Ashwini Kamath Mulki1,2, Mellissa Withers3. 1. Department of Family Medicine, Lehigh Valley Health Network, 1730 Chew St, Allentown, PA, 18104, USA. Ashwini.KamathMulki@lvhn.org. 2. Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA. Ashwini.KamathMulki@lvhn.org. 3. Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA.
Abstract
BACKGROUND: Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. METHODS: This study's objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs. RESULTS: Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86-97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants' homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75-97%, 18 studies), painless (60-90%, nine studies), and preferred over provider-collected sampling (57-100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. CONCLUSION: Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.
BACKGROUND: Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. METHODS: This study's objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs. RESULTS: Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86-97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants' homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75-97%, 18 studies), painless (60-90%, nine studies), and preferred over provider-collected sampling (57-100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. CONCLUSION: Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.
Authors: M Maza; M Melendez; R Masch; K Alfaro; A Chacon; E Gonzalez; M Soler; G Conzuelo-Rodriguez; J C Gage; T A Alonzo; P E Castle; J C Felix; M Cremer Journal: Prev Med Date: 2018-06-26 Impact factor: 4.018
Authors: Ebtesam M Kamal; Gamal Abbas El Sayed; Manal M El Behery; Gehan A El Shennawy Journal: Arch Gynecol Obstet Date: 2014-07-10 Impact factor: 2.344
Authors: Luana L S Rodrigues; Mariza G Morgado; Vikrant V Sahasrabuddhe; Vanessa S De Paula; Nathália S Oliveira; Elena Chavez-Juan; Diane M Da Silva; W Martin Kast; Alcina F Nicol; José H Pilotto Journal: Gynecol Oncol Date: 2018-08-04 Impact factor: 5.482
Authors: Megan J Huchko; Saduma Ibrahim; Cinthia Blat; Craig R Cohen; Jennifer S Smith; Robert A Hiatt; Elizabeth Bukusi Journal: Int J Gynaecol Obstet Date: 2018-01-03 Impact factor: 3.561
Authors: Anna Gottschlich; Alvaro Rivera-Andrade; Edwin Grajeda; Christian Alvarez; Carlos Mendoza Montano; Rafael Meza Journal: J Glob Oncol Date: 2017-01-18
Authors: Omenge Orang'o; Philip Tonui; Kapten Muthoka; Stephen Kiptoo; Titus Maina; Mercy Agosa; Aaron Ermel; Yan Tong; Darron Brown Journal: SAGE Open Med Date: 2022-05-23
Authors: Jessica Sormani; Bruno Kenfack; Ania Wisniak; Alida Moukam Datchoua; Sophie Lemoupa Makajio; Nicole C Schmidt; Pierre Vassilakos; Patrick Petignat Journal: Int J Environ Res Public Health Date: 2021-12-22 Impact factor: 3.390
Authors: Michelle B Shin; Patricia J Garcia; Enrique M Saldarriaga; José L Fiestas; Kristjana H Ásbjörnsdóttir; Sarah J Iribarren; Ruanne V Barnabas; Sarah Gimbel Journal: Lancet Reg Health Am Date: 2021-12-29