Tesfahunei Hanna Amanuel, Ghebreyesus Michael Solomon, Assefa Dawit Getachew, Zeleke Eden Dagnachew, Acam Joan, Joseph Michele, Getachew Emnet, Kajogoo Violet Dismas, Bekele Delayehu, Manyazewal Tsegahun
Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia.
Hager Biomedical Research Institute, Asmara, Eritrea.
Infect Agent Cancer. 2021 Jun 19;16(1):43. doi: 10.1186/s13027-021-00380-5.
Human papillomavirus (HPV) infection remains a major health threat in sub-Saharan Africa (SSA). HPV self-sampling could help find and treat cervical cancer at an early stage. We aimed to evaluate the effectiveness of HPV self-sampling over the standard health facility-based clinician-sampling for cervical cancer screening through a systematic review and meta-analysis of available randomized controlled trials.
We searched PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, and the WHO Global Health Library for articles in SSA published as of 31 May 2020. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for the design and reporting of the results. We included randomized control trials that compared HPV self-sampling with the standard of care. The primary endpoint was uptake of cervical cancer screening service. The secondary endpoints were linkage to care, acceptability, screening frequency, and adverse events. We used RevMan V.5.3 software for statistical analysis. We computed random-effect model to provide pooled estimates of available data and I-squared (I) test to assess heterogeneity.
Of 77 citations, we included four trials from Nigeria, Ethiopia, Kenya, and Uganda, encompassing 8200 participants with age ranging from 25 to 65 years. The pooled analysis showed significantly higher uptake of cervical cancer screening in women who used HPV self-sampling (risk ratio [RR] 1.72, 95% CI 1.58-1.87; p = 0.01), while this had a considerable heterogeneity as explained by subgroup analysis. Uptake was higher in women who were offered sampling kit at home or work (RR 2.05, 95% CI 1.80-2.33) and those who's kit was mailed to or invited to a nearby health center (RR 1.65, 95% CI 1.58-1.72, I = 0%) than those screened with the standard of care. There was no difference between the two groups in the rate of linkage to care of positive cases (RR 1.30, 95% CI 0.90-2.74, I = 91%). HPV self-sampling was acceptable and easy to use. None of the trials compared the frequency of screening or adverse events.
HPV self-sampling is an effective and feasible alternative to the standard health facility-based clinician-sampling for cervical cancer screening in SSA. It could improve the uptake of cervical cancer screening and harness the global strategy towards elimination of cervical cancer by 2030.
人乳头瘤病毒（HPV）感染仍是撒哈拉以南非洲地区（SSA）的一项重大健康威胁。HPV自我采样有助于早期发现和治疗宫颈癌。我们旨在通过对现有随机对照试验进行系统评价和荟萃分析，评估HPV自我采样相对于基于标准医疗机构临床医生采样在宫颈癌筛查中的有效性。
我们检索了截至2020年5月31日在SSA发表的PubMed、Cochrane对照试验中心注册库、ClinicalTrial.gov和世界卫生组织全球卫生图书馆中的文章。我们遵循2015年系统评价和荟萃分析方案的首选报告项目（PRISMA-P）指南进行设计和结果报告。我们纳入了比较HPV自我采样与护理标准的随机对照试验。主要终点是宫颈癌筛查服务的接受情况。次要终点是与护理的联系、可接受性、筛查频率和不良事件。我们使用RevMan V.5.3软件进行统计分析。我们计算随机效应模型以提供可用数据的合并估计值，并使用I²（I）检验评估异质性。
在77篇文献中，我们纳入了来自尼日利亚、埃塞俄比亚、肯尼亚和乌干达的四项试验，涵盖8200名年龄在25至65岁之间的参与者。汇总分析显示，使用HPV自我采样的女性接受宫颈癌筛查的比例显著更高（风险比[RR]1.72，95%置信区间1.58 - 1.87；p = 0.01），而亚组分析表明这存在相当大的异质性。在家或工作场所获得采样试剂盒的女性（RR 2.05，95%置信区间1.80 - 2.33）以及试剂盒通过邮寄或被邀请到附近健康中心的女性（RR 1.65，95%置信区间1.58 - 1.72，I = 0%）接受筛查的比例高于接受标准护理筛查的女性。两组在阳性病例与护理的联系率方面没有差异（RR 1.30，95%置信区间0.90 - 2.74，I = 91%）。HPV自我采样是可接受且易于使用的。没有试验比较筛查频率或不良事件。
在SSA，HPV自我采样是基于标准医疗机构临床医生采样进行宫颈癌筛查的一种有效且可行的替代方法。它可以提高宫颈癌筛查的接受率，并有助于实现到2030年消除宫颈癌的全球战略。
