Abstract
ObjectivesSelf-collection of genital specimens for high-risk types of human papillomavirus (hrHPV) detection may increase cervical cancer screening uptake. We hypothesized that women would prefer self-collection to clinician-collection of genital specimens. To test this hypothesis, and women’s preference between two different self-collection approaches, a total of 199 women were enrolled in a cross-sectional study in Mombasa, Kenya.Materials and methodsParticipants provided self-collected specimens using the Evalyn cytobrush (Rovers) stored in a dry tube and the Viba cytobrush (Rovers) stored in wet Aptima media (Hologic). A clinician also collected cervical specimens for hrHPV testing and for cytology, and performed visual inspection using acetic acid. A post-examination questionnaire assessed preferences for the different methods of specimen collection. To test the difference in proportions for each collection method, we performed an exact binomial probability test, under the null hypothesis that women would prefer each specimen-collection method equally.ResultsMost women preferred clinician-collection over self-collection (68% versus 32%, p < 0.01). For self-collection, dry-self collection with the Evalyn brush was preferred over the wet-selection with the Viba brush (53% versus 27%, p < 0.01). There was no association between preference for self-collection and preference for a particular self-collection cytobrush.ConclusionFurther research to understand and address obstacles to self-collection of genital specimens may be needed to improve the uptake of self-collection for cervical cancer screening, especially in settings with poor access to trained healthcare providers.
Highlights
Detection of high-risk human papillomavirus in genital specimens is current being used in conjunction with or as an alternative to Papanicolau (Pap) smears for primary cervical cancer screening [1,2,3,4,5,6]
Further research to understand and address obstacles to self-collection of genital specimens may be needed to improve the uptake of self-collection for cervical cancer screening, especially in settings with poor access to trained healthcare providers
Between August 2013 and April 2015, we conducted a study among 199 women at high risk of sexually transmitted infections (STIs) and Human immunodeficiency virus (HIV) in Mombasa, Kenya
Summary
Detection of high-risk human papillomavirus (hrHPV) in genital specimens is current being used in conjunction with (co-testing) or as an alternative to Papanicolau (Pap) smears for primary cervical cancer screening [1,2,3,4,5,6]. Women can self-collect cervico-vaginal specimens for hrHPV testing These self-collected specimens demonstrate similar sensitivity and specificity to cliniciancollected specimens for detecting high-grade cervical lesions (CIN 2+), and may improve access to screening [8]. Studies conducted in Europe, North and South America looking at the acceptability of self-collection of genital specimens for hrHPV testing indicate that self-collected HPV genital specimens were preferred compared to the conventional Pap smears for HPV screening. In the latter one study from South America, age and level of education were strongly correlated with increased preference for self-collection [4, 9]. Understanding women’s preference for self-collection versus clinician-collection of specimens will help to guide future interventions for cervical cancer screening
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