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.