Author:
Bakiewicz Aleksandra,Rasch Vibeke,Mwaiselage Julius,Linde Ditte S.
Abstract
Abstract
Background
Cervical cancer is the most common type of cancer in sub-Saharan Africa, and it is also the cancer disease that most women die from. The high mortality rate is partly due to low attendance rates to screening services and low sensitivity of visual inspection with acetic acid, which is the standard screening method used in screening programs in sub-Saharan Africa. In order to overcome of the burden of disease new screening strategies and methods are warranted. This study aims to explore the acceptability and feasibility of HPV self-sampling compared to provider-based sampling among cervical cancer screening clients living in Dar es Salaam.
Methods
Women attending cervical cancer screening at Ocean Road Cancer Institute in Dar es Salaam, Tanzania between February – April 2017 were invited into the study. The participants had (1) a provider-collected sample, and (2) a self-sample for HPV on top of the regular cervical cancer screening. 50% of the participants conducted the self-sample after receiving a written instruction guide of how to collect the sample (written). The other 50% received both the written and an oral introduction to self-sampling (written+). All participants could ask for nurse assistance during self-sample collection if needed. Individual semi-structured interviews were conducted with the participants post sample collection. Data collection stopped when saturation was reached. Data were analysed using a thematic content analysis.
Results
Twenty-one women participated in the study. Regardless of how women were introduced to the self-sample (written or written+), there was a high demand for nurse presence as they felt uncertain of their personal capabilities to collect the self-sample correctly. However, as long as nurse assistance was an option most women perceived self-sampling as easy and comfortable though few experienced bleeding and pain. The majority of women preferred self-sampling over provider-sampling primarily due to the method being more private than the provider-sampling.
Conclusions
HPV self-sampling was well-perceived and accepted, however, for the method to be feasible a nurse needed to be present. HPV Self-sampling may be an alternative method to increase uptake of cervical cancer screening. Larger quantitative studies are recommended to support the study findings.
Funder
Syddansk Universitet
Danish International Development Agency
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,Reproductive Medicine,General Medicine
Reference40 articles.
1. Broutet N, O’Neal Eckert L, Ullrich A, Bloem P. Comprehensive cervical Cancer control. A guide to essential practice. 2nd ed. Geneva: World Health Organization; 2014. Available from: http://apps.who.int/iris/bitstream/handle/10665/144785/9789241548953_eng.pdf?sequence=1.
2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014;136(5):E359–86.
3. Louie K, De Sanjose S, Mayaud P. Epidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review. Trop Med Int Health. 2009;14(10):1287–302.
4. Rahman R, Clark M, Collins Z, Traore F, Dioukhane E, Thiam H, Ndiaye Y, De Jesus E, Danfakha N, Peters K, Komarek T, Linn A, Linn P, Wallner K, Charles M, Hasnain M, Peterson C, Dykens J. Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review. Glob Health Action. 2019;12(1):1587894.
5. International Agency for Cancer Research. Tanzania, United Republic of. Source: Globocan, 2018 [Internet]: International Agency for Cancer Research; 2018. [cited 14 August 2019]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/834-tanzania-united-republic-of-fact-sheets.pdf.