Feasibility, validity and acceptability of self-collected samples for human papillomavirus (HPV) testing in rural Malawi|
Esber, Allahna; Norris, Alison; Jumbe, Enock; Kandodo, Jonathan; Nampandeni, Patrick; Reese, Patricia Carr & Turner, Abigail Norris
The World Health Organization (WHO) recently endorsed human papillomavirus (HPV) testing as a cervical cancer screening method
in countries without established programs. Self-collection for HPV testing may be an effective way to expand screening. Our objective
was to assess the feasibility, validity, and acceptability of self-collection for HPV testing in a population of care-seeking, unscreened
women in rural Malawi.
We enrolled women reporting to a rural Malawian clinic from January to August 2015. Participants were offered the option to self-collect
a vaginal sample and the study clinician collected a cervical sample for HPV testing. Using the clinician-collected sample as the
reference standard, we calculated a kappa statistic, sensitivity, and specificity by hr-HPV type. Participants also received a brief survey
assessing acceptability of the procedure.
Among the 199 enrolled women, 22% had any high risk-HPV. Comparing self- and clinician-collected samples for HPV testing, we
found generally high agreement (κ = 0.66-0.90) and high specificity (98%-100%), but varied sensitivity (50%-91%) for different types
of hr-HPV. We also found that self-collection was acceptable, with 98% of women reporting it was easy to do and 99% reporting
willingness to do so again.
WHO guidelines recommend that treatment is available immediately after a positive screening test for clinic-based cervical cancer
screening programs. Our findings demonstrate that self-collection of samples for HPV testing is a feasible and acceptable method of
cervical cancer screening in this rural Malawian population. High agreement between the self- and clinician-collected samples and high
levels of acceptability among women in the study suggest that self-collection of vaginal samples for HPV testing may be effectively
incorporated into screening programs among rural, largely unscreened populations.