HPV self-sampling for cervical cancer screening: a systematic review of values and preferences

Abstract

IntroductionThe WHO recommends human papillomavirus (HPV) cervical self-sampling as an additional screening method and HPV DNA testing as an effective approach for the early detection of cervical cancer for women aged ≥30 years. This systematic review assesses end user’s values and preferences related to HPV self-sampling.MethodsWe searched four electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and Embase) using search terms for HPV and self-sampling to identify articles meeting inclusion criteria. A standardised data extraction form was used to capture study setting, population, sample size and results related to values and preferences.ResultsOf 1858 records retrieved, 72 studies among 52 114 participants published between 2002 and 2018 were included in this review. Almost all studies were cross-sectional surveys. Study populations included end users who were mainly adolescent girls and adult women. Ages ranged from 14 to 80 years. Most studies (57%) were conducted in high-income countries. Women generally found HPV self-sampling highly acceptable regardless of age, income or country of residence. Lack of self-confidence with collecting a reliable sample was the most commonly cited reason for preferring clinician-collected samples. Most women preferred home-based self-sampling to self-sampling at a clinic. The cervical swab was the most common and most accepted HPV DNA sampling device.ConclusionsHPV self-sampling is generally a highly accepted method of cervical cancer screening for end users globally. End user preferences for self-sampling device, method and setting can inform the development of new and expanded interventions to increase HPV screening.

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 ].…”

“…The reasons for preferring clinician-sampling in these studies were concerns about not doing the test correctly and the belief that health providers are more expert (95.6%), which is consistent with our findings. In the literature, women also reported having a low level of self-confidence performing self-sampling properly and providing a good quality sample for analysis [ 8 , 16 , 27 , 28 , 29 ].…”

“…The presence of a healthcare provider during Self-HPV has been reported by some authors to have a positive effect on women. Support is therefore a way of increasing women’s confidence and comfort [ 8 , 28 ], but the option to choose clinical-sampled could be a solution for women who are unwilling to undergo Self-HPV, as was proposed in Australia [ 34 ]. In our program, an hour of educational and counselling intervention provided to women before performing the Self-HPV probably allows sufficient time to respond to the women’s specific fears.…”

“…Systematic reviews support the finding that Self-HPV has similar sensitivity and specificity for detecting precancerous lesions to samples collected by a physician or nurse [ 5 , 6 , 7 ] and is considered a safe and acceptable screening method by users [ 8 , 9 , 10 , 11 , 12 ]. This approach reduces the discomfort and pain that can be associated with pelvic examination, is considered less invasive, allows women more autonomy and privacy, and might facilitate screening participation [ 8 , 13 , 14 ]. In the context of primary screening, a negative HPV result indicates a very low risk of developing CC within the next decade and a positive result can generally be safely managed by adequately trained health care providers [ 15 ].…”

Prevalence and Genotype Distribution of Human Papillomavirus Infection among 12 076 Iranian Women

“…Approximately 570 0 0 0 new cases and 310 0 0 0 deaths of CC are estimated annually worldwide ( Wang et al, 2019 ). Viral infections, especially human papillomavirus infection (HPV), which is recognized as one of the most common sexually transmitted infections worldwide, are now one of the known risk factors for CC ( Nishimura et al, 2021 ), i.e., CC is by far the most frequent HPV-related disease ( Xing et al, 2021 ). More than 200 genotypes of HPV have been identified so far; approximately 40 may infect genital areas ( Wang et al, 2015 ).…”