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 cancerscreening. Self-sampling HPV could increase the overall cervical screening and contribute toalleviating 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 HPVscreening method can increase uptake of cervical cancer screening in low-middle-incomecountries.
Methods: CENTRAL (Cochrane Central Registry of controlled trials), MEDLINE (throughPubMed), Clinicaltrial.gov, WHO Global Health Library, and EMBASE were searched. Referencelists of the relevant studies found were assessed to further search for relevant studies. The MeSHterms for HPV (MeSH (DNA Probes, HPV) (Human Papillomavirus DNA Tests)) and cervicalcancer 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 byCochrane from all LMIC countries listed by World bank was used. Where multiple studies reportedthe same comparable outcome of interest, we conducted a metaanalysis. Random-effects modelswas used to generate pooled effect size of relative risk with a 95% confidence interval using RevMan5.4.
Results: Six RCTs (randomized control trials) were included in this review. The studies were fromEthiopia, Kenya, Nigeria, Uganda, Argentina, and Mexico. These studies included a total of 39,274participants with in the age group ranged from 25 – 65 years. All the studies compared aninterventional group of HPV self-sampling method with a control group of a standard of care. HPVself-sampling was reported to be acceptable, and participants stated the device was easy to use andthey would use HPV self-sampling instead of the regular hospital screening in the future. There wereno adverse events associated with the self-sampling device. In the meta-analysis, uptake of cervicalcancer screening services showed that the likelihood of participants to use self-sampling HPVscreening 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 nodifference 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 ofcervical cancer screening in LMICs, and is acceptable by women. Moreover, this technique helpsovercome 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 burdenin LMICs.
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Keywords
HPV testing,Cervical cancer ,women