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