Comparison of self-collected versus clinician collected cervicovaginal specimens for detection of high risk human papillomavirus among HIV infected women in Ethiopia

Abstract

Background In order to meet the WHO 2030 cervical cancer elimination program, evaluation and utilization of sensitive testing method, and feasible sampling technique is a paradigm for enhancing cervical cancer screening coverage. Self-sampling for screening of HPV DNA testing is one of the easiest and sensitive techniques, though the evidence was limited in the Ethiopian context. This study aimed to compare the performance of self-collected vaginal specimen versus clinician collected cervical specimen for detection of HPV among HIV positive women in Ethiopia. Methods We conducted a comparative cross-sectional study design to collect cervicovaginal specimens among HIV positive women of age older than 24 years. Data were collected from six government hospitals from January to October 2021. A total of 994 cervicovaginal specimens was collected by clinicians and HIV positive women themselves in the cervical cancer screening unit using Abbott Cervi-Collect Specimen Collection Kit, and molecular HPV testing was conducted. Data were entered into an Excel spreadsheet and analyzed using SPSS version 25. Sensitivity, specificity and kappa were reported with p < 0.05 considered as statistically significant. Results The prevalence of high-risk HPV was 29.4% among self-sampled specimen and 23.9% among clinician collected specimens. The overall concordance of the test result was 87.3%. Oncogenic HPV types, other than HPV16&18 were predominant in both sampling techniques, 19.9% from vaginal self-collected specimen and 16.7% of clinician collected cervical specimens. The sensitivity and specificity of self-sampled HPV test was 84.0% and 88.4%, respectively. The level of agreement was good (k = 0.68) and statistically significant (p < 0.001). The discriminatory power of the test as true positive and negative was excellent with an area under the curve of 0.86. Conclusion The magnitude of oncogenic HPV was higher in self-collected samples than the clinician collected specimen with good agreement between the two sampling methods. Thus, we recommend the Ministry of Health in Ethiopia to expand utilization of the self-sampled technique and enhance the coverage of screening in the country.

Misconceptions About Female Cancers Contributing to Late Presentation to Health Facilities in Ethiopia: A Qualitative Study

“…Likewise, raising awareness about self-sampling devices for the collection of samples directly by women at home would increase the coverage of screening services as evidenced by previous studies in Ethiopia and a review of randomized control trails (RCTs) and other observational studies. 32 …”

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.…”

Mapping evidence on the acceptability of human papillomavirus self-sampling for cervical cancer screening among women in sub-Saharan Africa: a scoping review

“… 7 HPVSS has the potential to increase uptake of CC screening by reducing some of the personal barriers to screening. 8 Studies conducted in Zimbabwe 9 and Ethiopia 10 to compare the utility of self-collected versus clinician-collected specimens for hrHPV detection demonstrated good agreement between the two methods. In addition, HPVSS has been associated with increased participation of women who have not previously been screened and those who do not attend CC screening regularly in LMICs.…”