High-risk HPV-RNA screening of physician- and self-collected specimens for detection of cervical lesions among female sex workers in Nairobi, Kenya

Int J Gynaecol Obstet. 2018 Nov;143(2):217-224. doi: 10.1002/ijgo.12628. Epub 2018 Sep 8.


Objective: To compare accuracy of detecting high-grade cervical lesions (squamous intraepithelial lesions or greater, HSIL+) by high-risk HPV messenger RNA (hrHPV-RNA) testing between physician- and self-collected specimens, and by conventional cytology.

Methods: The present prospective longitudinal study included data collected among female sex workers (FSWs) in Nairobi, Kenya, between December 2, 2009, and February 15, 2013. Participants self-collected cervico-vaginal specimens for hrHPV-RNA testing, and a physician collected cervical specimens for hrHPV-RNA testing and conventional cytology. hrHPV-RNA testing was conducted every 3 months, and conventional cytology every 6 months.

Results: Overall, 350 FSWs aged 18-50 years participated. hrHPV-RNA prevalence decreased slightly from 29.9% (103/344) at baseline to 24.3% (53/218) at 24 months for physician-collected, and 28.5% (98/344) to 24.3% (53/218) for self-collected specimens. Agreement between the sampling methods appeared to increase over time (baseline κ 0.55, 95% confidence interval [CI] 0.45-0.65; 24 months κ 0.83, 95% CI 0.74-0.91). Among 21 patients with HSIL+ over 24 months, 18 (86%) and 17 (81%) had hrHPV-RNA-positive results at baseline in physician- and self-collected specimens, respectively; and 20 (95%) had baseline hrHPV-RNA-positive results or cytology anomalies.

Conclusion: Overall agreement between physician- and self-collected hrHPV-RNA results was moderate and appeared to increase over time. Baseline physician- and self-collected hrHPV-RNA tests were similarly strong indicators of cumulative HSIL+ over 24 months.

Keywords: Cohort; Cytology; Female sex workers; HPV screening; High-risk women; Kenya; Self-collection.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Humans
  • Kenya / epidemiology
  • Longitudinal Studies
  • Middle Aged
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / epidemiology
  • Prospective Studies
  • RNA, Messenger / blood
  • Sex Workers / statistics & numerical data*
  • Specimen Handling / methods*
  • Specimen Handling / standards
  • Squamous Intraepithelial Lesions of the Cervix / diagnosis*
  • Squamous Intraepithelial Lesions of the Cervix / epidemiology
  • Vaginal Smears / methods
  • Young Adult


  • RNA, Messenger