title: Assessment of high-risk human papillomavirus infections using clinician- and self-collected cervical sampling methods in rural women from far western Nepal.
abstract: BACKGROUND
  Nepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening.
  
  
  METHODS
  Study participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA.
  
  
  RESULTS
  Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3-13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43-0.81), indicating a "good" level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%).
  
  
  CONCLUSIONS
  This is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services.
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Derek C
authors: DC
authors: Johnson
authors: College of Public Health, Kent State University, Kent, Ohio, United States of America.
authors: Madhav P
authors: MP
authors: Bhatta
authors: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors: Jennifer S
authors: JS
authors: Smith
authors: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America; Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Mirjam-Colette
authors: MC
authors: Kempf
authors: Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Thomas R
authors: TR
authors: Broker
authors: Vanderbilt University, Institute for Global Health, Nashville, Tennessee, United States of America.
authors: Sten H
authors: SH
authors: Vermund
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Eric
authors: E
authors: Chamot
authors: Nepal Family Health Division, Kathmandu, Nepal.
authors: Shilu
authors: S
authors: Aryal
authors: Nepal Fertility Care Center, Kathmandu, Nepal.
authors: Pema
authors: P
authors: Lhaki
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Sadeep
authors: S
authors: Shrestha
mesh_terms: D000293:Adolescent; D000328:Adult; D001519:Behavior; D003710:Demography; D005260:Female; D006801:Humans; D017056:Medical Laboratory Personnel / Q000706:statistics & numerical data*; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D027383:Papillomaviridae / Q000235:genetics / Q000502:physiology*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D018570:Risk Assessment; D012424:Rural Population / Q000706:statistics & numerical data*; D018401:Sample Size; D013048:Specimen Handling / Q000379:methods*; D014626:Vaginal Smears / Q000379:methods*; D055815:Young Adult
chemical_list: D012333:RNA, Messenger