 28.1 (±SD = 6.6) years. The self-reported HIV prevalence was 21.5% (n = 91). There were 138 (32.6%) participants who had ever been screened for cervical cancer (uptake), while 397 (93.9%) were willing to be screened (acceptability). There was a significant difference in cervical cancer screening uptake between women living with HIV (WLHIV) and those who were HIV negative, 59.3% vs 26.9% respectively (P < 0.001). The significant factors associated with uptake of cervical cancer screening included living with HIV, adjusted prevalence ratio (aPR) = 1.53 (95%CI: 1.15-2.07), increasing number of biological children, aPR = 1.14 (1.06-1.24) living near a private not for profit (PNFP) facility, aPR = 2.84 (95% CI; 1.68-4.80) and availability of screening services at the nearest health facility, aPR = 1.83 (95% CI, 1.30-2.57). Factors significantly associated with acceptability of cervical cancer screening included being 40 years or older, aPR = 1.22 (95%CI: 1.01-1.47), having a family history of cervical cancer, aPR = 1.05 (1.01-1.10), and living near a PNFP facility, aPR = 1.17 (95% CI, 1.09-1.27) and having ever screened before, aPR = 0.92 (0.86-0.98). Female sex workers living with HIV are more likely to screen for cervical cancer than the HIV negative clients. Cervical cancer screening uptake is relatively low among the female sex workers. However, majority of the FSWs are willing to be screened for cervical cancer if the services are provided in the nearby healthcare facilities. There is need to make cervical cancer screening services available to all eligible women especially the female sex workers and integrate the services with sexual reproductive health services in general and not just HIV/ART clinics services.

PURPOSE In Ethiopia, cervical cancer screening uptake remains low (14%), despite efforts to increase access to preventive services. While Ethiopia’s national screening program currently uses a “screen-and-treat” approach with visual inspection with acetic acid (VIA), human papillomavirus (HPV) self-sampling may be a screening option available in the future, which has been found to be a safe and easy approach for sample collection in many global contexts. Some concerns exist among age-eligible women for HPV self-sampling, therefore understanding the nuanced perceptions towards HPV self-sampling from an Ethiopian perspective is important. This qualitative study explores perceived pros and cons to cervical cancer screening with HPV self-sampling so that this approach can be tailored to the cultural and social context of Ethiopia to increase screening uptake. METHODS In 2022, four focus groups were conducted with 50 Ethiopian women to discuss their perceptions towards cervical cancer and cervical cancer screening methods. Participants were shown educational videos on VIA and HPV self-sampling. They were prompted to compare the two screening modalities and discuss why they liked or disliked each. Audio recordings were translated and transcribed, transcripts were coded with Dedoose software, and content analysis was conducted to identify major themes contributing to hesitancy to screen using HPV self-sampling. RESULTS A lack of awareness, coupled with a lack of confidence in collecting their own specimen, influenced many women to have notable negative views of the HPV self-sampling process. Many women thought the self-sampling would be “difficult,” as it “might hurt sensitive places.” A participant shared: “I might not use the device properly. If I have the courage and the desire, I prefer to see a doctor.” Interestingly, participants often stated that they would be more willing to try HPV self-sampling if they had increased understanding, education, and “awareness” of cervical cancer and the procedure. CONCLUSION To promote cancer screening services in underserved communities such as in Ethiopia, it is imperative to understand the major factors that influence screening. Focus groups revealed reasons that women may be hesitant to screen for cervical cancer using HPV self-sampling. Education and screening interventions should address these concerns and self-described knowledge gaps to empower patients to make informed decisions about screening.

Cervical cancer (CC) screening is essential for reducing its incidence, yet engaging under-screened women remains challenging. Self-sampling has emerged as a promising solution to enhance attendance; however, its integration into programmes has proven difficult. This study evaluated a multimodal approach combining self-sampling, human papillomavirus (HPV) testing, and personalized contact to reach women not attending conventional CC screening. To achieve this, 801 women aged 30–59 who had not participated in Portugal’s Central Region CC screening programme for more than 4 years were selected based on specific criteria. Of these, 114 women were excluded for not meeting eligibility criteria, resulting in 687 eligible participants. Using an ‘opt-in’ approach, women who consented to participate received cervicovaginal self-sampling kits at home. Multiple contact strategies, including phone calls and reminder letters, were employed to encourage participation. Women testing positive for high-risk HPV (hr-HPV) were referred for gynaecological follow-up. Of the eligible women, 307 (44.7%) consented to participate and 198 (28.8%) provided valid samples for hr-HPV testing. Approximately 60.0% of participants were enrolled after the first reminder phone call, while additional contact strategies accounted for one-third of submitted samples. Among 12 hr-HPV positive cases, 11 completed gynaecological follow-up, resulting in the identification of six cervical lesions. This study confirms the feasibility and effectiveness of combining self-sampling, HPV testing, and personalized contact strategies to improve CC screening uptake among under-screened women. The findings highlight the potential of such interventions to address participation gaps and enhance early detection of cervical lesions, ultimately reducing CC incidence.

To determine the impact of trained community health educators on the uptake of cervical and breast cancer screening, and HPV vaccination in rural communities in southeast Nigeria. A prospective population-based intervention study, with a before-and-after design, involved four randomly selected communities in southeast Nigeria from February 2014 to February 2016. Before the intervention, baseline data were collected on the uptake of cervical and breast cancer prevention services. The intervention was house-to-house education on cervical cancer and breast cancer prevention. Postintervention outcome measures included the uptake of cervical and breast cancer screening, and HPV vaccination within 6months of intervention. In total, 1327 women were enrolled. Before the intervention, 42 (3.2%) women had undergone cervical cancer screening; afterwards, 897 (67.6%) women had received screening (P<0.001). Clinical breast examination was performed for 59 (4.4%) women before and 897 (67.6%) after the intervention (P<0.001). Only 2 (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 (33.2%) after the intervention (P<0.001). The use of community health educators for house-to-house cervical and breast cancer prevention education was associated with significant increases in the uptake of cervical cancer screening, clinical breast examination, and HPV vaccination.

BackgroundCervical cancer is the leading cause of cancer incidence and mortality among Malawian women, despite being a largely preventable disease. Implementing a cervical cancer screening and preventive treatment (CCSPT) program that utilizes rapid human papillomavirus (HPV) testing on self-collected cervicovaginal samples for screening and thermal ablation for treatment may achieve greater coverage than current programs that use visual inspection with acetic acid (VIA) for screening and cryotherapy for treatment. Furthermore, self-sampling creates the opportunity for community-based screening to increase uptake in populations with low screening rates. Malawi’s public health system utilizes regularly scheduled outreach and village-based clinics to provide routine health services like family planning. Cancer screening is not yet included in these community services. Incorporating self-sampled HPV testing into national policy could address cervical cancer screening barriers in Malawi, though at present the effectiveness, acceptability, appropriateness, feasibility, and cost-effectiveness still need to be demonstrated.MethodsWe designed a cluster randomized feasibility trial to determine the effectiveness, acceptability, appropriateness, feasibility, and budget impact of two models for integrating a HPV-based CCSPT program into family planning (FP) services in Malawi: model 1 involves only clinic-based self-sampled HPV testing, whereas model 2 includes both clinic-based and community-based self-sampled HPV testing. Our algorithm involves self-collection of samples for HPV GeneXpert® testing, visual inspection with acetic acid for HPV-positive women to determine ablative treatment eligibility, and same-day thermal ablation for treatment-eligible women. Interventions will be implemented at 14 selected facilities. Our primary outcome will be the uptake of cervical cancer screening and family planning services during the 18 months of implementation, which will be measured through an Endline Household Survey. We will also conduct mixed methods assessments to understand the acceptability, appropriateness, and feasibility of the interventions, and a cost analysis to assess budget impact.DiscussionOur trial will provide in-depth information on the implementation of clinic-only and clinic-and-community models for integrating self-sampled HPV testing CCSPT with FP services in Malawi. Findings will provide valuable insight for policymakers and implementers in Malawi and other resource-limited settings with high cervical cancer burden.Trial registrationClinicalTrials.gov identifier: NCT04286243. Registered on February 26, 2020.

Cervical cancer screening is an important screening test commonly used to detect abnormal cervical cells, including precancerous cervical lesions, as well as early cervical cancer. Cervical cancer is a deadly disease which can be prevented through screening. Not much has been documented on awareness and uptake of cervical cancer screening among female undergraduate students in the University of Benin. This study investigated the awareness and uptake of cervical cancer screening among female students in School of Basic Medical Sciences, University of Benin. A cross-sectional descriptive survey was conducted among two hundred (200) female undergraduates selected using simple random sampling technique. A pretested structured questionnaire was used to elicit information on respondent knowledge awareness and uptake of cervical cancer screening and was analyzed using the Statistical Package for Social Sciences (SPSS) version 17. Results showed that 86.7% of the respondents had knowledge of cervical cancer. Eighteen percent have had a screening for cervical cancer. Findings also revealed that the level of uptake of cervical cancer screening is low compared to the level of knowledge about cervical screening. Intensifying the need for nurses to engage in health education and awareness programs that will increase general awareness of the people on the advantages of uptake of cervical cancer screening is essential.