Bansil Pooja, Wittet Scott, Lim Jeanette L, Winkler Jennifer L, Paul Proma, Jeronimo Jose
PATH, Seattle, Washington, USA.
BMC Public Health. 2014 Jun 12;14:596. doi: 10.1186/1471-2458-14-596.
Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown.
In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women's and providers' experiences with self-sampling, women's opinions of sampling at home, and their future needs.
Among surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn't mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%).
Self-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women's preference for self-sampling.
采用人乳头瘤病毒（HPV）-DNA检测进行阴道自我采样是一种很有前景的宫颈癌初筛方法。然而，在资源匮乏地区，女性对这种检测的体验、担忧及接受程度仍不明确。
在印度、尼加拉瓜和乌干达，采用混合方法设计，通过调查（N = 3863）、定性访谈（N = 72；20名医疗服务提供者和52名女性）以及焦点小组（N = 30名女性）收集有关女性和医疗服务提供者自我采样体验、女性对在家采样的看法及其未来需求的数据。
在接受调查的女性中，90%提供了自我采集的样本。其中，75%报告称这很容易，尽管52%的女性最初担心会弄伤自己，24%的女性担心采集不到好的样本。大多数接受调查的女性更喜欢自我采样（78%）。然而，尚不清楚她们是因自我采样的隐私性还是避免盆腔检查的便利性，或者两者兼具而做出这样的回应。在后续访谈中，大多数女性报告称她们不介意自我采样，但许多人更希望由医疗服务提供者采集阴道样本。大多数女性也更喜欢基于诊所的筛查（而非在家自我采样），因为样本可由医疗服务提供者采集，女性如有需要可接受治疗，且诊所卫生并提供隐私保护。当医疗服务提供者通过教育让女性做好准备、允许女性检查采集刷并在自我采集过程中在场时，自我采样的接受度更高。在调查受访者中，未来有助于自我采样的辅助手段有：工作人员协助（53%）、图文说明中增加图片（31%）以及有机会事先用玩偶/模型练习（26%）。
自我采样和阴道采样在资源匮乏地区的女性中广泛可接受。医疗服务提供者有独特的机会对女性进行自我采样教育并做好准备，并灵活适应女性对自我采样的偏好。
