Acceptability of Self-Sampling for Cervical Cancer Screening Among Women Living With HIV and HIV-Negative Women in Limbé, Cameroon

Abstract

Introduction: Like many countries in Sub-Saharan Africa, Cameroon has a high burden of cervical cancer and low availability and uptake of screening. Self-collection has the potential to increase the uptake of cervical cancer screening among Cameroon women. This paper explores patient and community insights surrounding self-collection among women living with HIV and HIV[-] women as well as the barriers and facilitators to obtaining and utilizing self-collected specimens in cervical cancer screening programs.Materials and methods: We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews during data collection that took place from May to August 2018. A two-stage sampling strategy was used to select 80 women who participated in six focus group discussions and eight in-depth interviews. We utilized the socio-ecological framework to guide data analysis.Results: All participants indicated that self-sampling was an acceptable method of specimen collection and should be offered as an option for cervical cancer screening in Cameroon. Whereas, most women, regardless of HIV status, preferred the option for self-collection, barriers were identified, such as lack of education about self-collection procedure, being uncomfortable, embarrassed or in pain from the procedure, fear of consequences, perceived competence about ability to self-collect and privacy and confidentiality. We also found that HIV-related stigma was a major concern for HIV[-] women that could prevent them from accessing cervical cancer screening integrated within HIV treatment settings.Conclusions: To promote self-collection for cervical cancer screening, educational interventions with both patients and providers are necessary to increase knowledge of and overall willingness to utilize self-collection. Further research is recommended to examine the role of stigma for HIV[-] women in screening locations associated with HIV treatment.

Exploring Factors Associated with Patients Who Prefer Clinician-Sampling to HPV Self-Sampling: A Study Conducted in a Low-Resource Setting

“…Some women (23.1%) preferred sampling performed by clinicians, as has been previously reported in other studies [8,[22][23][24]. In Cameroon, an earlier study explored the perceptions and preferences regarding self-versus physician-sampling in a population of women living with HIV and observed that most preferred clinician-sampling [25]. This was found in another study conducted in Britain among Muslim women interviewed in the context of cervical cancer screening [23].…”

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

“…Overall, 3178 women were enrolled in those studies and 2105 (66%) of the women were with HIV. Seven studies included women with HIV only, but five studies included both women with HIV and HIV-negative women, with the latter group used as a comparison group [ 36 , 45 , 46 , 47 , 48 ]. Study participants were women between the ages of 25 and 65 years and the sample size for the studies markedly varied.…”

“…The majority of studies were conducted using quantitative methods (six were cross-sectional studies [ 47 , 48 , 49 , 50 , 51 , 52 ], three studies were quasi-experimental studies [ 41 , 45 , 53 ], and one was a prospective observational study [ 36 ]). Two were qualitative studies (interviews [ 46 , 54 ] and focus group discussion [ 46 ]), while one used mixed methods (i.e., focus group and survey [ 53 ]). Most of the cross-sectional studies involved short interventions or instructions where study participants received instructions about screening and/or about steps for using sampling kits [ 36 , 41 , 45 , 48 , 49 , 50 , 51 , 52 ].…”

“…Studies were generally similar in terms of study settings (clinics or hospitals) and recruitment methods (face-to-face). However, one study used mobile phone technology to recruit participants [ 54 ] and a few others did not report how they recruited study participants [ 36 , 46 , 52 ].…”

Exploring Factors Associated with Patients Who Prefer Clinician-Sampling to HPV Self-Sampling: A Study Conducted in a Low-Resource Setting

“…Some women (23.1%) preferred sampling performed by clinicians, as was previously reported in other studies [ 8 , 23 , 24 , 25 ]. In Cameroon, an earlier study explored the perceptions and preferences regarding self- versus physician-sampling in a population of women living with HIV and observed that most preferred clinician-sampling [ 26 ]. This was found in another study conducted in Britain among Muslim women interviewed in the context of cervical cancer screening [ 24 ].…”