From the The Ohio State University College of Public Health, Columbus, OH.
Harvard T.H. Chan School of Public Health, Boston, MA.
Sex Transm Dis. 2020 Apr;47(4):275-279. doi: 10.1097/OLQ.0000000000001119.
Human papilloma virus (HPV), the causative agent for cervical cancer, can be tested for using self-collected vaginal samples. Self-collection is promising for HPV screening in hard-to-reach populations. To assess the relationship between willingness to self-collect and subsequent uptake of self-collection, we conducted a longitudinal study of reproductive-age women in rural Malawi.
At baseline, we asked women if they would be willing to self-collect a vaginal sample for HPV testing. At follow-up (12-18 months later), we offered the same women the opportunity to self-collect a sample for HPV testing. We examined unadjusted and adjusted associations between baseline willingness to self-collect a sample for HPV testing and uptake of self-collection at follow-up using log-binomial models.
Among 122 women who, at baseline, indicated willingness to self-collect, n = 65 (53%) agreed to self-collect a sample at follow-up. Of 64 women who stated unwillingness at baseline to self-collect, n = 30 (47%) self-collected a sample for testing at follow-up. We observed no association between women's willingness at baseline and their observed self-collection decision at follow-up (unadjusted prevalence ratio, 1.14; 95% confidence interval, 0.83-1.55). The association remained null after adjustment for age, awareness of cervical cancer, and perceived behavioral control.
Our results suggest that evaluation of acceptability of self-collection should go beyond simply asking women if they would be willing to self-collect a vaginal sample. Given that half of this study's participants agreed to self-collect a sample when the opportunity was offered, regardless of their previously stated preferences, self-collection should be offered to everyone.
人乳头瘤病毒（HPV）是宫颈癌的致病因子，可以通过自我采集的阴道样本进行检测。自我采集对于难以接触的人群进行 HPV 筛查具有很大的潜力。为了评估愿意自我采集与随后接受自我采集之间的关系，我们对马拉维农村地区的育龄妇女进行了一项纵向研究。
在基线时，我们询问妇女是否愿意自我采集阴道样本进行 HPV 检测。在随访（12-18 个月后）时，我们向同一批妇女提供自我采集样本进行 HPV 检测的机会。我们使用对数二项式模型，在未调整和调整基线时愿意自我采集 HPV 检测样本与随访时自我采集样本的使用之间的关联。
在 122 名在基线时表示愿意自我采集的妇女中，有 n = 65 名（53%）同意在随访时自我采集样本。在 64 名在基线时表示不愿意自我采集的妇女中，有 n = 30 名（47%）在随访时自我采集样本进行检测。我们没有观察到妇女在基线时的意愿与她们在随访时的实际自我采集决策之间的关联（未调整的流行率比，1.14；95%置信区间，0.83-1.55）。在调整年龄、对宫颈癌的认识和感知行为控制后，这种关联仍然为零。
我们的研究结果表明，评估自我采集的可接受性不应仅仅局限于询问妇女是否愿意自我采集阴道样本。鉴于本研究的一半参与者在有机会时同意自我采集样本，而不管他们之前的偏好如何，应该向所有人提供自我采集。
