HPV self‐sampling acceptability and preferences among women living with HIV in Botswana

Abstract

Objective To assess the acceptability and preferences of HPV screening with self‐sampling and mobile phone results delivery among women living with HIV (WLWH) in Botswana, as an alternative to traditional speculum screening. Methods WLWH aged 25 years or older attending an infectious disease clinic in Gaborone were enrolled in a cross‐sectional study between March and April 2017. Women self‐sampled with a flocked swab, had a speculum exam, and completed an interviewer‐administered questionnaire about screening acceptability, experiences, and preferences. Results Of the 104 WLWH recruited, 98 (94%) had a history of traditional screening. Over 90% agreed self‐sampling was easy and comfortable. Ninety‐five percent were willing to self‐sample again; however, only 19% preferred self‐sampling over speculum exam for future screening. Preferences differed by education and residence with self‐sampling being considered more convenient, easier, less embarrassing, and less painful. Speculum exams were preferred because of trust in providers’ skills and women's low self‐efficacy to sample correctly. Almost half (47%) preferred to receive results via mobile phone call. Knowledge of cervical cancer did not affect preferences. Conclusion HPV self‐sampling is acceptable among WLWH in Botswana; however, preferences vary. Although self‐sampling is an important alternative to traditional speculum screening, education and support will be critical to address women's low self‐efficacy to self‐sample correctly.

Evaluation of ILEX SelfCerv for Detection of High-Risk Human Papillomavirus Infection in Gynecology Clinic Attendees at a Tertiary Hospital in South Africa

“…In the current study, the majority of participants were comfortable self-collecting the sample using the SelfCerv applicator tampon. Consistent with previous studies, participants reported self-sampling as being painless when using nylon-tipped flocked swabs and flocked swabs [ 32 , 33 ] and comfortable when using self-sampling devices such as Evalyn brushes, flocked swabs, and Dacron swabs [ 9 , 33 , 34 ]. However, there were conflicting findings, since some of the participants who had reported self-sampling using the applicator tampon being comfortable but also reported experiencing pain.…”

Human papillomavirus self-sampling versus standard clinician-sampling for cervical cancer screening in sub-Saharan Africa: a systematic review and meta-analysis of randomized controlled trials

“…And a significantly higher number of women gave positive feedback on favor of self-sampling, however, when it comes to their confidence of doing the test properly higher number of women reported that they would feel more comfortable of the results if it was performed by a clinician [ 23 – 26 , 30 ]. This was similar to the study done in Botswana, although the number was significantly high in favor of self-sampling when it comes to ease, comfort and preference, this was not the case when the women were asked if they felt confidence on doing the test properly [ 28 ]. Although a statistically significant majority of the participants preferred self-sampling, a proportion of them were concerned regarding their ability to collect the sample correctly and trusting the physician sampling.…”

“…Another review also shows that HPV self-sampling is highly accepted as the participants found it easy and convenient [22]. This was also reflected in observational studies [23][24][25][26][27][28][29][30]. Different observational studies conducted in sub-Saharan Africa assessed acceptance of self-sampling using different questions; ease of use of the device, the comfort, privacy, whether they would recommend to a friend, if they felt relaxed while using it, and if they felt confidence on doing the test properly.…”

“…This was also supported by a studies conducted in rural Ethiopia, Cameroon and South Africa, where the participants provided similar reasoning to their concern, and that is their trust in the doctor’s expertise and finding it reliable [ 23 , 24 , 29 ]. A number of observational studies tried to examine the association of this preferences to education and age, although there was no significant association to age, they found a significant association with education stating that the women who reported less confidence towards their sample are the ones with lower educational level [ 23 , 28 , 29 ]. This may indicate that provision of instructions appropriate to each study population, literate and illiterate, on HPV self-sampling is essential to increase women’s confidence in their ability to perform the test correctly and achieve a high uptake of HPV screening in sub-Saharan countries.…”

High-risk human papillomavirus detection in self-collected vaginal samples compared with healthcare worker collected cervical samples among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa

“…Regardless of the challenges of introducing HPV testing, it is important to evaluate the opportunities for introducing HPV testing as the primary screening method in LMICs. In Sub-Saharan Africa, particularly South Africa, the majority of studies have investigated women's perceptions, acceptability, and preference of HPV self-sampling [19][20][21][22][23] in comparison to healthcare worker sampling. However, studies comparing the detection rate of HPV between healthcare worker-collected-and self-collected samples in LMICs are limited.…”