Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence

Creagh, Nicola Stephanie; Boyd, Lucy Ann Patricia; Bavor, Claire; Zammit, Claire; Saunders, Tessa; Oommen, Anu Mary; Rankin, Nicole Marion; Brotherton, Julia Mary Louise; Nightingale, Claire Elizabeth

doi:10.1200/go.22.00297

Cited by 17Cervical Cancer and HPV ResearchHealth Policy Implementation ScienceWomen's cancer prevention and management

Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence

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Creagh, Nicola Stephanie, Boyd, Lucy Ann Patricia, Bavor, Claire, Zammit, Claire, Saunders, Tessa, Oommen, Anu Mary, Rankin, Nicole Marion, Brotherton, Julia Mary Louise +1 more·2023·JCO Global Oncology

DOI 10.1200/go.22.00297PMC PMC10166429

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Abstract

PURPOSE: Although cervical cancer is a disease of inequity, it can be eliminated as a public health problem through vaccination, screening, and treatment. Human papillomavirus vaginal self-collection cervical screening is a high-performance test that can increase reach of screening. This review describes the different contexts and models of care used to pilot or implement self-collection within the Asia-Pacific, measures the extent that implementation outcome measures are reported and, where available, summarizes key implementation findings. METHODS: A scoping review was conducted by searching five databases of the peer-reviewed literature on June 20, 2022. Two researchers assessed eligibility and extracted data independently to the model of care used and the Conceptual Framework for Implementation Outcomes. A mixed-method consolidation of findings (quantitative: count and frequencies; qualitative: content analysis) was undertaken to narratively report findings. RESULTS: Fifty-seven articles, comprising 50 unique studies from 11 countries and two special autonomous regions, were included; 82% were conducted in trials. The implementation of self-collection was conducted in low- (2%), lower-middle– (32%), upper-middle– (32%), and high-income (35%) settings, with 10 different delivery models used; 80% delivered through practitioner-supported models with diversity in how samples were processed, and treatment was offered. Acceptability (73%) and appropriateness (64%) measures were most reported, followed by adoption (57%), feasibility (48%), and fidelity (38%). Only 7% of articles reported implementation cost or penetration measures. No articles reported sustainability measures. CONCLUSION: The literature confirms that self-collection cervical screening has been implemented within the Asia-Pacific region, with evidence demonstrating that it is acceptable and appropriate from the user's perspective. Well-designed, high-quality implementation trials and real-world evaluations of self-collection that report the breadth of implementation outcomes can support the progression toward the elimination of cervical cancer.

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Self-collection is highly acceptable across settings internationally and helps overcome major barriers to cervical screening using cytology or VIA.
“Self-collection is highly acceptable across settings internationally and helps overcome some of the major barriers to cervical screening using cytology or VIA, including stigma, shame, embarrassment, past trauma, fear and shortage of time, space, and healthcare workers to undertake speculum-based screening.913”
From Protocol for a cervical screening implementation trial comparing two approaches for delivering HPV self-collection in low-resource settings in India: a type 3 hybrid cluster randomised controlled trial (SHE-CAN) (2025) · cites this paper as [9]
The Discussion (page unavailable) describes self-collection as highly acceptable across diverse Asia-Pacific settings and says this concurs with global reviews. The Introduction and Results say it can reduce barriers associated with clinician-collected, speculum-based screening, including embarrassment and the need for trained providers. Our copy does not establish that it overcomes barriers specific to VIA, or substantiate every listed barrier, such as past trauma and shortages of space. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Home or community-based screening has been evaluated in many countries and is now part of screening policy and routine practice in many countries, and this has led to improved screening rates among unscreened women.
“This has led to improved screening rates among unscreened women.8 9 16 18 48”
From Protocol for a cervical screening implementation trial comparing two approaches for delivering HPV self-collection in low-resource settings in India: a type 3 hybrid cluster randomised controlled trial (SHE-CAN) (2025) · cites this paper as [9]
The Discussion (page unavailable) reports that reviews found mail-out and door-to-door self-collection effective in increasing screening participation. The Results (Implementation Outcome Measures; page unavailable) report uptake in an underscreened group, but do not establish that screening rates improved specifically among previously unscreened women. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Self-collection is more acceptable than provider collection.
“and that self-collection is more acceptable than provider collection.9”
From Protocol for a cervical screening implementation trial comparing two approaches for delivering HPV self-collection in low-resource settings in India: a type 3 hybrid cluster randomised controlled trial (SHE-CAN) (2025) · cites this paper as [9]

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Authors: Creagh, N. S., Boyd, L. A. P., Bavor, C., Zammit, C., Saunders, T., Oommen, A. M., Rankin, N. M., Brotherton, J. M. L., & Nightingale, C. E.
Affiliations: The University of Melbourne (AU)
Corresponding author: Creagh, Nicola Stephanie
ORCID: Creagh, Nicola Stephanie
Boyd, Lucy Ann Patricia
Bavor, Claire
Zammit, Claire
Saunders, Tessa
Oommen, Anu Mary
Rankin, Nicole Marion
Brotherton, Julia Mary Louise
Nightingale, Claire Elizabeth
Venue: JCO Global Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2023-06
Volume: 9
Issue: 9
Pages: e2200297-e2200297
ISSN: 2687-8941 (ISSN-L)
DOI: 10.1200/go.22.00297
PMC: PMC10166429
OpenAlex: W4318769423
Cited by: 17
References: 77
Citations by year: 2026: 7 · 2025: 3 · 2024: 5 · 2023: 2
FWCI: 0.66
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JCO Global Oncology (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords: HPV testing, cervical cancer screening, implementation outcomes, models of care, acceptability, feasibility, fidelity, adoption, Asia-Pacific region, cervical cancer elimination, human papillomavirus
MeSH terms: Asia, Uterine Cervical Neoplasms, Female, Humans, Income, Early Detection of Cancer

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Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence

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