For Human Papillomavirus Self-Sampling, Stated Willingness Does Not Correspond With Subsequent Uptake by Rural Malawian Women

• Published in: Sexually transmitted diseases Vol. 47; no. 4; pp. 275 - 279
• Main Authors: Hood, Robert B., Turner, Abigail Norris, Huber-Krum, Sarah, Lancaster, Kathryn E., Mwapasa, Victor, Poindexter, Tiara, Nampandeni, Patrick, Esber, Allahna, Norris, Alison H.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-04-2020; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Cancer; Cervical cancer; Cervix; Collection; Confidence intervals; Correlation analysis; Female; Human papillomavirus; Humans; Intention; Longitudinal Studies; Malawi - epidemiology; Mass Screening - methods; Medical screening; Papillomaviridae; Papillomavirus Infections - diagnosis; Papillomavirus Infections - prevention & control; Patient Acceptance of Health Care - statistics & numerical data; Perceived control; Population Surveillance; Rural communities; Rural Population; Sampling; Self Care; Specimen Handling; Tests; Uptake; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Vagina; Viruses; Willingness; Women; Malawi
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/OLQ.0000000000001119

Human papilloma virus (HPV), the causative agent for cervical cancer, can be tested for using self-collected vaginal samples. Self-collection is promising for HPV screening in hard-to-reach populations. To assess the relationship between willingness to self-collect and subsequent uptake of self-collection, we conducted a longitudinal study of reproductive-age women in rural Malawi.
At baseline, we asked women if they would be willing to self-collect a vaginal sample for HPV testing. At follow-up (12-18 months later), we offered the same women the opportunity to self-collect a sample for HPV testing. We examined unadjusted and adjusted associations between baseline willingness to self-collect a sample for HPV testing and uptake of self-collection at follow-up using log-binomial models.
Among 122 women who, at baseline, indicated willingness to self-collect, n = 65 (53%) agreed to self-collect a sample at follow-up. Of 64 women who stated unwillingness at baseline to self-collect, n = 30 (47%) self-collected a sample for testing at follow-up. We observed no association between women's willingness at baseline and their observed self-collection decision at follow-up (unadjusted prevalence ratio, 1.14; 95% confidence interval, 0.83-1.55). The association remained null after adjustment for age, awareness of cervical cancer, and perceived behavioral control.
Our results suggest that evaluation of acceptability of self-collection should go beyond simply asking women if they would be willing to self-collect a vaginal sample. Given that half of this study's participants agreed to self-collect a sample when the opportunity was offered, regardless of their previously stated preferences, self-collection should be offered to everyone.