A systematic review of self-sampling for HPV testing in Africa

Abstract

Background: Human papillomavirus (HPV) testing may be feasible for primary cervical cancer screening in low-resource countries.

Objective: To compare self-sampling by women with clinician-performed sampling for HPV testing in Africa.

Search strategy: MEDLINE, Google scholar, EMBASE, and several journals were searched from 2000 until 2015 using relevant terms.

Selection criteria: Selected studies compared self-sampled and clinician-sampled HPV tests.

Data collection and analysis: Data extraction forms included description of the type of HPV screening, description of any additional intervention components, study design, sample size, follow-up periods, analytic approach, reported numerical outcomes, results, and limitations.

Results: Twenty-five studies were identified. Women of a wide age range were successful at self-sampling in many African countries. More than 95% of self-samples yielded HPV DNA results. The concordance in test results between self-collected samples and clinician-collected samples was reasonably high in most studies. In all studies, the quality of cytology from self-sampling matched that of clinician-sampling. Women were generally positive about self-collection, but noted some concerns.

Conclusion: Self-sampling for HPV DNA testing seems to represent a feasible alternative to the Pap test. Further research is needed to provide a solid evidence base to inform using of self-sampling for HPV DNA testing for primary cervical cancer screening.

Keywords: HPV screening; Human papillomavirus; Physician obtained smear; Self-sampling; Sub-Saharan Africa.