title: Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador.
abstract: OBJECTIVE
  To determine the acceptability of self-collected versus provider-collected sampling among women participating in public sector HPV-based cervical cancer screening in El Salvador.
  
  
  METHODS
  Two thousand women aged 30-49 years underwent self-collected and provider-collected sampling with careHPV between October 2012 and March 2013 (Qiagen, Gaithersburg, MD, USA). After sample collection, a random sample of women (n=518) were asked about their experience. Participants were questioned regarding sampling method preference, previous cervical cancer screening, HPV and cervical cancer knowledge, HPV risk factors, and demographic information.
  
  
  RESULTS
  All 518 women approached to participate in this questionnaire study agreed and were enrolled, 27.8% (142 of 511 responding) of whom had not received cervical cancer screening within the past 3 years and were considered under-screened. Overall, 38.8% (n=201) preferred self-collection and 31.9% (n=165) preferred provider collection. Self-collection preference was associated with prior tubal ligation, HPV knowledge, future self-sampling preference, and future home-screening preference (P<0.05). Reasons for self-collection preference included privacy/embarrassment, ease, and less pain; reasons cited for provider-collection preference were result accuracy and provider knowledge/experience.
  
  
  CONCLUSIONS
  Self-sampling was found to be acceptable, therefore screening programs could consider offering this option either in the clinic or at home. Self-sampling at home may increase coverage in low-resource countries and reduce the burden that screening places upon clinical infrastructure.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, USA; Fulbright US Student Program, US Department of State, WA, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Rosenbaum
authors.affiliation: Department of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.affiliation: Basic Health International, San Salvador, El Salvador.
authors.forename: Karla M
authors.initials: KM
authors.lastname: Alfaro
authors.affiliation: Basic Health International, San Salvador, El Salvador.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Ditzian
authors.affiliation: Basic Health International, San Salvador, El Salvador.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Maza
authors.affiliation: University of AL at Birmingham, Birmingham, USA.
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Scarinci
authors.affiliation: Department of Pathology, University of Southern CA, Los Angeles, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Felix
authors.affiliation: Global Cancer Institute, Chestertown, USA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.affiliation: Ministry of Health of El Salvador, San Salvador, El Salvador.
authors.forename: Sofia
authors.initials: S
authors.lastname: Villalta
authors.affiliation: Ministry of Health of El Salvador, San Salvador, El Salvador.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Miranda
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, USA; Basic Health International, San Salvador, El Salvador. Electronic address: cremerm@mail.magee.edu.
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Cremer
mesh_terms: D000328:Adult; D001294:Attitude to Health; D055088:Early Detection of Cancer; D004544:El Salvador; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012424:Rural Population; D012648:Self Care; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods*
keywords: Acceptability; Cervical cancer; HPV; Latin America; Self-sampling