title: Uptake of community-based, self-collected HPV testing vs. visual inspection with acetic acid for cervical cancer screening in Kampala, Uganda: preliminary results of a randomised controlled trial.
abstract: OBJECTIVE
  To compare two cervical cancer screening methods: community-based self-collection of high-risk human papillomavirus (HR-HPV) testing and visual inspection with acetic acid (VIA).
  
  
  METHODS
  Pilot randomised controlled trial of 500 women aged 30-65 in the community of Kisenyi, Uganda. Women randomised to self-collection-based HR-HPV testing provided a cervico-vaginal swab for HR-HPV, and results were provided by phone after laboratory testing. Women who tested HPV positive were referred for VIA at the local health unit. Women randomised to VIA underwent screening at the local health unit, where women who tested positive with VIA were provided cryotherapy at time of screening, as per local standard of care. Women were referred for colposcopy when indicated. Outcome measures were uptake of screening, HR-HPV prevalence, VIA result and treatment rates.
  
  
  RESULTS
  In the HR-HPV arm, 248 of 250 (p < 0.01) women provided samples, while in the VIA arm, 121 of 250 (48.4%) women attended screening. Among the 73 of 248 HR-HPV-positive women, 45.2% (N = 33) attended VIA screening for follow-up, 21.2% (N = 7) of whom screened positive; five received treatment and two were missing clinical follow-up records. Of the 121 women in the VIA arm who attended screening, 13.2% (N = 16) screened positive; seven received cryotherapy, three refused treatment, five were referred to colposcopy; and one woman had suspected cervical cancer and received treatment after confirmatory testing.
  
  
  CONCLUSIONS
  This pilot study demonstrated trial feasibility and willingness of the women to participate and be randomised successfully into the two arms. Self-collection-based cervical cancer screening had a higher uptake than VIA.
authors.affiliation: Women's Health Research Institute, Vancouver, BC, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Moses
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Pedersen
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Sheona M
authors.initials: SM
authors.lastname: Mitchell
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Musa
authors.initials: M
authors.lastname: Sekikubo
authors.affiliation: Kisenyi Health Unit, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Mwesigwa
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Singer
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Christine
authors.initials: C
authors.lastname: Biryabarema
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Josaphat K
authors.initials: JK
authors.lastname: Byamugisha
authors.affiliation: Women's Health Research Institute, Vancouver, BC, Canada.|University of British Columbia, Vancouver, BC, Canada.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Money
authors.affiliation: Women's Health Research Institute, Vancouver, BC, Canada.|University of British Columbia, Vancouver, BC, Canada.
authors.forename: Gina S
authors.initials: GS
authors.lastname: Ogilvie
mesh_terms: D019342:Acetic Acid; D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D010865:Pilot Projects; D012648:Self Care / Q000379:methods; D013048:Specimen Handling / Q000379:methods; D014454:Uganda; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid
keywords: auto-collection; autorecolección; cancer du col utérin; cervical cancer; communautaire; community based; comunitario; cribado; cáncer cervical; dépistage; human papillomavirus; papillomavirus humain; screening; self-collection; virus del papiloma humano