Acceptability and Concordance of Self- Versus Clinician- Sampling for HPV Testing among Rural South Indian Women

Abstract

Background: Despite being largely preventable, HPV-related cervical cancers continues to be the second highest cause of cancer deaths among Indian women. HPV testing using self-sampled samples may offer an opportunity to expand cervical cancer screening in India where there is currently a shortage of providers and facilities for cervical cancer screening. The study examines acceptability and concordance of self vs. clinician collected samples for HPVrelted cervical cancer screening among rural South Indian women. Methods: Between May and August 2017, eight mobile screening clinics were conducted among 120 eligible women in rural villages in Mysore District, India. Women over the age of 30 underwent informed consent process and then self-sampled a sample for cervicovaginal HPV DNA testing. Next, the women underwent clinical exam where the clinician collected a cervicovaginal HPV DNA sample. Following the clinical exam, all participants answered an interviewer-administered questionnaire to assess their history of cervical cancer screening and acceptability of self-and clinician-sampling methods. To assess diagnostic accuracy, concordance of self-and clinician-sampled HPV DNA specimens was calculated in addition to five measures of acceptability (feeling of caring, privacy, embarrassment, genital discomfort, and genital pain). Results: Study participants had a median age 39 years, about four-in-ten (41.7%) had a secondary education or above, the vast majority (87.5%) were married and only 3.4% reported having screened for cervical cancer. For all measures of participant acceptability, self-sampling was rated significantly higher than clinician-sampling. Cohen's kappa was 0.73 (95% CI: 0.34, 1.00), indicating substantial agreement between self-and clinician-sampling. Conclusion: This study demonstrates that HPV self-sampling for cervical cancer screening is feasible and acceptable in a community setting among South Indian rural women. Concordance between self-sampling and clinician-sampling was adequate for screening in community settings.

Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence

“… 10 , 11 , 23 - 27 , 29 - 37 , 39 - 47 , 49 , 50 , 54 , 57 - 60 , 63 - 65 , 68 - 71 , 74 Studies reported high satisfaction of self-collection among women, 10 , 11 , 30 , 36 , 42 , 43 , 50 , 58 , 62 , 63 , 65 , 68 , 70 that women were willing to perform self-collection again, 10 , 11 , 23 , 27 , 29 - 31 , 35 , 41 , 49 , 57 , 58 , 60 , 68 , 69 and to recommend self-collection to others. 10 , 11 , 27 , 29 , 30 , 32 , 49 , 50 , 68 Self-collection was commonly described as easy, 10 , 11 , 26 , 29 , 30 , 33 - 36 , 39 - 41 , 43 , 50 ...…”

“… 68 Two studies compared practitioner-supported models with in-clinic collection versus mail-out or at-home collection models (n = 1 at-home testing, n = 1 opt-out); higher uptake was reported in mail-out/at-home testing models. 21 , 27 We note that in models that use a population-based mail-out approach, it is not always possible to confirm receipt of test, nor eligibility for screening (ie, hysterectomy). Thus, these lower-adoption measures may not accurately reflect participant engagement in programs.…”

Cross-Sectional Study of HPV Self-Sampling among Indian Women—A Way Forward

“…There are numerous studies that have reported comparable performance of self-sampling to clinician collected samples. 16,17 To our knowledge, this is the first study that compares the performance between the self-collected and trained PHWs collected HPV samples. Our study also demonstrates comparable agreements between HPV-SS and HPV-PHW samples.…”

“…Currently, resources are needed for one-to-one counseling for women before preparing them to undertake HPV-SS. 16 17 19 This strategy may not be feasible in human-resource-constrained countries like India. The art-based health promotion strategies have been proven effective in facilitating and mobilizing women among diverse settings.…”

The effectiveness of an extra-curricular lecture for STI prevention and sexual education

“…In Germany, infections with Treponema pallidum, causing syphilisa disease that can affect the central nervous system and potentially lead to death in later stagesincreased from 6834 cases to 7889 between 2015 and 2019 [2,3]. In contrast, the incidence of infections with the human immunodeficiency virus (HIV) [4] has largely remained unchanged in Germany over the last 10 years, while it remains challenging in developing countries [2,5]. In 2019, the worldwide prevalence of HIV was about 38 million people [6], and Germany is one of the countries with the lowest HIV infection incidence in Europe, most likely due to its successful preventive work [7].…”