ObjectiveHuman papillomavirus (HPV) self-sampling (Self-HPV) may be used as a primary cervical cancer screening method in a low resource setting. Our aim was to evaluate whether an educational intervention would improve women's knowledge and confidence in the Self-HPV method.MethodWomen aged between 25 and 65 years old, eligible for cervical cancer screening, were randomly chosen to receive standard information (control group) or standard information followed by educational intervention (interventional group). Standard information included explanations about what the test detects (HPV), the link between HPV and cervical cancer and how to perform HPV self-sampling. The educational intervention consisted of a culturally tailored video about HPV, cervical cancer, Self-HPV and its relevancy as a screening test. All participants completed a questionnaire that assessed sociodemographic data, women's knowledge about cervical cancer and acceptability of Self-HPV.ResultsA total of 302 women were enrolled in 4 health care centers in Yaoundé and the surrounding countryside. 301 women (149 in the “control group” and 152 in the “intervention group”) completed the full process and were included into the analysis. Participants who received the educational intervention had a significantly higher knowledge about HPV and cervical cancer than the control group (p<0.05), but no significant difference on Self-HPV acceptability and confidence in the method was noticed between the two groups.ConclusionEducational intervention promotes an increase in knowledge about HPV and cervical cancer. Further investigation should be conducted to determine if this intervention can be sustained beyond the short term and influences screening behavior.Trials RegistrationInternational Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN78123709

BackgroundInformation about women’s acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women’s acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV.MethodsWomen were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling.ResultsA sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30–65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling.ConclusionEducational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women. Further evaluation of the intervention in a larger sample and using a control group is recommended.

The World Health Organization recently advocated a two-stage strategy with human papillomavirus (HPV) testing followed by visual inspection of the cervix with acetic acid (VIA) as a suitable option for cervical cancer screening. However, its accuracy has never been directly assessed in the context of primary screening. To evaluate effectiveness of HPV testing on selfobtained specimens (self-HPV) followed by VIA (sequential testing) in a low-income setting, we recruited 540 women aged between 30 and 65 years in two Cameroonian periurban areas. Eligible women were counseled about cervical cancer and how to perform self-sampling. HPV positive and a random sample of HPV-negative women were called back for VIA and biopsy. Disease was defined by interpretation of cervical intraepithelial neoplasia Grade 2 or worse (CIN21). Performances of VIA, self-HPV and sequential testing were determined after adjustment for verification bias. HPV prevalence was 27.0%. VIA positivity was 12.9% and disease prevalence was 5%. Sensitivity and specificity of VIA for CIN21 were 36.4% [95% confidence interval (CI Cervical cancer is an important public health issue in lowincome settings. Eighty-eight percent of yearly about 530,000 new cervical cancer cases are diagnosed in developing countries where 240,000 women die from this disease every year. 1 In Cameroon-a central African country-age-standardized cervical cancer incidence and mortality rates are estimated at 24/100,000 and 17/100,000 per year, respectively. 2 Main reason for this imbalance is the absence of cervical cancer screening programs like in most low-income settings. 3 In major cities of Cameroon, sporadic screening options exist using Papanicolaou smear (Pap test) or visual inspection of the cervix after application of acetic acid (VIA) or Lugol's iodine (VILI). However, Pap test traditionally used in developed countries for primary screening, shows sensitivity for high-grade cervical lesions of 50-60%, which necessitates regularly repeated controls. 4 The method requires highly specialized laboratories, well-trained pathologists to analyze the specimens and adequate conditions during samples transport. Therefore, Pap test is hardly feasible on a large scale in low-income settings. 5 In contrast, VIA has the advantage of being low-cost and facile to perform. It can easily be carried out by nurses or midwifes after a short training. 6 Yet, even though VIA is easy to conduct its interpretation is challenging. A recent metaanalysis showed that VIA sensitivity for cervical intraepithelial neoplasia Grade 2 or worse (CIN21) ranged between 41 and 92% and its specificity between 49 and 98%. 7 Thus, the informative value of a positive or negative VIA result emerged to be highly dependent of the examiner's experience.Another option recommended by the World Health Organization (WHO) is testing of cervical or vaginal swabs for the

Although most of the women were more comfortable and less embarrassed with the self-HPV, they did not trust the method and did prefer physician sampling. The study underlines the need not only to educate women about HPV, cervical cancer, and its prevention but also to reassure them about the accuracy of self-HPV.

Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (Self-HPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US1) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa 5 0.74). HPV positivity by cytological diagnosis for ASC-US1 was similar with the two tests. positive predictive value of the Self-HPV for ASC-US1 was 20.4; odds ratio and number needed to treat were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer.