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

Abstract

ObjectivesThe objective of this scoping review was to map evidence on the acceptability of self-sampling for human papillomavirus testing (HPVSS) for cervical cancer screening among women in the sub-Saharan Africa region.DesignScoping review.MethodsUsing Arksey and O’Malley’s framework, we searched Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the acceptability of HPVSS among women aged 25 years and older published between January 2011 and July 2021. We included studies that reported evidence on the acceptability of HPVSS for cervical cancer screening. Review articles and protocols were excluded. We also searched for evidence from grey literature sources such as dissertations/theses, conference proceedings, websites of international organisations such as WHO and relevant government reports. Two reviewers independently performed the extraction using a pre-designed Excel spreadsheet and emerging themes were narratively summarised.ResultsThe initial search retrieved 1018 articles. Of these, 19 articles were eligible and included in the review. The following themes emerged from the included articles: acceptability of HPVSS; lack of self-efficacy to perform HPVSS, complications when performing HPVSS, preferences for provider sampling or assistance; setting of HPVSS; HPVSS by vulnerable populations.ConclusionEvidence shows that HPVSS is highly acceptable for cervical cancer screening in sub-Saharan Africa. Further research exploring the acceptability of HPVSS among women residing in rural areas is required, as well as studies to determine women’s preferences for HPVSS intervention including the preferred type of sampling devices. Knowledge on the acceptability and preferences for HPVSS is important in designing women-centred interventions that have the potential to increase screening coverage and participation in cervical cancer screening programmes.

Experiences of women participating in a human papillomavirus-based screen-triage-and treat strategy for cervical cancer prevention in Malawi

“…Many felt that self-collection could mitigate the fear and stigma surrounding speculum exams. These findings are consistent with existing literature over the last couple of decades that has shown self-collection to be acceptable across a variety of geographic locations, cultures and age groups ( 8 , 9 ). Studies specific to African populations showed that women are willing to collect their own samples and that it is a more socially acceptable and feasible method than pelvic exam-based screening methods, such as Pap smear or VIA ( 24 , 25 ).…”

“…Semi-structured IDIs were developed around four main domains of inquiry: 1) baseline knowledge and perception of CxCa and CxCa screening; 2) attitudes towards self-collection; 3) experience with the screen-triage-treat procedures; and 4) understanding of screening results. Domains were developed based on existing literature that assessed acceptability of and perspectives on HPV-based screening ( 9 , 16 , 17 ). Interviews were conducted in Chichewa, the local language, by study staff experienced in qualitative data collection methods (WD).…”

“…Self-collection of vaginal sample for HPV testing has been validated as an effective and sensitive method for CxCa screening if highly sensitive assays are utilized, with notably lower provider burden compared to provider-collected tests ( 5 ). HPV self-collection has been shown to increase CxCa screening compared to VIA ( 7 ) and is acceptable to women all over the world ( 8 ), including in Sub-Saharan Africa (SSA) ( 9 ).…”

Co-creation of human papillomavirus self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe: nominal group technique

“…HPV testing has been used on clinician and self-collected specimens with comparable clinical accuracy ( 16 ). HPV self-sampling can potentially overcome some of the barriers that prevent women from accessing screening services ( 17 ). Evidence points to the acceptability of HPV self-sampling due to its ease of use, privacy and convenience ( 17 ).…”

“…HPV self-sampling can potentially overcome some of the barriers that prevent women from accessing screening services ( 17 ). Evidence points to the acceptability of HPV self-sampling due to its ease of use, privacy and convenience ( 17 ). Studies conducted in limited resource settings such as Cameroon ( 18 ), Ethiopia ( 19 ), Tanzania ( 20 ) and Malawi ( 21 ) have demonstrated the acceptability of HPV self-sampling for cervical cancer screening.…”