Assessment of High-Risk Human Papillomavirus Infections Using Clinician- and Self-Collected Cervical Sampling Methods in Rural Women from Far Western Nepal

Abstract

IntroductionNepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening.MethodsStudy participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA.ResultsOf 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3–13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43–0.81), indicating a “good” level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%).ConclusionThis is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services.

Cervical Cancer Screening Practices and Barriers among Women in Nepal

“…[16] Nepal Fertility Care Center conducted health camp in Achham District of rural far western which was first study in Nepal to identify high risk HPV (HR-HPV) among rural women and found prevalence rate is 9.6%. [17] …”

Cervical pap smear- A prospective study in a tertiary hospital

“…Over 2100 cases of cervical cancer are reported in Nepal each year, with a case-fatality rate of over 50%. 3 In developing countries, the higher prevalence of cervical cancer is due to ineffective screening programmes. Pap smear is a simple, convenient, cost effective and reliable test for easy screening of cervical lesions.…”

Spousal migration and human papillomavirus infection among women in rural western Nepal

“…13 Briefly, health camp auxiliary nurse midwives collected cervical specimens using ThinPrep PreservCyt medium (Hologic/Gen-Probe Inc. San Diego, CA, USA). Cervical specimens were transported to the Hologic/Gen-Probe Inc. laboratory in San Diego for HPV testing.…”

“…13 Briefly, survey questions were translated from English into Nepali, and then back-translated to English for quality control. The local Nepali dialect called Dotyali is sometimes spoken in the district of Achham and does not have a written form, and thus the survey could not be translated into the local Achham dialect.…”

“…2,13 The aim of this study therefore is to investigate the association between husbands' migration for employment, and HR-HPV infection and abnormal cervical cytology among their spouses, in the rural…”