Self sampling HPV testing as cervical cancer screening approach among women living in low-middle-income -countries: Systematic review and Meta-analysis.
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Date
2021
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Addis Abeba University
Abstract
Background: More than 85% of cervical cancer deaths occur in low-middle-income countries,
and 90% of the mortality burden is primarily attributed to low coverage of cervical cancer
screening. Self-sampling HPV could increase the overall cervical screening and contribute to
alleviating the burden of cervical cancer in LMICs (low-middle-income countries)
Objective: The general objective of this review and meta-analysis was to see if self-sampling HPV
screening method can increase uptake of cervical cancer screening in low-middle-income
countries.
Methods: CENTRAL (Cochrane Central Registry of controlled trials), MEDLINE (through
PubMed), Clinicaltrial.gov, WHO Global Health Library, and EMBASE were searched. Reference
lists of the relevant studies found were assessed to further search for relevant studies. The MeSH
terms for HPV (MeSH (DNA Probes, HPV) (Human Papillomavirus DNA Tests)) and cervical
cancer MeSH term (uterine cervical neoplasms) were found and as for the term self-sampling,
there was no MeSH term found therefore method of text words/synonyms (Self-sampling, Selfcollection,
Self-obtained) for self-sampling was used. For the LMIC, LMIC filter prepared by
Cochrane from all LMIC countries listed by World bank was used. Where multiple studies reported
the same comparable outcome of interest, we conducted a metaanalysis. Random-effects models
was used to generate pooled effect size of relative risk with a 95% confidence interval using RevMan
5.4.
Results: Six RCTs (randomized control trials) were included in this review. The studies were from
Ethiopia, Kenya, Nigeria, Uganda, Argentina, and Mexico. These studies included a total of 39,274
participants with in the age group ranged from 25 – 65 years. All the studies compared an
interventional group of HPV self-sampling method with a control group of a standard of care. HPV
self-sampling was reported to be acceptable, and participants stated the device was easy to use and
they would use HPV self-sampling instead of the regular hospital screening in the future. There were
no adverse events associated with the self-sampling device. In the meta-analysis, uptake of cervical
cancer screening services showed that the likelihood of participants to use self-sampling HPV
screening method was 75% higher than with standard of care (RR: 1.72, 95% CI 1.58 to 1.87, Isquared:
72%) with insignificant I2, (MODERATE quality of evidence). However, there was no
difference between linkage to care between the two groups (RR=1.18, 95% CI 0.77 to 1.81, I2=
87%) (VERY LOW quality of evidence).
Conclusion: Self-sampling HPV screening technique has the potential to increase the uptake of
cervical cancer screening in LMICs, and is acceptable by women. Moreover, this technique helps
overcome many barriers to cervical cancer screening in LMICs such as lack of trained personnel,
lack of laboratory supplies, infrastructure, socio-religious and cultural barriers to pelvic examination,
limited physical access to patient populations, and the need for spousal permission. As this can reduce social inequalities in access to cervical screening, it helps alleviate the cervical cancer burden
in LMICs.
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Keywords
HPV testing,Cervical cancer ,women