Preference for Human Papillomavirus–Based Cervical Cancer Screening

Abstract

Objective The objective of this study was to assess the conditions under which Zambia women with a history of cervical cancer screening by visual inspection with acetic acid might switch to HPV-based testing in the future. Methods We conducted a choice-based conjoint survey in a sample of women recently screened by visual inspection in Lusaka, Zambia. The screening attributes considered in hypothetical choice scenarios included: screening modality, sex and age of the examiner, whether screening results would be presented visually, distance from home to the clinic, and wait time for results. Results Of 238 women in the sample, 208 (87.4%) provided responses sufficiently reliable for analysis. Laboratory testing on a urine sample was the preferred screening modality, followed by visual screening, laboratory testing on a self-collected vaginal specimen, and laboratory testing on a nurse-collected cervical specimen. Market simulation suggested that only 39.7% (95% confidence interval, 33.8, 45.6) of respondents would prefer urine testing offered by a female nurse in her 30's over visual inspection of the cervix conducted by a male nurse in his 20's if extra wait time were as short as one hour and the option of viewing how their cervix looks like were not available. Conclusion Our study suggests that, for some women, level of preference for HPV-based screening strategies may depend highly on the process and conditions of service delivery.

Attributes Used for Cancer Screening Discrete Choice Experiments: A Systematic Review

“…DCEs typically collected preferences of a single population (42/49; 86%), most frequently the general public with mixed prior experience of screening (36/49; 73%), followed by HCPs (10/49; 20%) [41,51,52,60,61,66,67,70,74,77] with patients (9/49; 18%) [29,30,33,34,38,40,70,72,77] being considered least often. The target population of each study was reported and classified according to the authors' own definition; therefore the definition of "patients" varied and included those attending screening appointments or purchasing tests [29,30,33,34,38,40,70] and those attending appointments for other reasons [72,77].…”

Human papillomavirus genotype and viral load agreement between paired first-void urine and clinician-collected cervical samples

“…Together with results from the CapU study, in which home-based urine sampling increased the participation rate by 11–16% in screening non-responders (40–65 years) after receiving two reminders [ 14 ], these data indicate that FVU sampling shows potential as liquid biopsy source to reach (non-attending) women for home-based CxCa screening. Nevertheless, it remains to be investigated how home-based FVU sampling can be ideally implemented in practice, since in contrast to the positive outcomes obtained in the studies mentioned above, a lack of privacy at home, education, place of residence (urban versus rural), and women’s concerns about collecting the self-sample properly themselves could influence the acceptability of self-sampling [ 56 ]. The use of urine sampling to monitor the impact of HPV-vaccination has also been reported, focusing on urine as a sample to assess viral endpoints [ 20 , 57 , 58 ].…”

Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services

“…However, the relevance of attributes should be explored through qualitative methods before administering the experiment. In addition, since this study began, other DCEs in African settings 44 , 45 have been published, including two conducted in Malawi. 46 , 47 They confirm the potential to apply DCEs more widely in African populations to inform policies and interventions to reduce health disparities.…”