Abstract
BackgroundCervical cancer incidence and mortality rates in Sub-Saharan Africa (SSA) remain high due to several factors including low levels of uptake of cervical cancer screening. Self-collection of cervicovaginal samples for HPV DNA testing may be an effective modality that can increase uptake of cervical cancer screening in SSA and hard to reach populations in developed countries. We investigated whether self-collection of cervicovaginal samples for HPV DNA tests would be associated with increased uptake of screening compared with clinic based collection of samples. Furthermore, we compared the quality of samples collected by both approaches for use in HPV genotyping.MethodsWe conducted a community based randomized trial in a semi-urban district of Abuja, Nigeria with 400 women, aged 30 to 65 years randomized to either hospital-collection or self-collection of cervicovaginal samples. We compared cervical cancer screening uptake among the 2 groups and evaluated the concentration of human DNA in the samples by measuring RNase P gene levels using qPCR. High-risk HPV DNA detection and typing was done using the GP5+/6+ Luminex system.ResultsMost participants in the self-collection arm (93%, 185/200) submitted their samples while only 56% (113/200) of those invited to the hospital for sample collection attended and were screened during the study period (p value < 0.001). Human genomic DNA was detected in all but five (1.7%) participants, all of whom were in the self-collection arm. The prevalence of high-risk HPV in the study population was 10% with types 35, 52 and 18 being the commonest.ConclusionsOur study shows that self-sampling significantly increased uptake of HPV DNA based test for cervical cancer screening in this population and the samples collected were adequate for HPV detection and genotyping. Cervical cancer screening programs that incorporate self-sampling and HPV DNA tests are feasible and may significantly improve uptake of cervical cancer screening in SSA.
Highlights
Cervical cancer incidence and mortality rates in Sub-Saharan Africa (SSA) remain high due to several factors including low levels of uptake of cervical cancer screening
In this study, we found that significantly higher proportion of women in the self-collection group completed HPV DNA based tests for cervical cancer screening compared to women invited to hospital for health professionals’ collections of samples
Majority of participants in this study identified lack of cervical cancer screening services in healthcare facilities as the reason why they had not participated in screening in the past
Summary
Cervical cancer incidence and mortality rates in Sub-Saharan Africa (SSA) remain high due to several factors including low levels of uptake of cervical cancer screening. Self-collection of cervicovaginal samples for HPV DNA testing may be an effective modality that can increase uptake of cervical cancer screening in SSA and hard to reach populations in developed countries. More than 85% of new cases occur in low and middle income countries (LMIC) and the incidence is projected to rise by 5% over the 10 years [2] It is the second most frequently diagnosed cancer and the leading cause of cancer deaths in SubSaharan African (SSA) women [2]. The incidence and mortality of cervical cancer has declined significantly in developed countries due to widespread availability and uptake of cervical cancer screening [4] These screening programs were initially based on cervical cytology but HPV DNA based tests are increasingly used. Cervical cancer screening in LMIC has not been so successful due to several factors including low levels of awareness, cost, cultural barriers and lack of screening programmes [5,6,7]
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