Human papillomavirus (HPV) testing on self-collected specimens: perceptions among HIV positive women attending rural and urban clinics in South Africa

Pan Afr Med J. 2014 Mar 11;17:189. doi: 10.11604/pamj.2014.17.189.3454. eCollection 2014.


Introduction: Cervical cancer is the most common cancer among women in Sub-Saharan Africa. Cervical cancer is treatable if detected timeously, yet only 20% of South African women have ever been for a Pap smear in their lifetime due to limited access to screening, transport or child care responsibilities.

Objective: To evaluate the acceptability of self-collection for cervical cancer screening. We aimed to identify which self-collection device women prefer and if they would consider using them for routine cervical cancer screening.

Methods: HIV-positive women (>18 years) from urban and rural HIV clinics were interviewed following an education session on HIV, human papillomavirus (HPV) and cervical cancer. Participants were shown three self-collection devices; (i) an Evalyn cervical brush, (ii) a Delphilavager and (iii) a tampon-like plastic wand before completing a short questionnaire.

Results: A total of 106 women from the urban (n = 52) and rural (n = 54) clinic were interviewed. Overall 51% of women preferred the cervical brush, while fewer women preferred the tampon-like plastic wand (31%) or lavage sampler (18%). More than 75% of women from the rural site preferred the cervical brush, compared to 22% from the urban site (p < 0.001). Women from the urban clinic preferred the tampon-like plastic wand (45%) and then the lavage sampler (33%), as compared to women from the rural clinic (19% and 4%, respectively).

Conclusion: Women from urban or rural settings had different preferences for the various self-collection devices. Patient self-collection with HPV testing may be an acceptable way to improve coverage to cervical cancer screening in high risk HIV-seropositive women.

Keywords: HIV-positive women; South Africa; acceptability; cervical cancer; human papillomavirus; resource-limited setting; self-collection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude to Health*
  • Diagnostic Self Evaluation*
  • Early Detection of Cancer / methods*
  • Female
  • HIV Seropositivity / virology
  • Humans
  • Middle Aged
  • Papillomaviridae / isolation & purification*
  • Patient Preference
  • Rural Health Services
  • South Africa
  • Specimen Handling*
  • Surveys and Questionnaires
  • Urban Health Services
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / virology*