Knowledge and Acceptability of Pap Smears, Self-Sampling and HPV Vaccination among Adult Women in Kenya

Abstract

ObjectivesOur study aimed to assess adult women’s knowledge of human papillomavirus (HPV) and cervical cancer, and characterize their attitudes towards potential screening and prevention strategies.MethodsWomen were participants of an HIV-discordant couples cohort in Nairobi, Kenya. An interviewer-administered questionnaire was used to obtain information on sociodemographic status, and sexual and medical history at baseline and on knowledge and attitudes towards Pap smears, self-sampling, and HPV vaccination at study exit.ResultsOnly 14% of the 409 women (67% HIV-positive; median age 29 years) had ever had a Pap smear prior to study enrollment and very few women had ever heard of HPV (18%). Although most women knew that Pap smears detect cervical cancer (69%), very few knew that routine Pap screening is the main way to prevent ICC (18%). Most women reported a high level of cultural acceptability for Pap smear screening and a low level of physical discomfort during Pap smear collection. In addition, over 80% of women reported that they would feel comfortable using a self-sampling device (82%) and would prefer at-home sample collection (84%). Nearly all women (94%) reported willingness to be vaccinated to prevent cervical cancer if offered at no or low cost.ConclusionsThese findings highlight the need to educate women on routine use of Pap smears in the prevention of cervical cancer and demonstrate that vaccination and self-sampling would be acceptable modalities for cervical cancer prevention and screening.

Assessment of knowledge and attitude of medical and nursing students towards screening for cervical carcinoma and HPV vaccination in a tertiary care teaching hospital

“…Early screening is known to prevent up to 80% of the invasive cervical cancer cases. 8 However, educational barriers and behavioral patterns have been acknowledged as major reasons for low screening prevalence in developing countries. 9 Knowledge plays an important role in deciding preventive behaviors.…”

Determinants of women¿s likelihood of vaginal self-sampling for human papillomavirus to screen for cervical cancer in Taiwan: a cross-sectional study

“…The uptake of cervical screening services was influenced by knowledge of cervical cancer [17,18], previous Pap testing [11], educational level [3,11], and household income l [19], but was not associated with marital status [20]. Furthermore, barriers to Pap testing such as the issues of time [20,21], cost [5,18], and clinical site [21] might be barriers to women's likelihood of self-sampling for HPV.…”

Classical Molecular Tests Using Urine Samples as a Potential Screening Tool for Human Papillomavirus Detection in Human Immunodeficiency Virus-Infected Women

“…Most new cases occur in developing countries, where screening programs based primarily on the Papanicolaou (Pap) test are limited by several factors, such as sampling and detection errors (1). In addition to reduced coverage, the test's low acceptability among women yields reduced effectiveness in CC prevention programs (2).…”

“…Proposed self-sampling from urine constitutes a foundation for alternative collection methods that are practical, are economical, and have high acceptability among women (2); even though this approach usually yields lower cell counts than direct exfoliation sampling methods, it has been reported to be a convenient screening method, as the viral load in these specimens is associated with the presence of cervical lesions (11). In addition, using urine samples could contribute to strengthening screening programs, as this approach should decrease lesions caused in the cervical epithelial tissue (as with the conventional smear test) and would not stimulate the natural progression of the illness (i.e., tissue damage during smear testing facilitates viral entry) (12).…”