HPV self-sampling as a cervical screening strategy in sub-Saharan Africa: A scoping review

Authors: Lott BE, Baum C, Trejo MJ, McClelland J, Adsul P, Madhivanan P, Carvajal S, Ernst K, Ehiri JE

Category: Global Cancer Research
Conference Year: 2020

Abstract Body:
Purpose To assess HPV self-sampling as a strategy to improve uptake of cervical cancer screening in sub-Saharan Africa (SSA). Methods A systematic search of four databases (PubMed, Web of Science, Embase, CINAHL) was conducted through May 2019 to identify studies that assessed the effect of HPV self-sampling on uptake of cervical cancer screening for asymptomatic adult women in sub-Saharan Africa. Multiple reviewers conducted screening and data extraction. Results Of 3,704 search results, four studies assessed HPV testing with self-sampling. One before-and- after study and three randomized control trials were set in South Africa, Nigeria, Uganda, and Kenya. Self-sampling was implemented through community-based education in a variety of settings: sample collection kits were distributed to women, aged 25 to 65, in their homes and workplaces, at a school, and in community pop-up tents. Two studies used community health workers to collect completed kits; one had women return their samples to a school; one offered postal delivery and designated drop-off point return options. The school-based intervention combined cancer prevention services by offering cervical screening for mothers and HPV vaccination for daughters in grades 4-7. All four interventions resulted in significant increases in screening uptake compared to facility-based screening, with coverage ranging from 58.9% to 99.2%. Conclusions The limited available evidence suggests that community-based self-sampling for HPV testing may be effective for increasing cervical cancer screening in SSA. Difficulty notifying participants of test results by phone was one challenge compared to other “screen-and-treat” strategies. While most women were compliant with requests for HPV samples, self-reported screening rates lower than the number of samples collected suggests women may not have fully understood the test’s purpose. Benefits of HPV self-sampling include high coverage and improved efficiency by triaging out HPV-negative women, freeing up health workers to focus screening for high-risk HPV-positive women. Future studies may compare HPV self-sampling in different community settings, address opportunities for improved patient notification, and assess cancer-related health outcomes of HPV testing.

Keywords: cervical cancer screening, HPV testing, self-sampling, sub- Saharan Africa