Results of a community‐based cervical cancer screening pilot project using human papillomavirus self‐sampling in Kampala, Uganda

Ogilvie, Gina; Mitchell, Sheona; Sekikubo, Musa; Biryabarema, Christine; Byamugisha, Josaphat; Jerónimo, José; Miller, Dianne; Steinberg, Malcolm; Money, Deborah

doi:10.1016/j.ijgo.2013.03.019

Cited by 53 publications

(79 citation statements)

References 22 publications

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“…More than half (54.5 %) of women who were invited to self-collect a vaginal sample for HPV testing participated in this study, and 92.5 % of these women successfully completed and returned a sample for testing. A high prevalence (17.8 %) of HPV was detected using self-collection, which is comparable to studies of self-collection that have been conducted in controlled healthcare settings (18.4 %) and to that of communitybased screening in rural settings (17.6 %), providing further evidence of the performance of self-collected sampling in non-clinical settings [17,30]. The vast majority (87.1 %) of women who completed the kit found self-collection to be easy to do.…”

Section: Discussionsupporting

confidence: 68%

Human Papillomavirus Infection in Women Who Submit Self-collected Vaginal Swabs After Internet Recruitment

et al. 2014

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Submission of vaginal samples collected at home could remove barriers that women face in getting screened for cervical cancer. From December 2013 to January 2014, women aged 21-30 years were recruited online to participate in either (1) self-collected testing for human papillomavirus (HPV) infection and an online survey, or (2) an online survey regarding their perceptions of self-collected testing for HPV infection. Demographics, risk factors, testing perceptions, and satisfaction with self-collected testing were assessed with online questionnaires. Women who performed self-collection were sent a home sampling kit by US mail, which was returned via US mail for HPV testing. A total of 197 women were enrolled, with 130 completing the online survey and 67 participating in both the survey and self-collection. Of the 67 women who were sent kits, 62 (92.5%) were returned for testing. Sixty kits contained a sample sufficient for testing. The overall prevalence of HPV infection was 17.8%, however 6 women (9.7%) were infected with >1 type of HPV. Women who self-collected a sample reported more favorable attributes of self-collection compared to women who only participated in the online survey, including ease of sampling (87.1 vs. 18.9%), no pain during sampling (72.6 vs. 5.6%), and lack of embarrassment (67.7 vs. 12.9%). A high prevalence of HPV infection was demonstrated among women recruited via the internet. Online recruitment and at home screening methods have the potential to engage women in screening by offering an approach that might be more acceptable to women of different backgrounds.

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Section: Discussionsupporting

confidence: 68%

Human Papillomavirus Infection in Women Who Submit Self-collected Vaginal Swabs After Internet Recruitment

et al. 2014

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“…This is much higher than other studies that ASPIRE has conducted in Kisenyi where HPV positivity rates among HIV negative women was only 28.9%, of which 5.3% were HPV 16 or 18 [22]. Our HIV positive population was more likely to live or work outside of Kisenyi, compared to past studies where self-collection was offered by community outreach workers at their homes [23, 24]. This suggests that a model for screening with self-collection for WHIV may be more appropriately based out of a health center, as these women are already engaged in care, thereby avoiding unnecessary travel.…”

Section: Discussionmentioning

confidence: 68%

“…Self-collection for HPV screening has been demonstrated as a highly acceptable and effective method of cervical cancer screening, particularly in susceptible populations such as WHIV [14, 15]. This highly scalable model can be adapted and implemented in various ways to improve access using minimal infrastructure.…”

Section: Discussionmentioning

confidence: 99%

Self-collection based HPV testing for cervical cancer screening among women living with HIV in Uganda: a descriptive analysis of knowledge, intentions to screen and factors associated with HPV positivity

et al. 2017

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BackgroundWomen living with HIV (WHIV) are disproportionately impacted by cervical dysplasia and cancer. The burden is greatest in low-income countries where limited or no access to screening exists. The goal of this study was to describe knowledge and intentions of WHIV towards HPV self-collection for cervical cancer screening, and to report on factors related to HPV positivity among women who participated in testing.MethodsA validated survey was administered to 87 HIV positive women attending the Kisenyi Health Unit aged 30–69 years old, and data was abstracted from chart review. At a later date, self-collection based HPV testing was offered to all women. Specimens were tested for high risk HPV genotypes, and women were contacted with results and referred for care. Descriptive statistics, Chi Square and Fischer-exact statistical tests were performed.ResultsThe vast majority of WHIV (98.9%) women did not think it necessary to be screened for cervical cancer and the majority of women had never heard of HPV (96.4%). However, almost all WHIV found self-collection for cervical cancer screening to be acceptable. Of the 87 WHIV offered self-collection, 40 women agreed to provide a sample at the HIV clinic. Among women tested, 45% were oncogenic HPV positive, where HPV 16 or 18 positivity was 15% overall.ConclusionsIn this group of WHIV engaged in HIV care, there was a high prevalence of oncogenic HPV, a large proportion of which were HPV genotypes 16 or 18, in addition to low knowledge of HPV and cervical cancer screening. Improved education and cervical cancer screening for WHIV are sorely needed; self-collection based screening has the potential to be integrated with routine HIV care in this setting.

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“…12 There is also interest in self-sampling for HPV testing as a method of primary screening in countries where resources and access to healthcare and healthcare professionals are limited. 40,41 Although this is a reasonable option for non-responders to invitations for screening, it would be of value to explore more cost-effective approaches to target non-responders. When considered as primary screening, self-collection for HPV testing tends to have a lower sensitivity and specificity compared with clinician samples.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial in non-responders from Newcastle upon Tyne invited to return a self-sample for Human Papillomavirus testing versus repeat invitation for cervical screening

Cadman

Wilkes

Mansour³

et al. 2014

J Med Screen

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Background: Non-attenders for cervical screening are at increased risk of cervical cancer. Studies offering self-sampling for high-risk Human Papillomavirus (HrHPV) testing have shown greater uptake than sending another invitation for cytology. Objectives: To explore whether uptake would increase in a less diverse, more stable population than the previous English study, which demonstrated a lower response rate than other studies. The primary objective was whether non-attenders were more likely to respond to a postal invitation, including kit, to collect a self-sample compared with a further invitation for cytology screening. The secondary objective was whether women with an abnormal result would attend for follow-up. Methods: 6000 non-attenders for screening in this pragmatic, randomized (1:1) controlled trial in Newcastle-upon-Tyne were sent an HPV self-sample kit (intervention) or a further invitation for cytology screening (comparator). Results: 411(13%) responded to the intervention, returning a self-sample (247(8%)) or attending for cytology (164(5%)), compared with 183(6%) attending for cytology, relative risk 2.25 (95% CI 1.90-2.65) (comparator arm). Of those testing hrHPV positive (32(13%)), 19(59%) subsequently attended cytology screening. Of those in the intervention group who attended for cytology screening without returning an hrHPV self-sample (n ¼ 164), 5% (n ¼ 8) were referred for colposcopy -all attended. In the comparator group eight of the nine referred for colposcopy attended. Conclusion: Persistent non-responders to invitations for cervical screening are significantly more likely to respond to a postal invitation to return a self-collected sample for HPV testing than a further invitation for cytology screening. However, just over half followed up on this positive HPV result.

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Results of a community‐based cervical cancer screening pilot project using human papillomavirus self‐sampling in Kampala, Uganda

Abstract: Self-collection of samples for community-based HPV testing was an acceptable option; most women who tested positive attended for definitive treatment. Self-sampling could potentially allow for effective recruitment to screening programs in limited-resource settings.

Cited by 53 publications

References 22 publications

Human Papillomavirus Infection in Women Who Submit Self-collected Vaginal Swabs After Internet Recruitment

Human Papillomavirus Infection in Women Who Submit Self-collected Vaginal Swabs After Internet Recruitment

Self-collection based HPV testing for cervical cancer screening among women living with HIV in Uganda: a descriptive analysis of knowledge, intentions to screen and factors associated with HPV positivity

A randomized controlled trial in non-responders from Newcastle upon Tyne invited to return a self-sample for Human Papillomavirus testing versus repeat invitation for cervical screening

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