Concordance in HPV Detection Between Self-Collected and Health Provider–Collected Cervicovaginal Samples Using careHPV in Tanzanian Women

Abstract

PURPOSE Cervical cancer screening is one of the strategies to prevent the disease among women at risk. Human papillomavirus (HPV) DNA testing is increasingly used as the cervical cancer screening method because of its high sensitivity. Self-collection of cervical specimens has the potential to improve participation. However, there is only limited information on comparison between self-collected and provider-collected samples with regard to detection of high-risk HPV using the careHPV method. The study aimed to compare HPV detection by careHPV in self-collected and provider-collected cervical samples and to assess the acceptability of self-collection techniques. MATERIAL AND METHODS Women attending cervical cancer screening clinics at Ocean Road Cancer Institute, Kilimanjaro Christian Medical Centre or Mawenzi Hospital in Tanzania were included in the study. They underwent a face-to-face interview, HIV testing, and collected a self-sample using Evalyn Brush. Subsequently, they had a cervical sample taken by a health provider. Both samples were tested for high-risk HPV DNA using careHPV. RESULTS Overall, 464 women participated in the study. The high-risk HPV prevalence was 19.0% (95% CI, 15.6 to 22.9) in the health provider samples, but lower (13.8%; 95% CI, 10.9 to 17.3) in the self-collected samples. There was a good overall agreement 90.5% (95% CI, 87.5 to 93.0) and concordance (κ = 0.66; 95% CI, 0.56 to 0.75) between the two sets of samples. Sensitivity and specificity were 61.4% (95% CI, 50.4 to 71.6) and 97.3% (95% CI, 95.2 to 98.7), respectively, varying with age. Most women preferred self-collection (79.8%). CONCLUSION Overall, self-sampling seems to be a reliable alternative to health-provider collection and is acceptable to the majority of women. However, instructions on proper procedures for sample collection to the women are important.

Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012

“…We have previously observed higher specimen inadequacy among men who have sex with women compared to MSM. 31 It is possible that receptive anal sex might abrade the anal canal mucosa allowing more productive collection of exfoliated swabs, although using lubrication for sex was not associated with inadequacy in the current data (Fisher’s Exact p = 0.17). It is also possible that faecal matter might increase the risk for an inadequate specimen given the potential for bacterial growth that may interfere with PCR assays.…”

Accuracy of HPV testing on self-collected and clinician-collected samples for different screening strategies in African settings: A systematic review and meta-analysis

“…Most common exclusion criterion was 'no comparable clinician testing' (n = 29), followed by 'no outcome measure of interest' (n = 3), 'no African setting' (n = 1), 'no full-text' available (n = 1) and 'doubtful quality' (n = 1). Finally, 28 articles were included in the systematic review [20, and 21 in the meta-analysis [36,38,[40][41][42][43][44][45][46][47][48][50][51][52][56][57][58][59][60][61][62] (see Fig. 1).…”

“…Study settings were mostly urban (n = 25), whereas three studies were conducted in rural regions [36,48,53]. Recruitment methods comprised 'clinic attendant' [36,38,40,41,43,45,47,49,51,[59][60][61][62] (n = 13), 'outreach' [39,42,46,50,52,54,56,57] (n = 8) and 'community' [20,37,44,48,53,55,58] (n = 7). Seven studies dealt with a population at risk [38,42,45,47,50,57,59] and 21 with a general population [20,36,37,[39][40][41]43,44,46,48,49,[51]...…”

“…Cohen's kappa was reported in 22 studies [36,38,[40][41][42][43][44][45][46][47][48][49][50][51][52][56][57][58][59][60][61][62]. Most of these studies (n = 19) sampled with an HPV test which detects high-risk HPV, two [41,56] used HPV-tests suitable for high-and lowrisk HPV detection.…”

“…Most of these studies (n = 19) sampled with an HPV test which detects high-risk HPV, two [41,56] used HPV-tests suitable for high-and lowrisk HPV detection. Sensitivity and specificity were reported in 21 studies [20,36,39,[42][43][44][45][46][49][50][51][52][53][54][55][57][58][59][60][61][62]. Different gold standards were applied, mainly clinician sampling to detect overall high-risk HPV [36,[43][44][45]49,51,[58][59][60]62].…”