马拉维农村地区自我采集样本用于人乳头瘤病毒（HPV）检测的可行性、有效性和可接受性
Feasibility, validity and acceptability of self-collected samples for human papillomavirus (HPV) testing in rural Malawi.
作者信息
Esber Allahna, Norris Alison, Jumbe Enock, Kandodo Jonathan, Nampandeni Patrick, Reese Patricia Carr, Turner Abigail Norris
机构信息
Division of Epidemiology, The Ohio State University, Columbus, USA.
Child Legacy International, Umoyo wa Thanzi Research, Lilongwe Malawi.
出版信息
Malawi Med J. 2018 Jun;30(2):61-66. doi: 10.4314/mmj.v30i2.2.
AIM
The World Health Organization (WHO) recently endorsed human papillomavirus (HPV) testing as a cervical cancer screening method in countries without established programs. Self-collection for HPV testing may be an effective way to expand screening. Our objective was to assess the feasibility, validity, and acceptability of self-collection for HPV testing in a population of care-seeking, unscreened women in rural Malawi.
METHODS
We enrolled women reporting to a rural Malawian clinic from January to August 2015. Participants were offered the option to self-collect a vaginal sample and the study clinician collected a cervical sample for HPV testing. Using the clinician-collected sample as the reference standard, we calculated a kappa statistic, sensitivity, and specificity by hr-HPV type. Participants also received a brief survey assessing acceptability of the procedure.
RESULTS
Among the 199 enrolled women, 22% had any high risk-HPV. Comparing self- and clinician-collected samples for HPV testing, we found generally high agreement (ϰ = 0.66-0.90) and high specificity (98%-100%), but varied sensitivity (50%-91%) for different types of hr-HPV. We also found that self-collection was acceptable, with 98% of women reporting it was easy to do and 99% reporting willingness to do so again.
CONCLUSIONS
WHO guidelines recommend that treatment is available immediately after a positive screening test for clinic-based cervical cancer screening programs. Our findings demonstrate that self-collection of samples for HPV testing is a feasible and acceptable method of cervical cancer screening in this rural Malawian population. High agreement between the self- and clinician-collected samples and high levels of acceptability among women in the study suggest that self-collection of vaginal samples for HPV testing may be effectively incorporated into screening programs among rural, largely unscreened populations.
目的
世界卫生组织（WHO）最近认可人乳头瘤病毒（HPV）检测作为在尚无既定筛查项目的国家中进行宫颈癌筛查的一种方法。自行采集样本用于HPV检测可能是扩大筛查范围的有效途径。我们的目标是评估在马拉维农村地区寻求医疗服务且未接受过筛查的女性群体中，自行采集样本用于HPV检测的可行性、有效性和可接受性。
方法
我们纳入了2015年1月至8月期间前往马拉维农村诊所就诊的女性。参与者可选择自行采集阴道样本，研究临床医生则采集宫颈样本进行HPV检测。以临床医生采集的样本作为参考标准，我们按高危型HPV类型计算了kappa统计量、敏感性和特异性。参与者还接受了一项简短调查，以评估该程序的可接受性。
结果
在199名纳入研究的女性中，22%感染了任何高危型HPV。比较自行采集和临床医生采集的用于HPV检测的样本，我们发现总体一致性较高（κ = 0.66 - 0.90）且特异性较高（98% - 100%），但不同类型的高危型HPV的敏感性有所不同（50% - 91%）。我们还发现自行采集是可接受的，98%的女性表示操作简便，99%的女性表示愿意再次这样做。
结论
WHO指南建议，对于基于诊所的宫颈癌筛查项目，在筛查检测呈阳性后应立即提供治疗。我们的研究结果表明，自行采集样本用于HPV检测在这个马拉维农村人群中是一种可行且可接受的宫颈癌筛查方法。自行采集和临床医生采集的样本之间的高度一致性以及研究中女性的高接受度表明，自行采集阴道样本用于HPV检测可有效地纳入农村地区、大部分未接受过筛查的人群的筛查项目中。
Zotero 插件