Human papillomavirus (HPV) testing on self-collected specimens: perceptions among HIV positive women attending rural and urban clinics in South Africa.
BACKGROUND
Cervical cancer is the most common cancer among women in Sub-Saharan Africa. Cervical cancer is treatable if detected timeously, yet only 20% of South African women have ever been for a Pap smear in their lifetime due to limited access to screening, transport or child care responsibilities.


OBJECTIVE
To evaluate the acceptability of self-collection for cervical cancer screening. We aimed to identify which self-collection device women prefer and if they would consider using them for routine cervical cancer screening.


METHODS
HIV-positive women (>18 years) from urban and rural HIV clinics were interviewed following an education session on HIV, human papillomavirus (HPV) and cervical cancer. Participants were shown three self-collection devices; (i) an Evalyn cervical brush, (ii) a Delphilavager and (iii) a tampon-like plastic wand before completing a short questionnaire.


RESULTS
A total of 106 women from the urban (n = 52) and rural (n = 54) clinic were interviewed. Overall 51% of women preferred the cervical brush, while fewer women preferred the tampon-like plastic wand (31%) or lavage sampler (18%). More than 75% of women from the rural site preferred the cervical brush, compared to 22% from the urban site (p < 0.001). Women from the urban clinic preferred the tampon-like plastic wand (45%) and then the lavage sampler (33%), as compared to women from the rural clinic (19% and 4%, respectively).


CONCLUSIONS
Women from urban or rural settings had different preferences for the various self-collection devices. Patient self-collection with HPV testing may be an acceptable way to improve coverage to cervical cancer screening in high risk HIV-seropositive women.
Right to Care, Johannesburg, South Africa.
Kay
K
Mahomed
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Denise
D
Evans
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Celeste
C
Sauls
Department of Medical Virology, University of Pretoria, National Health Laboratory Service, Pretoria, South Africa.
Karin
K
Richter
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, United States of America.
Jennifer
J
Smith
Right to Care, Johannesburg, South Africa ; Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Cindy
C
Firnhaber
D000328:Adult; D001294:Attitude to Health; D059026:Diagnostic Self Evaluation; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006679:HIV Seropositivity / Q000821:virology; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D057240:Patient Preference; D019035:Rural Health Services; D013019:South Africa; D013048:Specimen Handling; D011795:Surveys and Questionnaires; D019037:Urban Health Services; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology*
HIV-positive women; South Africa; acceptability; cervical cancer; human papillomavirus; resource-limited setting; self-collection