Abstract
BackgroundIncidence and mortality rates of cervical cancer in Bolivia are the highest in Latin America. Vaginal cell self-sampling can improve screening coverage. Information on common reasons for low screening coverage and preferences for future screening are essential to reduce cervical cancer incidence. We aimed to evaluate the knowledge about human papillomavirus (HPV) and cervical cancer of Bolivian women from urban, peri-urban and rural areas of Cochabamba and to determine their degree of acceptability and confidence towards vaginal HPV self-sampling. In addition, we assessed the impact of self-sampling on cervical cancer screening coverage in a selected peri-urban area.MethodsWe gathered information from women living in urban, peri-urban and rural areas of Cochabamba province in Bolivia using two different structured questionnaires. In Survey1, we collected information from 222 women about their knowledge on HPV and cervical cancer. In Survey 2, the acceptance and confidence towards vaginal HPV self-sampling compared to the physician-sampling was assessed in 221 women. A non-probabilistic stratified sampling by areas was carried out for the two questionnaires. In the third phase of the study, we determined the impact of HPV self-sampling collection on screening coverage in a peri-urban area of Cochabamba.ResultsBolivian women knew little or nothing about cervical cancer and HPV infection in all areas. They all found self-sampling collection easier to perform (86.9 to 93.2%) and more comfortable (79.4 to 83.3%) compared to physician sampling. Sampling accuracy to detect cervical cancer was probably higher in their point of view when it was taken by physician (35.1 to 63.5%). However in rural areas women preferred self-sampling. Accordingly, the campaign of vaginal HPV self-sampling in this peri-urban area increased screening coverage, reaching in three months the annual rate average.ConclusionsThe knowledge about cervical cancer and HPV infection is poor in Bolivia. Despite greater acceptance of the vaginal HPV self-sampling in all areas, women kept greater confidence in the screening performed by the gynecologist although HPV self-sampling improved coverage rate.
Highlights
Incidence and mortality rates of cervical cancer in Bolivia are the highest in Latin America
Degree of knowledge about cervical cancer and human papillomavirus (HPV) and their prevention As summarized in Table 1, we observed in the survey 1 that few Bolivian women have a good knowledge about cervical cancer in the three areas
Less than 32.3% of women had a good level of knowledge about cervical cancer prevention in the three regions and only 25.0, 12.0 and 1.7% of women in urban, peri-urban and rural areas, respectively, had good level of knowledge about HPV
Summary
Incidence and mortality rates of cervical cancer in Bolivia are the highest in Latin America. We aimed to evaluate the knowledge about human papillomavirus (HPV) and cervical cancer of Bolivian women from urban, peri-urban and rural areas of Cochabamba and to determine their degree of acceptability and confidence towards vaginal HPV self-sampling. We assessed the impact of self-sampling on cervical cancer screening coverage in a selected peri-urban area. Cervical cancer is widely preventable, it is the fourth most common cancer among women throughout the world, being a real public health issue, especially in Cervical cancer-related deaths have declined significantly in developed countries because of extensive cytology screening. Prevention of cervical cancer in Bolivia is primarily based on Papanicolaou smear cytology test (Pap) and more recently on visual inspection under acetic acid (VIA) [7, 8]. Pap smear coverage, from 2005 to 2016, do not exceed 16.6% and coverage of VIA in 2015 and 2016 does not exceed 19% [7, 8]
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