Exploring women's preferences for HPV-based cervical cancer screening in South Africa

Int J Gynaecol Obstet. 2019 Aug;146(2):192-199. doi: 10.1002/ijgo.12869. Epub 2019 Jun 17.


Objective: To determine preferences for HPV-based cervical cancer screening among South African women.

Methods: A discrete choice experiment survey was conducted among 298 women who attended two public-sector clinics in South Africa from February 1 to May 31, 2018. Participants chose between hypothetical screening scenarios: method of swab collection (self or provider); timing of treatment (same day or return visit); type of clinic (static or mobile); cost of services (US $0 or US $4); and time spent at the clinic (30, 60, or 120 minutes). A logistic regression model was generated to evaluate the importance of each attribute. A market simulation analysis was performed to determine potential uptake of the various screening strategies.

Results: The participants expressed strong preferences for free services (β=0.50; P<0.001) and same-day HPV testing and treatment (β=0.40; P<0.001). The market simulation indicated that 83.8% of women would be willing to undergo screening if services were free; the swab was collected by the provider; and treatment was offered at a return visit. Including same-day testing and treatment in the model increased uptake to 96.4%.

Conclusion: Offering same-day HPV testing and treatment could substantially improve uptake of cervical cancer screening in the South African public healthcare sector.

Keywords: Cervical cancer; Cervical screening; Discrete choice experiment survey; HPV test-and-treat approach; Primary HPV testing; Self-collected swab.

MeSH terms

  • Adolescent
  • Adult
  • Early Detection of Cancer / economics
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Mass Screening / economics
  • Mass Screening / methods
  • Middle Aged
  • Papillomavirus Infections / diagnosis*
  • Patient Preference*
  • South Africa
  • Surveys and Questionnaires
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears / economics
  • Vaginal Smears / methods*