Bula Agatha K, Mhango Patani, Tsidya Mercy, Chimwaza Wanangwa, Kaira Princess, Ghambi Kachengwa, Heitner Jesse, Lee Fan, McGue Shannon, Chinula Lameck, Mwapasa Victor, Tang Jennifer H, Smith Jennifer S, Chipeta Effie
Tidziwe Centre, University of North Carolina UNC Project-Malawi, Private Bag, Lilongwe, A- 104, Malawi.
School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
BMC Public Health. 2025 May 9;25(1):1718. doi: 10.1186/s12889-025-22761-w.
Invasive Cervical cancer is a largely preventable disease through screening, but access to cervical cancer screening (CCS) remains a challenge in Malawi. Integration of CCS with family planning (FP) services through Human papillomavirus (HPV) self-sampling may increase screening coverage. We aimed to evaluate women's perceptions, motivations, and satisfaction with integration of HPV self-sampling with family planning in Malawi.
In this mixed-methods study, we purposively sampled and interviewed 29 women who underwent HPV self-sampling for CCS through one of two different CCS-FP integration models in Malawi. We also completed 766 Client Exit Surveys with CCS patients from both models. Model 1 involved only clinic-based HPV self-sampling, while Model 2 included both clinic-based and community-based HPV self-sampling supported by community health workers. In-depth interviews (IDIs) were conducted using a semi-structured guide, audio-recorded, transcribed, and translated into English for analysis. Qualitative data were analyzed using NVivo 12.0 software and thematic analysis, and quantitative data were analyzed using statistical software.
Women screened in both models reported reduced transport costs for screening. Those clinic-based valued the convenience of accessing both CCS and FP services in a single visit while those screened in the community appreciated accessing services within their communities. Many found HPV self-sampling easy to use and ensured privacy, especially in the community model where samples were mainly collected within their homes, rather than public toilets or clinic consultation rooms. Women were motivated to undergo CCS due to the perceived risks of cervical cancer, particularly among those living with HIV, the availability of services within the community, and the experience of gynecological symptoms. IDI women expressed satisfaction with being able to make decisions without consulting their spouses, and none reported experiencing social harm following the disclosure of HPV results. The client exit survey data showed that 92.5% of women in both models were very satisfied with the procedure.
Our findings highlight that women were satisfied with HPV self-sampling, valuing its convenience, privacy, and cost-effectiveness, which enhanced their willingness to undergo CCS. These findings suggest that integrating CCS self-sampling into FP services could potentially improve CCS uptake in Malawi.
浸润性宫颈癌在很大程度上可通过筛查预防，但在马拉维，获得宫颈癌筛查（CCS）服务仍然是一项挑战。通过人乳头瘤病毒（HPV）自我采样将CCS与计划生育（FP）服务相结合，可能会提高筛查覆盖率。我们旨在评估马拉维女性对HPV自我采样与计划生育相结合的看法、动机和满意度。
在这项混合方法研究中，我们有目的地抽取并采访了29名通过马拉维两种不同的CCS-FP整合模式之一进行HPV自我采样以进行CCS的女性。我们还对来自两种模式的CCS患者完成了766份客户出院调查。模式1仅涉及基于诊所的HPV自我采样，而模式2包括由社区卫生工作者支持的基于诊所和社区的HPV自我采样。使用半结构化指南进行深入访谈（IDI），进行录音、转录并翻译成英文进行分析。定性数据使用NVivo 12.0软件和主题分析进行分析，定量数据使用统计软件进行分析。
在两种模式下接受筛查的女性都报告说筛查的交通成本降低了。那些在诊所进行筛查的女性重视在一次就诊中同时获得CCS和FP服务的便利性，而那些在社区接受筛查的女性则赞赏在社区内获得服务。许多人发现HPV自我采样易于使用并能确保隐私，特别是在社区模式中，样本主要在她们家中采集，而不是在公共厕所或诊所咨询室。由于意识到宫颈癌的风险，特别是在感染艾滋病毒的女性中，社区内服务的可及性以及妇科症状的经历，女性有动力接受CCS。IDI女性表示对能够在不咨询配偶的情况下做出决定感到满意，并且没有人报告在披露HPV结果后遭受社会伤害。客户出院调查数据显示，两种模式下92.5%的女性对该程序非常满意。
我们的研究结果表明，女性对HPV自我采样感到满意，重视其便利性、隐私性和成本效益，这增强了她们接受CCS的意愿。这些结果表明，将CCS自我采样纳入FP服务可能会提高马拉维的CCS接受率。
