The preference of women living with HIV for the HPV self-sampling of urine at a rural HIV clinic in Uganda

Abstract

Background: Women living with HIV have a double risk of acquiring cervical cancer (CC) due to repeated human papilloma virus (HPV) infections resulting from reduced immunity, with CC screening being low at 46.7%.Objectives: To determine the factors associated with the preference for HPV self-sampling using urine as well as establish its feasibility among women living with HIV attending a rural HIV clinic in Uganda.Method: A cross-sectional study design using quantitative data collection methods was used at the HIV clinic, Luweero District Hospital, among 426 women aged between 30 and 65 years. Data were analysed using descriptive statistics and modified Poisson regression. Urine samples were analysed using a Liferiver high-risk HPV genotyping real-time polymerase chain reaction (PCR) kit to determine the prevalence of the 15 HPV subtypes. Cervical intraepithelial neoplasia 2 (CIN2) was determined by visual inspection under acetic acid (VIA) using the nurse-led approach.Results: Most women (296/426, 70%) preferred nurse-led screening. Preference for HPV self-sampling using urine was associated with older age (46–65 years) (adjusted prevalence risk ratios [aPRR] 1.59; 95% confidence interval [CI]: 1.13–2.24), history of sexually transmitted infections (aPRR 0.74: 95% CI: 0.55–0.98) and acquisition of CC information from the television (aPRR 1.48: 95% CI: 1.09–2.02). Approximately 97% (68/70) of women living with HIV tested HPV positive with one or more subtypes. The most prevalent subtype of HPV was HPV 58 (87.1%). Only one woman tested positive with VIA.Conclusion: Nurse-led CC screening is preferred among women living with HIV, and HPV self-sampling using urine is feasible at the HIV clinic. Therefore, educational programmes to reassure the masses about urine HPV self-sampling need to be designed.Contribution: This study’s findings provide early insights into the merits and demerits of the current HPV sample collection approaches. Hence, HPV testing should be tailored to routine HIV care in rural communities.

Facilitators and Barriers to HPV Self-Sampling as a Cervical Cancer Screening Option among Women Living with HIV in Rural Uganda

“…The decline in HPV self-sampling could be attributed to religion in this study, mainly with Muslims and Anglicans. Reasons for refusal were consistent with findings from previous studies, where the fear of finding the disease and being Moslem were the main reasons for refusing to screen for HPV and CC [28,[36][37][38].…”

“…Perceived benefits of the clinic-based HPV self-sampling were mainly considered to be the visualization of the cervix and free service. An example would be the findings in other studies, where HIV-infected women were motivated to screen for CC at the clinic [9], and all those who were suspected of having the disease completed treatment, compared to the HIV-negative women [28,32]. In Uganda, HIV-infected women are also motivated to be screened at the clinic and by the HW, as this increases the chances for the early diagnosis and treatment of the disease [28].…”

“…An example would be the findings in other studies, where HIV-infected women were motivated to screen for CC at the clinic [9], and all those who were suspected of having the disease completed treatment, compared to the HIV-negative women [28,32]. In Uganda, HIV-infected women are also motivated to be screened at the clinic and by the HW, as this increases the chances for the early diagnosis and treatment of the disease [28]. This finding was critical, similar to a systematic review conducted in Sub-Saharan Africa, where women preferred home-based HPV self-sampling because of the privacy and convenience when collecting the sample [33].…”

HPV-Based Self-Sampling in Cervical Cancer Screening: An Updated Review of the Current Evidence in the Literature

“…Both the prevalence of hrHPV and the burden of cervical precancer among HIV patients are alarming, especially in LMIC countries with limited infrastructures [ 40 , 41 ]. With similar laboratory performance of self-sampling procedures to clinician-performed sampling, high participation and reported satisfaction rates for the individuals, there is clear potential for increasing overall cervical cancer screening uptake with VSS in this population and maximizing efficiency and cost-effectiveness, essentially implementing the same networks and infrastructures, with comparatively lower additional costs.…”