“The best thing is that you are doing it for yourself” – perspectives on acceptability and feasibility of HPV self-sampling among cervical cancer screening clients in Tanzania: a qualitative pilot study

Abstract

Background: Cervical cancer is the most common type of cancer in sub-Saharan Africa, and it is also the cancer disease that most women die from. The high mortality rate is partly due to low attendance rates to screening services and low sensitivity of visual inspection with acetic acid, which is the standard screening method used in screening programs in sub-Saharan Africa. In order to overcome of the burden of disease new screening strategies and methods are warranted. This study aims to explore the acceptability and feasibility of HPV self-sampling compared to provider-based sampling among cervical cancer screening clients living in Dar es Salaam. Methods: Women attending cervical cancer screening at Ocean Road Cancer Institute in Dar es Salaam, Tanzania between February-April 2017 were invited into the study. The participants had (1) a provider-collected sample, and (2) a self-sample for HPV on top of the regular cervical cancer screening. 50% of the participants conducted the self-sample after receiving a written instruction guide of how to collect the sample (written). The other 50% received both the written and an oral introduction to self-sampling (written+). All participants could ask for nurse assistance during self-sample collection if needed. Individual semi-structured interviews were conducted with the participants post sample collection. Data collection stopped when saturation was reached. Data were analysed using a thematic content analysis.

Acceptability and feasibility of self‐sampling and follow‐up attendance after text message delivery of human papillomavirus results: A cross‐sectional study nested in a cohort in rural Tanzania

“…The feasibility and acceptability of the self‐collection procedure, and the interest of the women in delivery of HPV test results via text messages were assessed by the use of five‐point Likert scales ranging from strongly agree to strongly disagree. By acceptability, we mean the women's perception/attitude towards the HPV self‐sampling procedure, 8 and by feasibility, we mean the women's abilities to conduct the HPV self‐sampling correctly and any difficulties they experienced during the self‐sampling. Good feasibility was defined as participant's ability to understand the instructions of the self‐sampling procedure and take the self‐swab in the absence of the nurse.…”

“…[5][6][7] Furthermore, direct and indirect economic costs, such as transportation costs, lost income, and waiting time have been found to have a negative effect on cervical cancer screening attendance. 8 In Tanzania, the standard screening method is visual inspection with acetic acid (VIA), which requires a gynecological examination. 3 A meta-analysis of 77 cross-sectional studies observed that the sensitivity of VIA to detect cervical intraepithelial neoplasia grade 2 or worse ranges between 14% and 95%.…”

Agreement between careHPV and hybrid capture 2 in detecting high‐risk HPV in women in Tanzania

“…In future, by coupling care HPV testing with HPV self‐collection, the screening service could be brought even closer to women, especially to older women living in remote areas. Such an approach is supported by the findings from a qualitative study conducted in Tanzania in which the majority of the women preferred self‐sampling over provider‐based sampling 29 …”

“…Such an approach is supported by the findings from a qualitative study conducted in Tanzania in which the majority of the women preferred self-sampling over provider-based sampling. 29 When considering implementing HPV testing to identify women at highest risk of HSIL + , it is of great importance that the screening is coupled with systematic treatment. This can be implemented by a see-and-treat approach where HPV-positive women undergo colposcopy, digital cervicography or VIA and -if positive -subsequent treatment.…”

Female health-care providers’ advocacy of self-sampling after participating in a workplace program for cervical cancer screening in Ghana: a mixed-methods study

“…The uptake and scale-up of such emerging screening approaches largely depend on knowledgeable, motivated and capable health-care providers that are well respected by the communities they serve. A recent study from Tanzania showed that even though self-sampling was perceived as acceptable there was a high demand for nurse presence during self-sampling [ 22 ], which points to the importance of health-care providers for and during the self-sampling screening process.…”