Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;30(2):61-66.
doi: 10.4314/mmj.v30i2.2.

Feasibility, validity and acceptability of self-collected samples for human papillomavirus (HPV) testing in rural Malawi

Allahna Esber  1 , Alison Norris  1 , Enock Jumbe  2 , Jonathan Kandodo  2 , Patrick Nampandeni  2 , Patricia Carr Reese  3 , Abigail Norris Turner  4
Affiliations

Feasibility, validity and acceptability of self-collected samples for human papillomavirus (HPV) testing in rural Malawi

Allahna Esber et al. Malawi Med J. 2018 Jun.

Abstract

Aim: The World Health Organization (WHO) recently endorsed human papillomavirus (HPV) testing as a cervical cancer screening method in countries without established programs. Self-collection for HPV testing may be an effective way to expand screening. Our objective was to assess the feasibility, validity, and acceptability of self-collection for HPV testing in a population of care-seeking, unscreened women in rural Malawi.

Methods: We enrolled women reporting to a rural Malawian clinic from January to August 2015. Participants were offered the option to self-collect a vaginal sample and the study clinician collected a cervical sample for HPV testing. Using the clinician-collected sample as the reference standard, we calculated a kappa statistic, sensitivity, and specificity by hr-HPV type. Participants also received a brief survey assessing acceptability of the procedure.

Results: Among the 199 enrolled women, 22% had any high risk-HPV. Comparing self- and clinician-collected samples for HPV testing, we found generally high agreement (ϰ = 0.66-0.90) and high specificity (98%-100%), but varied sensitivity (50%-91%) for different types of hr-HPV. We also found that self-collection was acceptable, with 98% of women reporting it was easy to do and 99% reporting willingness to do so again.

Conclusions: WHO guidelines recommend that treatment is available immediately after a positive screening test for clinic-based cervical cancer screening programs. Our findings demonstrate that self-collection of samples for HPV testing is a feasible and acceptable method of cervical cancer screening in this rural Malawian population. High agreement between the self- and clinician-collected samples and high levels of acceptability among women in the study suggest that self-collection of vaginal samples for HPV testing may be effectively incorporated into screening programs among rural, largely unscreened populations.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Potential outcomes of GeneXpert HPV assay
See this image and copyright information in PMC

References

    1. International Agency for Research on Cancer, author. Cervix cancer screening. Lyon: 2005.
    1. Campos NG, Kim JJ, Castle PE, Ortendahl JD, O'Shea M, Diaz M, et al. Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa. Int J Cancer. 2012;130:2672–2684. doi: 10.1002/ijc.26269. - DOI - PMC - PubMed
    1. Khozaim K, Orang'o E, Christoffersen-Deb A, Itsura P, Oguda J, Muliro H, et al. Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2013;124:12–18. doi: 10.1016/j.ijgo.2013.06.035. - DOI - PubMed
    1. Ajenifuja K, Gage J. A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria. Int J Gynecol Cancer. 2013;23:507–512. doi: 10.1097/IGC.0b013e318280f395. - DOI - PMC - PubMed
    1. Longatto-Filho A, Naud P, Derchain SF, Roteli-Martins C, Tatti S, Hammes LS, et al. Performance characteristics of Pap test, VIA, VILI, HR-HPV testing, cervicography, and colposcopy in diagnosis of significant cervical pathology. Virchows Arch Int J Pathol. 2012;460:577–585. doi: 10.1007/s00428-012-1242-y. - DOI - PubMed

Publication types

MeSH terms