title: Primary screening for cervical cancer through self sampling.
abstract: OBJECTIVE
  To evaluate the use of community health agents (CHAs) to instruct women living in poor rural areas in obtaining self-collected cervical samples and compare the high-risk HPV (hrHPV) hybrid capture (HC) results obtained to those for gynecologist-collected samples.
  
  
  METHODS
  After a one-day training, CHAs visited sexually active women, instructing each in the use of collection brush and the Universal Collection Medium tube. One week thereafter, a gynecologist collected cervical samples from, and performed colposcopies on, the same women. A single reference lab performed all HCs.
  
  
  RESULTS
  878 women (Age: 15-69 years) participated. Among self-collected samples, hrHPV prevalence was 33.9% (95% CI: 30.8%-37%), compared with 28.6% (95% CI: 27%-30%) among gynecologist-collected samples. However, 9.3% of the patients were HPV HC II-positive in the self-collected sample and HPV HC II-negative in the gynecologist-collected samples (95% CI: 7.38%-11.22%), whereas 4% tested positive in gynecologist-collected samples and negative in self-collected samples (95% CI: 2.7%-5.3%) (P<0.01; kappa=0.7). Of 9 cases of histologically-confirmed, high-grade squamous intraepithelial lesion, self-collected and provider-collected samples missed one each.
  
  
  CONCLUSIONS
  Self-collected vaginal sampling could be made an additional CHA function under existing program conditions, improving access to cervical cancer screening in poor rural settings.
authors.affiliation: State of Ceará Secretary of Health, Fortaleza, Brazil. Holanda_junior@msn.com
authors.forename: F
authors.initials: F
authors.lastname: Holanda
authors.forename: A
authors.initials: A
authors.lastname: Castelo
authors.forename: T M C W
authors.initials: TM
authors.lastname: Veras
authors.forename: F M L
authors.initials: FM
authors.lastname: de Almeida
authors.forename: M Z
authors.initials: MZ
authors.lastname: Lins
authors.forename: G B
authors.initials: GB
authors.lastname: Dores
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002584:Cervix Uteri / Q000821:virology*; D003153:Community Health Services; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D010353:Patient Education as Topic; D011203:Poverty; D012424:Rural Population; D012648:Self Care / Q000379:methods*; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000821:virology*