Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia.
Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany.
Cancer Prev Res (Phila). 2019 Sep;12(9):609-616. doi: 10.1158/1940-6207.CAPR-19-0156. Epub 2019 Jul 23.
In Ethiopia, the standard method of cervical cancer screening is using Visual Inspection with Acetic Acid (VIA). Self-collection-based human papillomavirus (HPV) testing is assumed to improve the uptake of screening, especially for hard to reach populations. We investigated whether HPV DNA testing with the self-collection of cervical samples would be associated with increased uptake and adherence to procedures at the population level compared with VIA within defined rural population in Ethiopia. A total of 22 clusters (comprising 2,356 women ages 30-49 years) were randomized in two arms. Following the community mobilization, women of the clusters were invited to go either to the local health post for a self-collection-based HPV DNA testing (arm A) or Butajira Hospital for VIA screening (arm B). In the HPV arm, of the 1,213 sensitized women, 1,020 (84.1%) accessed the health post for self-sampling compared with the VIA arm, where 575 of 1,143 (50.5%) visited the hospital for VIA ( < 0.0001). Of those women who attended the VIA and HPV arms, 40% and 65.4% adhered to all procedures expected after screening, respectively. Out of women positive for high risk HPV, 122 (85%) attended VIA as a follow-up test. The trial demonstrated significantly higher levels of population-based uptake and adherence for self-collection HPV testing. Women were more receptive for VIA after their HPV testing result was positive. Self-collection HPV testing can be done at the local health facility and may significantly improve the uptake of cervical cancer screening in Ethiopia.
在埃塞俄比亚，宫颈癌筛查的标准方法是使用醋酸视觉检查（VIA）。人们认为，基于自我采集的人乳头瘤病毒（HPV）检测可以提高筛查的参与率，尤其是对难以接触到的人群。我们研究了在埃塞俄比亚特定农村人群中，与 VIA 相比，基于自我采集的宫颈样本 HPV DNA 检测是否会与筛查参与率和程序依从性的提高相关。共有 22 个集群（包括 2356 名年龄在 30-49 岁的妇女）在两个臂中进行了随机分组。在社区动员之后，邀请集群中的妇女前往当地卫生所进行基于自我采集的 HPV DNA 检测（A 组）或前往 Butajira 医院进行 VIA 筛查（B 组）。在 HPV 组中，在 1213 名接受敏感性检测的妇女中，有 1020 名（84.1%）前往卫生所进行自我采样，而在 VIA 组中，有 575 名（50.5%）前往医院进行 VIA（<0.0001）。在参加 VIA 和 HPV 组的妇女中，分别有 40%和 65.4%的妇女遵守了所有预期的筛查后程序。在 HPV 检测呈阳性的妇女中，有 122 人（85%）接受了 VIA 作为随访检测。该试验表明，基于人群的自我采集 HPV 检测的参与率和依从率显著提高。在 HPV 检测结果阳性后，妇女对 VIA 的接受程度更高。自我采集 HPV 检测可以在当地卫生机构进行，并且可能会显著提高埃塞俄比亚的宫颈癌筛查参与率。
