Performance and Acceptability of Self- Versus Clinician-Collected Swabs
for Testing of High-Risk HPV DNA among Women in Mysore, India:
Diagnostic Study
Abstract
Objective: To assess the feasibility and acceptability of self-sampling
for HPV testing as compared to clinician-collected sample in a
community-based setting in rural Mysore among asymptomatic women.
Design: Cross-sectional Study Setting: Rural communities in Mysore,
India Population: Women aged over 30 years eligible for cervical cancer
screening Methods: Cervical cancer screening was conducted using mobile
medical clinics in community based settings. Women self-collected
vaginal samples followed by a clinical exam and sample collection for
assessing high-risk HPV DNA. Summary statistics were calculated on a
range of sociodemographic and health behavior variables. Main Outcome
Measures: Measures of sensitivity, specificity, concordance with
physician-collected specimens were calculated. Five measures of
acceptability (feeling of caring, privacy, embarrassment, genital
discomfort, and genital pain) Results: Median age of the respondents was
39 years. The largest percentage of respondents (41.7%, n=50) had a
secondary education or above and were married (87.5%, n=105). Most
respondents (57.1%, n=68), had never been screened for cervical cancer.
The self-collected specimen for HPV DNA had higher specificity (98.1%;
95% CI: 95.5, 100) than it did sensitivity (66.7%; 95% CI: 42.8,
90.6). For all measures of acceptability, the self-collected mean was
significantly higher than the clinician-collected mean. Conclusion: This
study demonstrated that self-collected sampling performed just as well
as clinician-collected samples to screen for HPV DNA. Self-collection
was preferred by women living in rural communities, especially when the
instructions on collection are provided in a user-friendly,
non-judgmental manner.