Comparison of self-collected versus clinician collected cervicovaginal specimens for detection of high risk human papillomavirus among HIV infected women in Ethiopia

Abstract

Background: In order to meet the WHO 2030 cervical cancer elimination program, evaluation and utilization of sensitive testing method, and feasible sampling technique is a paradigm for enhancing cervical cancer screening coverage. Self-sampling for screening of HPV DNA testing is one of the easiest and sensitive techniques, though the evidence was limited in the Ethiopian context. This study aimed to compare the performance of self-collected vaginal specimen versus clinician collected cervical specimen for detection of HPV among HIV positive women in Ethiopia. Methods: We conducted a comparative cross-sectional study design to collect cervicovaginal specimens among HIV

positive women of age older than 24 years. Data were collected from six government hospitals from January to Octo- ber 2021. A total of 994 cervicovaginal specimens was collected by clinicians and HIV positive women themselves in

the cervical cancer screening unit using Abbott Cervi-Collect Specimen Collection Kit, and molecular HPV testing was conducted. Data were entered into an Excel spreadsheet and analyzed using SPSS version 25. Sensitivity, specifcity and kappa were reported with p<0.05 considered as statistically signifcant.

Results: The prevalence of high-risk HPV was 29.4% among self-sampled specimen and 23.9% among clinician col- lected specimens. The overall concordance of the test result was 87.3%. Oncogenic HPV types, other than HPV16&18

were predominant in both sampling techniques, 19.9% from vaginal self-collected specimen and 16.7% of clinician

collected cervical specimens. The sensitivity and specifcity of self-sampled HPV test was 84.0% and 88.4%, respec- tively. The level of agreement was good (k=0.68) and statistically signifcant (p<0.001). The discriminatory power of

the test as true positive and negative was excellent with an area under the curve of 0.86. Conclusion: The magnitude of oncogenic HPV was higher in self-collected samples than the clinician collected specimen with good agreement between the two sampling methods. Thus, we recommend the Ministry of Health in Ethiopia to expand utilization of the self-sampled technique and enhance the coverage of screening in the country. Keywords: Cervical cancer, Cervicovaginal sampling, HPV DNA test, Ethiopia