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Traore B, Kassogue Y, Diakite B, Diarra F, Cisse K, Kassogue O, Diarra M, Coulibaly A, Coulibaly B, Diallo H, Diarra Z, Ly M, Maiga A, Sissoko SB, Sissoko AS, Traore CB, Kamate B, Teguete I, Bah S, Dolo G, Gursel DB, Holl J, Hou L, Maiga M. Prevalence of high-risk human papillomavirus genotypes in outpatient Malian women living with HIV: a pilot study. BMC Infect Dis 2024; 24:513. [PMID: 38778266 PMCID: PMC11110247 DOI: 10.1186/s12879-024-09412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Long-term exposure to high-risk human papillomavirus (Hr-HPV) is a well-known necessary condition for development of cervical cancer. The aim of this study is to screen for Hr-HPV using vaginal self-sampling, which is a more effective approach to improve women's adherence and increase screening rates. METHODS This pilot study included a total of 100 Women living with HIV (WLWHIV), recruited from the Center for Listening, Care, Animation, and Counseling of People Living with HIV in Bamako. Hr-HPV genotyping was performed on Self-collected samples using the Cepheid GeneXpert instrument. RESULTS The median age of WLWHIV was 44 (interquartile range [IQR], 37-50) years. Approximately 92% of the study participants preferred self-sampling at the clinic, and 90% opted to receive result notifications via mobile phone contact. The overall prevalence of Hr-HPV among study participants was 42.6%, and the most frequent Hr-HPV sub-types observed were HPV18/45 (19.1%), HPV31/35/33/52/58 (13.8%), and HPV39/68/56/66 (12.8%), followed by HPV16 (5.3%), and HPV51/59 (5.3%). WLWHIV under 35 years of age had a higher frequency of Hr-HPV compared to their older counterparts, with rates of 30% versus 11.1% (p = 0.03). The duration of antiretroviral treatment showed an inverse association with Hr-HPV negativity, with patients on treatment for 15 (IQR, 10-18) years versus 12 (IQR = 7-14) years for Hr-HPV positive patients (95% CI [1.2-5.8], t = 3.04, p = 0.003). WLWHIV with baseline CD4 T-Cell counts below 200 exhibited a higher frequency of Hr-HPV compared to those with baseline CD4 T-Cell counts above 200 (17.9% versus 1.9%, p = 0.009). However, other demographics and clinical factors, such as marital status, age of sexual debut, parity, education, history of abortion, history of preeclampsia, and cesarean delivery, did not influence the distribution of Hr-HPV genotypes. CONCLUSION Our findings indicate that WLWHIV under the age of 35 years old exhibited the highest prevalence of Hr-HPV infection, with HPV18/45 being the most prevalent subtype. Additionally, WLWHIV with baseline CD4 T-Cell counts below 200 showed the highest infection rates.
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Affiliation(s)
- Ban Traore
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Yaya Kassogue
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali.
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Brehima Diakite
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fousseyni Diarra
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Kadidiatou Cisse
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Oumar Kassogue
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Modibo Diarra
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Aissata Coulibaly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Bourama Coulibaly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hama Diallo
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Zoumana Diarra
- Center of Listening, Care, Animation, and Counseling for People Living With HIV, Bamako, Mali
| | - Madani Ly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Aminata Maiga
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi Boula Sissoko
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Seydou Sissoko
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Bougadari Traore
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahima Teguete
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou Bah
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Guimogo Dolo
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Demirkan Besim Gursel
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Holl
- Department of Neurology, University of Chicago, Chicago, IL, 60637, USA
| | - Lifang Hou
- Institute for Global Health, Northwestern University, Chicago, IL, 60611, USA
- Preventive Medicine Department, Northwestern University, Chicago, IL, 60611, USA
| | - Mamoudou Maiga
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- Preventive Medicine Department, Northwestern University, Chicago, IL, 60611, USA
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Ogale YP, Grabowski MK, Nabakka P, Ddaaki W, Nakubulwa R, Nakyanjo N, Nalugoda F, Kagaayi J, Kigozi G, Denison JA, Gaydos C, Kennedy CE. Self-collected samples as an additional option for STI testing in low-resource settings: a qualitative study of acceptability among adults in Rakai, Uganda. BMJ Open 2023; 13:e073241. [PMID: 37963696 PMCID: PMC10649464 DOI: 10.1136/bmjopen-2023-073241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda. METHODS Nested within the Rakai Community Cohort Study, we conducted semistructured interviews with 36 adults who SCS for STI testing. We analysed the data using an adapted version of the Framework Method. RESULTS Overall, SCS was acceptable to both male and female participants, regardless of whether they reported recent STI symptoms. Perceived advantages of SCS over provider-collection included increased privacy and confidentiality, gentleness and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future. CONCLUSION SCS are acceptable among adults in this low-resource setting and could be offered as an additional option to expand STI diagnostic services.
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Affiliation(s)
- Yasmin Parvizi Ogale
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Proscovia Nabakka
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - William Ddaaki
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Rosette Nakubulwa
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Neema Nakyanjo
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Fred Nalugoda
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Julie A Denison
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charlotte Gaydos
- Department of Infectious Diseases, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dzobo M, Dzinamarira T, Maluleke K, Jaya ZN, Kgarosi K, Mashamba-Thompson TP. Mapping evidence on the acceptability of human papillomavirus self-sampling for cervical cancer screening among women in sub-Saharan Africa: a scoping review. BMJ Open 2023; 13:e062090. [PMID: 37085299 PMCID: PMC10124230 DOI: 10.1136/bmjopen-2022-062090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES The objective of this scoping review was to map evidence on the acceptability of self-sampling for human papillomavirus testing (HPVSS) for cervical cancer screening among women in the sub-Saharan Africa region. DESIGN Scoping review. METHODS Using Arksey and O'Malley's framework, we searched Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the acceptability of HPVSS among women aged 25 years and older published between January 2011 and July 2021. We included studies that reported evidence on the acceptability of HPVSS for cervical cancer screening. Review articles and protocols were excluded. We also searched for evidence from grey literature sources such as dissertations/theses, conference proceedings, websites of international organisations such as WHO and relevant government reports. Two reviewers independently performed the extraction using a pre-designed Excel spreadsheet and emerging themes were narratively summarised. RESULTS The initial search retrieved 1018 articles. Of these, 19 articles were eligible and included in the review. The following themes emerged from the included articles: acceptability of HPVSS; lack of self-efficacy to perform HPVSS, complications when performing HPVSS, preferences for provider sampling or assistance; setting of HPVSS; HPVSS by vulnerable populations. CONCLUSION Evidence shows that HPVSS is highly acceptable for cervical cancer screening in sub-Saharan Africa. Further research exploring the acceptability of HPVSS among women residing in rural areas is required, as well as studies to determine women's preferences for HPVSS intervention including the preferred type of sampling devices. Knowledge on the acceptability and preferences for HPVSS is important in designing women-centred interventions that have the potential to increase screening coverage and participation in cervical cancer screening programmes.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Kuhlula Maluleke
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Ziningi Nobuhle Jaya
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Ogale YP, Grabowski MK, Nabakka P, Ddaaki W, Nakubulwa R, Nakyanjo N, Nalugoda F, Kagaayi J, Kigozi G, Denison JA, Gaydos C, Kennedy CE. The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286055. [PMID: 36865312 PMCID: PMC9980269 DOI: 10.1101/2023.02.17.23286055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Introduction Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda. Methods Nested within the Rakai Community Cohort Study, we conducted semi-structured interviews with 36 symptomatic and asymptomatic adults who self-collected samples for STI testing. We analyzed the data using an adapted version of the Framework Method. Results Overall, participants did not find SCS physically uncomfortable. Reported acceptability did not meaningfully differ by gender or symptom status. Perceived advantages to SCS included increased privacy and confidentiality, gentleness, and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future. Conclusion Despite a preference for provider-collection, SCS are acceptable among adults in this setting and support expanded access to STI diagnostic services.
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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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Nyabigambo A, Mayega RW, Mendoza H, Shiraz A, Doorbar J, Atuyambe L, Ginindza TG. The preference of women living with HIV for the HPV self-sampling of urine at a rural HIV clinic in Uganda. S Afr J Infect Dis 2022; 37:414. [PMID: 36568333 PMCID: PMC9772712 DOI: 10.4102/sajid.v37i1.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background Women living with HIV have a double risk of acquiring cervical cancer (CC) due to repeated human papilloma virus (HPV) infections resulting from reduced immunity, with CC screening being low at 46.7%. Objectives To determine the factors associated with the preference for HPV self-sampling using urine as well as establish its feasibility among women living with HIV attending a rural HIV clinic in Uganda. Method A cross-sectional study design using quantitative data collection methods was used at the HIV clinic, Luweero District Hospital, among 426 women aged between 30 and 65 years. Data were analysed using descriptive statistics and modified Poisson regression. Urine samples were analysed using a Liferiver high-risk HPV genotyping real-time polymerase chain reaction (PCR) kit to determine the prevalence of the 15 HPV subtypes. Cervical intraepithelial neoplasia 2 (CIN2) was determined by visual inspection under acetic acid (VIA) using the nurse-led approach. Results Most women (296/426, 70%) preferred nurse-led screening. Preference for HPV self-sampling using urine was associated with older age (46-65 years) (adjusted prevalence risk ratios [aPRR] 1.59; 95% confidence interval [CI]: 1.13-2.24), history of sexually transmitted infections (aPRR 0.74: 95% CI: 0.55-0.98) and acquisition of CC information from the television (aPRR 1.48: 95% CI: 1.09-2.02). Approximately 97% (68/70) of women living with HIV tested HPV positive with one or more subtypes. The most prevalent subtype of HPV was HPV 58 (87.1%). Only one woman tested positive with VIA. Conclusion Nurse-led CC screening is preferred among women living with HIV, and HPV self-sampling using urine is feasible at the HIV clinic. Therefore, educational programmes to reassure the masses about urine HPV self-sampling need to be designed. Contribution This study's findings provide early insights into the merits and demerits of the current HPV sample collection approaches. Hence, HPV testing should be tailored to routine HIV care in rural communities.
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Affiliation(s)
- Agnes Nyabigambo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda,Health Economics and HIV/AIDS Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Roy W. Mayega
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Hilbert Mendoza
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Aslam Shiraz
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Feng N, Ezechi O, Uwandu M, Abimbola BS, Vincent GD, Idigbe I, Okoli LC, Adesina M, Okwuzu J, Ahmed RA, Sokei J, Shaibu JO, Momoh AE, Sowunmi O, Labo-Popoola OH, Ohihoin G, David A, Nzeribe E, Olaleye O, Dong XP, Onwuamah CK. Self-collected versus medic-collected sampling for human papillomavirus testing among women in Lagos, Nigeria: a comparative study. BMC Public Health 2022; 22:1922. [PMID: 36243709 PMCID: PMC9569041 DOI: 10.1186/s12889-022-14222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and performance of self-collected vaginal swab samples for HPV screening among women in Lagos, Nigeria. METHODS A cross-sectional study was implemented from March to August 2020 among sexually active women. Study participants provided same-day paired vaginal swab samples. Medic-sampling and poster-directed self-sampling methods were used to collect the two samples per participant. A real-time PCR assay detected HPV 16, HPV 18, other-high-risk (OHR) HPV, and the human β-globin gene. The self-collected samples' sensitivity, specificity, and accuracy were determined against the medic-collected samples using the MedCalc Online Diagnostic Calculator. RESULTS Of the 213 women aged 16 ~ 63-year-old recruited, 187 (88%) participants had concordant results, while 26 (12%) participants had discordant results. Among the 187 concordant results, 35 (19%) were HPV positive, 150 (80%) participants were HPV negative, and two (1%) were invalid. 18 (69%) out of the 26 discordant samples were invalid. The self-collected sample was invalid for 14 (54%) participants. Two (8%) medic-collected samples were invalid. Compared to the medic-collected sample, the self-collected sample was 89.80% (95% CI: 77.77 ~ 96.60%) sensitive and 98.21% (95% CI: 94.87 ~ 99.63%) specific, with an accuracy of 96.31% (95% CI: 92.87 ~ 98.40%). The mean age for HPV positive and negative participants were 39 and 40, respectively, with an ANOVA p-value of 0.3932. The stratification of HPV infection by the age group was not statistically significant (P > 0.05). CONCLUSIONS With high accuracy of 96%, self-collected sampling is adequate when tested with real-time PCR and may increase the uptake of HPV testing. Though more self-collected samples were invalid than medic-collected samples, most likely due to poor collection, they could be identified for repeat testing. Future implementation can avoid this error with improved guidance and awareness.
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Affiliation(s)
- Ning Feng
- Center for Global Public Health, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Oliver Ezechi
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Mabel Uwandu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Bowofoluwa Sharon Abimbola
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Grace Deborah Vincent
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Ifeoma Idigbe
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Leona Chika Okoli
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Mary Adesina
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Jane Okwuzu
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Rahaman Ademolu Ahmed
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Judith Sokei
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Joseph Ojonugwa Shaibu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Abidemi Esther Momoh
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Omowunmi Sowunmi
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Olaoniye Habeebat Labo-Popoola
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | | | - Greg Ohihoin
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Agatha David
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Emily Nzeribe
- Federal Medical Centre, 105 Orlu Road, Owerri, Imo State, Nigeria
| | | | - Xiao-Ping Dong
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Chika Kingsley Onwuamah
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria.
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Asare M, Abah E, Obiri-Yeboah D, Lowenstein L, Lanning B. HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done? Healthcare (Basel) 2022; 10:healthcare10071270. [PMID: 35885798 PMCID: PMC9317927 DOI: 10.3390/healthcare10071270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.
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Affiliation(s)
- Matthew Asare
- Robbins College of Health and Human Services, Department of Public Health, Baylor University, Waco, TX 76798, USA; (E.A.); (B.L.)
- Correspondence: ; Tel.: +1-254-710-4154
| | - Elakeche Abah
- Robbins College of Health and Human Services, Department of Public Health, Baylor University, Waco, TX 76798, USA; (E.A.); (B.L.)
| | - Dorcas Obiri-Yeboah
- School of Medical Sciences, Department of Microbiology and Immunology, University of Cape Coast, Cape Coast, P.O. Box University Mail, Ghana;
| | - Lisa Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Beth Lanning
- Robbins College of Health and Human Services, Department of Public Health, Baylor University, Waco, TX 76798, USA; (E.A.); (B.L.)
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9
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Dzobo M, Dzinamarira T, Kgarosi K, Mashamba-Thompson TP. Human papillomavirus self-sampling for cervical cancer screening among women in sub-Saharan Africa: a scoping review protocol. BMJ Open 2022; 12:e056140. [PMID: 35501094 PMCID: PMC9062804 DOI: 10.1136/bmjopen-2021-056140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Evidence shows that women in sub-Saharan Africa have high rates of cervical cancer (CC) mortality compared with women in high-income countries. Effective screening programmes have significantly reduced the burden of CC in high-income countries. Self-sampling for human papillomavirus testing (HPVSS) has been reported to increase the participation and engagement of women in CC screening. Before HPVSS can be introduced for CC screening there is a need to establish its acceptability among end-users to ensure the increase in CC screening rates. Here, we outline a protocol for a scoping review aimed at mapping literature on the use and acceptability of HPVSS for screening CC in sub-Saharan Africa to reveal gaps to guide future research and practice. METHOD The scoping review protocol was developed according to Arksey and O'Malley and Levac et al, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We will search Scopus, PubMed, Medline Ovid, Cochrane and Web of Science databases for evidence on the use and acceptability of HPVSS published between January 2011 and July 2021. We will also search grey literature in the form of dissertations/theses, conference proceedings, websites of international organisations such as the WHO, and relevant government reports reporting evidence on HPVSS programmes for screening CC among women in sub-Saharan Africa. ETHICS AND DISSEMINATION No ethical approval is needed for the study as it will not include animals or human participants. The results of the proposed scoping review will be disseminated electronically in peer-reviewed journals, in print and through conference presentations.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Kabelo Kgarosi
- Department of Library Services, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
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10
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Cicconi P, Wells C, McCarthy B, Wareing S, Andersson MI, Fox J, Lwanga J, Pal N, Burns F, Woodward C, Malek R, Sabin CA, Dorrell L. Re-valuation of annual cytology using HPV self-sampling to upgrade prevention (REACH UP): A feasibility study in women living with HIV in the UK. HIV Med 2022; 23:390-396. [PMID: 35243750 PMCID: PMC9314078 DOI: 10.1111/hiv.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022]
Abstract
Introduction Current UK guidelines for cervical cancer screening are based on the assumption that most women living with HIV (WLWH) are also high‐risk (HR) human papillomavirus (HPV)‐positive. We aimed to provide data on prevalence of HR‐HPV in WLWH in the UK and to assess feasibility and acceptability of HR‐HPV self‐sampling in this group. Methods Women living with HIV attending six HIV services in London/south of England, with no history of cervical cancer, were enrolled. Participants self‐collected a vaginal swab for the detection of HR‐HPV, completed a survey about sexual/gynaecological history, attitudes towards annual screening and perception of HR‐HPV self‐sampling, and were asked to have their annual cervical smear. Results In all, 67 women were included: 86.5% were of black ethnicity, the median (range) age was 47 (24–60) years, median CD4 T‐cell count was 683 cells/µL [interquartile range (IQR): 527–910], and 95.4% had viral load ≤ 50 copies/mL. All performed the vaginal swab. Eighteen (27%) had no cervical smear results; none of these women attended HIV services where this was routinely offered. No cervical samples were positive for HR‐HPV. Three‐quarters (75.8%) of participants reported adherence to annual screening, with only one woman (1.5%) attending irregularly. On visual analogue scales (from 0 to 100), median (IQR) acceptability and necessity of smear tests were 100 (75–100) and 100 (85–100), respectively. Conclusions Our results suggest that the prevalence of HR‐HPV in WLWH in the UK may be low. Self‐sampling seems to be acceptable, suggesting, if validated, its potential role in supporting less frequent smear testing and improving screening uptake in WLWH.
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Affiliation(s)
- Paola Cicconi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Wells
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Blanka McCarthy
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan Wareing
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Monique Ingrid Andersson
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Nisha Pal
- The Garden Clinic, Upton Hospital, Slough, UK
| | - Fiona Burns
- Institute for Global Health University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Clare Woodward
- HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Ramona Malek
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Caroline Anne Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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11
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Desai S, Zhu MJ, Lapidos-Salaiz I. Cervical cancer prevention: Human papillomavirus testing as primary screening. Cancer 2021; 128:939-943. [PMID: 34767263 DOI: 10.1002/cncr.34006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Abstract
Low- and middle-income countries carry a high burden of preventable cervical cancer cases and deaths. Because human papillomavirus DNA-based testing is increasingly becoming the preferred method of screening for cervical cancer prevention, this commentary discusses next steps and key considerations for its expansion.
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Affiliation(s)
- Shreya Desai
- US Agency for International Development, Washington, DC
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12
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Tiiti TA, Mashishi TL, Nkwinika VV, Molefi KA, Benoy I, Bogers J, Selabe SG, Lebelo RL. Evaluation of ILEX SelfCerv for Detection of High-Risk Human Papillomavirus Infection in Gynecology Clinic Attendees at a Tertiary Hospital in South Africa. J Clin Med 2021; 10:jcm10214817. [PMID: 34768334 PMCID: PMC8584638 DOI: 10.3390/jcm10214817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The SelfCerv Self-Collection Cervical Health Screening Kit (Ilex Medical Ltd., Johannesburg, South Africa) is an applicator tampon designed for self-collection of vaginal samples for the detection of human papillomavirus (HPV) deoxyribonucleic acid (DNA) and E6/E7 messenger ribonucleic acid (mRNA). The study aimed to evaluate the performance of the SelfCerv applicator tampon for the detection of hr-HPV for cervical cancer screening, and further to investigate women's experiences and preferences regarding self-sampling. METHODS Vaginal samples were collected from 527 gynecology clinic attendees aged ≥18 years at a tertiary hospital in Gauteng Province, South Africa. Self-samples were collected using the SelfCerv kit, followed by endocervical samples collected by a healthcare professional using Cervex-Brush® Combi. Participants completed a self-administered questionnaire on self-sampling experiences and preferences. Both samples were tested for 14 high-risk (hr) HPV types and E6/E7 mRNA using the Abbott RealTime HR-HPV and Aptima HR-HPV mRNA assays, respectively. RESULTS The overall agreement for hr-HPV typing between 527 paired samples was good (87.1%; κ =0.74) with high sensitivity (86.2%) and specificity (88.0%). HPV-16 (96.4%; κ = 0.83) had higher agreement rate than HPV-18 (96.8%; κ = 0.72) and the other 12 hr-HPVs (86.5%; κ = 0.72). Two hundred and eighty-five (285) sample pairs tested for E6/E7 mRNA showed fair agreement (70.2%; κ= 0.34). Furthermore, self-sampling was reported as comfortable (90.5%) and painless (86.7%), with 88.4% of women preferring self-collection. CONCLUSIONS Self-collected samples had good agreement with the healthcare professional-collected samples for the detection of hr-HPV DNA and the procedure was highly preferred by women. Self-sampling using SelfCerv can be used as an alternative to healthcare professional sampling in clinic-based routine cervical cancer screening.
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Affiliation(s)
- Teboho Amelia Tiiti
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
| | - Tebogo Loraine Mashishi
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Kgotlaethata Aaron Molefi
- Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Ina Benoy
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
| | - Johannes Bogers
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
- Department of Anatomical Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Selokela Gloria Selabe
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Ramokone Lisbeth Lebelo
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Correspondence: ; Tel.: +27-12521-3038
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13
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Tiiti TA, Mashishi TL, Nkwinika VV, Benoy I, Selabe SG, Bogers J, Lebelo RL. High-risk human papillomavirus detection in self-collected vaginal samples compared with healthcare worker collected cervical samples among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa. Virol J 2021; 18:192. [PMID: 34556128 PMCID: PMC8461856 DOI: 10.1186/s12985-021-01662-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, the South African National Department of Health (NDoH) Cervical Cancer Prevention and Control Policy was revised. Human papillomavirus (HPV) testing on self-collected samples may offer improved screening uptake. The objectives of the study were to compare the positivity of high-risk (hr)-HPV deoxyribonucleic acid (DNA) and hrHPV viral messenger ribonucleic acid (mRNA) between healthcare worker-collected cervical and self-collected vaginal samples and investigate the accuracy of the applicator-tampon-based self-collected samples in detecting hrHPV DNA and hrHPV mRNA. METHODS A total of 527 women aged 18 years and older and seeking gynecology services at a tertiary hospital in Pretoria, South Africa, were enrolled. Vaginal samples were self-collected using SelfCerv applicator tampon, followed by cervical samples collected by a healthcare worker using a Cervex Brush® Combi. Both samples were tested with the Abbott m2000 analyzer for 14-hrHPV types and 285 paired samples were tested for hrHPV E6/E7 mRNA using the Aptima HR-HPV mRNA assay. The prevalence of hrHPV DNA and hrHPV E6/E7 mRNA was estimated and the positivity between the two collection methods was compared for the total group as well as per age group. RESULTS HrHPV prevalence was 48.0% (95% CI 43.7-52.4) among healthcare worker collected samples and 47.6% (95% CI 43.3-52.0) among self-collected samples. There was no difference in positivity between healthcare worker collection (48.0%) and applicator-tampon-based self-collection, 47.6% (p-value = 0.90). The proportions of hrHPV were equal between the age groups as shown by the McNemar test (p = 0.9036) results for correlated proportions. The prevalence of hrHPV mRNA was 78.6% (95% CI 73.4-83.2) and 58.6% (95% CI 52.6-64.4) for healthcare worker- and self-collection, respectively. The McNemar test for correlated proportions was highly significant (p < 0.0001), indicating that the hrHPV mRNA proportions are not comparable, although this differed between age groups. CONCLUSIONS Applicator-tampon-based self-collection has a comparable hrHPV DNA positivity rate as healthcare worker collection but different positivity rates for hrHPV mRNA. Self-sampling showed high concordance with healthcare worker-collected sampling for hrHPV DNA detection, especially regarding HPV 16/18 detection. HrHPV DNA was equally detected between the total group as well as per age group. Implementation of self-sampling using an applicator tampon as a primary screening tool may be considered.
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Affiliation(s)
- Teboho Amelia Tiiti
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Tebogo Loraine Mashishi
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ina Benoy
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.,Algemeen Medisch Laboratorium (AML), Sonic Healthcare, Antwerpen, Belgium
| | - Selokela Gloria Selabe
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,National Health Laboratory Service/Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johannes Bogers
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.,Algemeen Medisch Laboratorium (AML), Sonic Healthcare, Antwerpen, Belgium.,Department of Anatomical Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ramokone Lisbeth Lebelo
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa. .,South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa. .,National Health Laboratory Service/Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
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14
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Tesfahunei HA, Ghebreyesus MS, Assefa DG, Zeleke ED, Acam J, Joseph M, Getachew E, Kajogoo VD, Bekele D, Manyazewal T. Human papillomavirus self-sampling versus standard clinician-sampling for cervical cancer screening in sub-Saharan Africa: a systematic review and meta-analysis of randomized controlled trials. Infect Agent Cancer 2021; 16:43. [PMID: 34147103 PMCID: PMC8214270 DOI: 10.1186/s13027-021-00380-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection remains a major health threat in sub-Saharan Africa (SSA). HPV self-sampling could help find and treat cervical cancer at an early stage. We aimed to evaluate the effectiveness of HPV self-sampling over the standard health facility-based clinician-sampling for cervical cancer screening through a systematic review and meta-analysis of available randomized controlled trials. METHOD We searched PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, and the WHO Global Health Library for articles in SSA published as of 31 May 2020. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for the design and reporting of the results. We included randomized control trials that compared HPV self-sampling with the standard of care. The primary endpoint was uptake of cervical cancer screening service. The secondary endpoints were linkage to care, acceptability, screening frequency, and adverse events. We used RevMan V.5.3 software for statistical analysis. We computed random-effect model to provide pooled estimates of available data and I-squared (I2) test to assess heterogeneity. RESULT Of 77 citations, we included four trials from Nigeria, Ethiopia, Kenya, and Uganda, encompassing 8200 participants with age ranging from 25 to 65 years. The pooled analysis showed significantly higher uptake of cervical cancer screening in women who used HPV self-sampling (risk ratio [RR] 1.72, 95% CI 1.58-1.87; p = 0.01), while this had a considerable heterogeneity as explained by subgroup analysis. Uptake was higher in women who were offered sampling kit at home or work (RR 2.05, 95% CI 1.80-2.33) and those who's kit was mailed to or invited to a nearby health center (RR 1.65, 95% CI 1.58-1.72, I2 = 0%) than those screened with the standard of care. There was no difference between the two groups in the rate of linkage to care of positive cases (RR 1.30, 95% CI 0.90-2.74, I2 = 91%). HPV self-sampling was acceptable and easy to use. None of the trials compared the frequency of screening or adverse events. CONCLUSION HPV self-sampling is an effective and feasible alternative to the standard health facility-based clinician-sampling for cervical cancer screening in SSA. It could improve the uptake of cervical cancer screening and harness the global strategy towards elimination of cervical cancer by 2030.
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Affiliation(s)
- Hanna Amanuel Tesfahunei
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Hager Biomedical Research Institute, Asmara, Eritrea
| | | | - Dawit Getachew Assefa
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Eden Dagnachew Zeleke
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Midwifery, College of Health Science, Bule-Hora University, Bule-Hora, Ethiopia
| | - Joan Acam
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Pope John’s Hospital Aber, Oyam District, Uganda
| | - Michele Joseph
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
| | - Emnet Getachew
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Arsi University, Asella, Ethiopia
| | - Violet Dismas Kajogoo
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Mafia District Hospital, Mafia Island, Tanzania
| | - Delayehu Bekele
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
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15
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Multimodality screening and prevention of cervical cancer in sub-Saharan Africa: a collaborative model. Curr Opin Obstet Gynecol 2021; 32:28-35. [PMID: 31804231 DOI: 10.1097/gco.0000000000000597] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Although cervical cancer continues to decrease in incidence throughout the developed world because of rigorous screening and vaccination campaigns, the disease remains a major cause of cancer-related morbidity and mortality in resource-limited regions including sub-Saharan Africa. This review summarizes current efforts to implement cost-effective and widespread cervical cancer education, screening, and community-based interventions in Africa and the challenges faced by local healthcare workers. RECENT FINDINGS Effective screening with cytology (with or without high-risk human papillomavirus [HPV] DNA testing) as well as HPV self-sampling remains problematic in African countries because of a paucity of cytopathologists and resources. Accordingly, visual inspection of the cervix with acetic acid (VIA) with cryotherapy triage has gained traction in mass-screening campaigns because of low-cost supplies. SUMMARY Public education to facilitate screening is essential. VIA remains a strong community-based approach. The involvement of technology in teaching local providers, advertising screenings to the community, and helping improve follow-up may also improve screening efforts. Ultimately, the best form of prevention is through HPV vaccination, which also requires implementation of ongoing public education programs.
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16
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Chatzistamatiou K, Vrekoussis T, Tsertanidou A, Moysiadis T, Mouchtaropoulou E, Pasentsis K, Kitsou A, Moschaki V, Ntoula M, Zempili P, Halatsi D, Truva T, Piha V, Agelena G, Daponte A, Vanakara P, Paschopoulos M, Stefos T, Lymberis V, Kontomanolis EN, Makrigiannakis A, Deligeoroglou E, Panoskaltsis T, Adonakis G, Michail G, Stamatopoulos K, Agorastos T. Acceptability of Self-Sampling for Human Papillomavirus-Based Cervical Cancer Screening. J Womens Health (Larchmt) 2020; 29:1447-1456. [DOI: 10.1089/jwh.2019.8258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kimon Chatzistamatiou
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Thomas Vrekoussis
- Department of Obstetrics and Gynecology, University of Crete, Herakleion University Hospital, Herakleion, Greece
| | - Athena Tsertanidou
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Centre for Research & Technology—Hellas, Thessaloniki, Greece
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Konstantinos Pasentsis
- Institute of Applied Biosciences, Centre for Research & Technology—Hellas, Thessaloniki, Greece
| | - Anastasia Kitsou
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Viktoria Moschaki
- Department of Neonatology, Hippokratio General Hospital, Midwifery Association of Thessaloniki, Thessaloniki, Greece
| | - Maria Ntoula
- Primary Health Care Unit 25th Martiou, Thessaloniki, Midwifery Network Coordinator, 4th Health District, Thessaloniki, Greece
| | - Paraskevi Zempili
- Department of Obstetrics and Gynecology, General Hospital of Komotini, Midwifery Association of Thrace, Komotini, Greece
| | - Despina Halatsi
- Department of Obstetrics and Gynecology, Hatzikosta General Hospital of Ioannina, Midwifery Association of Ioannina, Ioannina, Greece
| | - Theoni Truva
- Health Center Palama, Midwifery Association of Larissa, Karditsa, Greece
| | - Vaia Piha
- Department of Obstetrics and Gynecology, General Hospital of Chania, Midwifery Association of Crete, Chania, Greece
| | - Georgia Agelena
- Department of Obstetrics and Gynecology, General Hospital of Korinth, Midwifery Association of Nafplion, Korinth, Greece
| | - Alexandros Daponte
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa University Hospital, Larissa, Greece
| | - Polyxeni Vanakara
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa University Hospital, Larissa, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina University Hospital, Ioannina, Greece
| | - Theodoros Stefos
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina University Hospital, Ioannina, Greece
| | - Vasilis Lymberis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, University of Crete, Herakleion University Hospital, Herakleion, Greece
| | - Efthimios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, National Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Theodoros Panoskaltsis
- 2nd Department of Obstetrics and Gynecology, National Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - George Adonakis
- Department of Obstetrics and Gynecology, University of Patras, Patras University Hospital, Patras, Greece
| | - George Michail
- Department of Obstetrics and Gynecology, University of Patras, Patras University Hospital, Patras, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research & Technology—Hellas, Thessaloniki, Greece
| | - Theodoros Agorastos
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
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