Self- versus physician-collected samples for the follow-up of human papillomavirus-positive women in sub-Saharan Africa

Abstract

IntroductionHuman papillomavirus (HPV) testing is a suitable tool for primary cervical cancer (CC) screening and follow-up in low-resource settings. Vaginal samples taken by women themselves (Self-HPV) are an interesting alternative to physician-performed sampling (Dr-HPV). Our aim was to assess the performance of Self-HPV and Dr-HPV at 6 and 12 months following a CC screening campaign.MethodsThis study was carried out at the Dschang District Hospital, Cameroon. Women aged 30–49 years were recruited in a CC screening campaign. HPV-positive women, of whom 2/3 were treated with thermoablation because of abnormal results at baseline screening, were invited to participate in a follow-up study. Self- and Dr-HPV, as well as cytology, were performed at 6 and 12 months. HPV samples were analyzed using the Xpert HPV assay. Sensitivity and specificity for the detection of low-grade squamous intraepithelial lesion or worse and of high-grade squamous intraepithelial lesion or worse were calculated for Self-HPV and Dr-HPV, using cytology as the reference diagnosis.ResultsOverall, 188 HPV-positive women were invited to attend follow-up. The obtained follow-up visits’ attendance was 154 (81.9%) and 131 (69.7%) at 6 and 12 months, respectively. While the overall performance of Dr-HPV at 6 months was slightly superior, Self-HPV showed an improved sensitivity for HSIL+ detection at 12 months when compared with Dr-HPV (83.3% [95% CI 41.8–98.9] versus 71.4% [95% CI 21.5–95.8], respectively). The overall HPV positivity agreement between Self- and Dr-HPV at 6 and 12 months corresponded to a κ value of 0.62 and 0.52, respectively. Among women treated with thermoablation (n=121) at baseline screening, Self-HPV was as sensitive as Dr-HPV, although less specific (P=0.003).ConclusionSelf-HPV is a valuable tool for the follow-up of HPV-positive women in low-resource settings. Larger, randomized trials are needed to confirm the validity of our findings.

A systematic review of self‐sampling for HPV testing in Africa

“…In total, 13 of the included studies were cohort studies, and 8 reported cross‐sectional findings in eligible populations.…”

“…The non‐randomized studies recruited populations with different characteristics. For example, Viviano et al., Adamson et al., and Rositch et al . enrolled women with HIV in a cohort study; Toliman et al .…”

“…Nodjikouambaye et al., Viviano et al., Toliman et al., Adler et al., Boggan et al., Broquet et al., Crofts et al., Fall et al., Brandt et al., Saidu et al., Unteit et al., Ogilvie et al., Berner et al., and Tebeu et al . analyzed participants aged 30–49 years attending cervical cancer screening.…”

“…In 15 non‐randomized studies, HPV tests on self‐ and clinician‐collected samples were compared. Six studies evaluated self‐sampling by an interviewer‐administered questionnaire, and one compared self‐collected vaginal samples for HPV testing between women in a rural setting and those in an urban setting …”

“…Viviano et al . found a moderate‐to‐substantial agreement between self‐sampled and clinician‐sampled when stratified by the women's sociodemographic and clinical characteristics.…”