Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach
Open accessAbstract
BACKGROUND: Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown. METHODS: In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women's and providers' experiences with self-sampling, women's opinions of sampling at home, and their future needs. RESULTS: Among surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn't mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%). CONCLUSION: Self-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women's preference for self-sampling.
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HPV DNA tests are easily reproducible and have higher sensitivity for detecting high-grade cervical intraepithelial neoplasia than cytological tests.
“Tests for HPV DNA are easily reproducible and have higher sensitivity for detecting high-grade cervical intraepithelial neoplasia than cytological tests (WHO; Sankaranarayanan et al., 2011; Bansil et al., 2014; Sankaranarayanan, 2014; Racey and Gesink, 2015).”
From Acceptability and Concordance of Self- Versus Clinician- Sampling for HPV Testing among Rural South Indian Women (2021) · cites this paper as Bansil et al., 2014
The Background reports 50% sensitivity for Pap smears detecting moderate to severe CIN or cancer, versus 84–100% for provider-collected and 66–88% for self-collected HPV-DNA tests. This supports the higher-sensitivity comparison, but the paper does not say that HPV-DNA tests are easily reproducible. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFear of disease and death has been identified in other studies.
“which has been identified in other studies [18, 52].”
From Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (2019) · cites this paper as [18]
The Results (Reasons for not self-sampling; page unavailable) identify fear of finding cancer or pre-cancer, and the Discussion likewise describes fear of learning one has cancer. Neither passage identifies fear of death as a reported concern, so the source supports only the disease-related part of the claim. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn that study, women in rural Uttar Pradesh (93.1%), Hyderabad (95.5%), Uganda (64.5%) and Nicaragua (50.0%) preferred self-sampling over clinician sampling.
“The study found that women in rural Uttar Pradesh (93.1%), Hyderabad (95.5%), Uganda (64.5%) and Nicaragua (50.0%) preferred self-sampling over clinician sampling.”
From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [70]
Table 2 in Results > Ease and preference of self-sampling reports the four self-sampling percentages exactly as quoted. But in Nicaragua, 50.0% preferred self-collection and 50.0% preferred provider collection, so women there did not prefer self-sampling over clinician sampling. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn that study, women across all study sites preferred to conduct self-sampling in a clinic setting rather than at home so that a provider could clarify questions or do the test if needed.
“Women across all study sites preferred to conduct self-sampling in a clinic setting rather than at home so that a provider could clarify questions or do the test if needed.”
From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [70]
The Results section (‘Preference of self sampling at a clinic’; page unavailable) reports that some respondents preferred the clinic because a provider could collect the sample if needed, among other reasons. The Abstract reports that most women preferred clinic-based screening, but does not establish that preference separately for every site. The Discussion attributes the specific reason that a provider could clarify questions to women in a separate Mexican study, not to participants across this paper’s study sites. (LLM, conf=0.88)
Experimental — accuracy not yet measuredStudies have confirmed high acceptability of HPV self-sampling in different settings.
“Studies have confirmed a high acceptability to HPV self-sampling in different settings [15, 18, 19].”
The finding that women in rural western Kenya had positive expectations of and personal experiences with HPV self-sampling is consistent with other studies done in Africa and Asia.
“which is consistent to other studies done in Africa and Asia [18, 19, 33–35].”
The finding on pelvic exam as a barrier to screening is consistent with other studies done in Africa and Asia which showed concerns around speculum use, embarrassment, and reluctance to have a male provider perform the exam.
“The findings on pelvic exam as a barrier to screening is consistent with other studies done in Africa and Asia [18, 19, 33–35] which showed concerns around speculum use, embarrassment, and reluctance to have a male provider perform the exam [37–39].”
In that study, more than half of surveyed respondents in each site reported self-sampling as 'easy', with the lowest percentage in Hyderabad (53.6%) and the highest in Uganda (89.7%).
“More than half of surveyed respondents in each site reported self-sampling as ‘easy’ with the lowest percentage in Hyderabad (53.6%) and the highest percentage in Uganda (89.7%).”
From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [70]
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“The domain on belief about consequences also reflected the women’s motivation construct that highlight barriers to HPV screening which include the fear of disease and death which has been identified in other studies [18, 52].”
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“The self-sampler kits after collection were sent to the nodal hospital for analysis by Hybrid capture System II {Digene}, on a Qiagen platform, which detects 13 different high-risk HPV types {16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68}.”
- Authors
- Bansil, P., Wittet, S., Lim, J. L., Winkler, J. L., Paul, P., & Jeronimo, J.
- Affiliations
- Program for Appropriate Technology in Health (US)
- Corresponding author
- Bansil, Pooja
- Venue
- BMC Public Health
- Published
- 2014-06-12
- Volume
- 14
- Issue
- 1
- Pages
- 596-596
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4061776
- OpenAlex
- W1980779000
- Cited by
- 184
- References
- 0
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 28 · 2023: 33 · 2022: 21 · 2021: 12 · 2020: 18 · 2019: 15 · 2018: 7 · 2017: 19 · 2016: 5 · 2015: 4 · 2014: 3
- FWCI
- 7.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- HPV testing, self-sampling, cervical cancer screening, acceptability, resource-limited settings, vaginal self-sampling, home-based screening, provider education, women's experiences, cervical cancer prevention
- MeSH terms
- Adult, Uterine Cervical Neoplasms, Cross-Sectional Studies, Female, Humans, India, Medically Underserved Area, Nicaragua, Patient Compliance, Surveys and Questionnaires, Self Care, Specimen Handling, Uganda, Vaginal Smears, Papillomaviridae, Papillomavirus Infections
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