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?

Abstract

Introduction. Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.

Intervention to Increase Cervical Cancer Screening Behavior Among Medically Underserved Women: Effectiveness of 3R Communication Model

“…Another strong finding was that the women reported a positive experience with collecting self-sampling. This finding is supported by a recent meta-analysis of 37 studies among 18,516 women from 24 countries across five continents and a scoping review [54] that indicated women have a strong acceptance and preference for self-sampling over clinician sampling [36]. The women in our study implied that self-sampling could help alleviate the economic burden and increase the accessibility of cervical cancer screening for low-income women.…”

Intervention to Increase Cervical Cancer Screening Behavior among Medically Underserved Women: Effectiveness of 3R Communication Model

“…Another strong finding was that the women reported a positive experience with collecting self-sampling. This finding is supported by a recent meta-analysis of 37 studies among 18,516 women from 24 countries across five continents and a scoping review [57] that indicated women have a strong acceptance and preference for self-sampling over clinician sampling [37]. The women in our study implied that self-sampling could help alleviate the economic burden and increase the accessibility of cervical cancer screening for low-income women.…”

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

“…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. This gains additional importance, given the contribution of underserved patients living with HIV in the global burden of cervical precancer and cancer morbidity and mortality [ 42 , 43 ].…”