title: High-risk human papillomavirus messenger RNA testing in physician- and self-collected specimens for cervical lesion detection in high-risk women, Kenya.
abstract: BACKGROUND
  Little is known about the performance of physician-versus self-collected specimens for high-risk human papillomavirus (hrHPV) messenger RNA (mRNA) testing or risk factors for hrHPV mRNA positivity in physician- versus self-collected specimens. We compared the performance of hrHPV mRNA testing of physician- and self-collected specimens for detecting cytological high-grade squamous intraepithelial lesions or more severe (≥HSIL) and examined risk factors for hrHPV mRNA positivity in female sex workers in Nairobi.
  
  
  METHODS
  From 2009 to 2011, 344 female sex workers participated in this cross-sectional study. Women self-collected a cervicovaginal specimen. A physician conducted a pelvic examination to obtain a cervical specimen. Physician- and self-collected specimens were tested for hrHPV mRNA and sexually transmitted infections using APTIMA nucleic acid amplification assays (Hologic/Gen-Probe Incorporated, San Diego, CA). Cervical cytology was conducted using physician-collected specimens and classified according to the Bethesda criteria.
  
  
  RESULTS
  Overall hrHPV mRNA prevalence was similar in physician- and self-collected specimens (30% vs. 29%). Prevalence of ≥HSIL was 4% (n = 15). Overall sensitivity of hrHPV testing for detecting ≥HSIL was similar in physician-collected (86%; 95% CI, 62%-98%; 13 cases detected) and self-collected specimens (79%; 95% CI, 55%-95%; 12 cases detected). Overall specificity of hrHPV mRNA for ≥HSIL was similar in both physician-collected (73%; 95% CI, 68%-79%) and self-collected (75%; 95% CI, 70%-79%) specimens. High-risk HPV mRNA positivity in both physician- and self-collected specimens seemed higher in women who were younger (<30 years), had Trichomonas vaginalis or Mycoplasma genitalium infections, or had more than 8 years of educational attainment.
  
  
  CONCLUSIONS
  Self-collected specimens for hrHPV mRNA testing seemed to have similar sensitivity and specificity as physician-collected specimens for the detection of ≥HSIL among high-risk women.
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. jieting@email.unc.edu
authors: Jie
authors: J
authors: Ting
authors: Nelly
authors: N
authors: Mugo
authors: Jessie
authors: J
authors: Kwatampora
authors: Craig
authors: C
authors: Hill
authors: Michael
authors: M
authors: Chitwa
authors: Suha
authors: S
authors: Patel
authors: Hannah
authors: H
authors: Gakure
authors: Joshua
authors: J
authors: Kimani
authors: Victor J
authors: VJ
authors: Schoenbach
authors: Charles
authors: C
authors: Poole
authors: Jennifer S
authors: JS
authors: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D012333:RNA, Messenger / Q000235:genetics; D012307:Risk Factors; D012680:Sensitivity and Specificity; D060386:Sex Workers; D015229:Sexually Transmitted Diseases, Viral / Q000175:diagnosis* / Q000821:virology; D013048:Specimen Handling / Q000379:methods* / Q000592:standards; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
chemical_list: D004279:DNA, Viral; D012333:RNA, Messenger