Feasibility and acceptability of HPV self-sampling in cervical cancer screening – a qualitative study in Tanzania

Description

Abstract:

Introduction: Cervical cancer is the most common type of cancer in sub-Saharan Africa. The disease has a high mortality rate as it is often not detected until advanced stages. Therefore, the need for effective screening methods is essential. The aim of this thesis is to assess women´s perception of human papillomavirus (HPV) self-sampling as an alternative method for cervical cancer screening in Tanzania. HPV self-sampling allows the detection of high-risk HPV infection which is the main established cause of cervical cancer.

Methods: 21 semi-structured interviews were conducted at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania between February – April 2017. On top of the regular cervical cancer screening based on physician-sampling, participating women conducted a self-collection test for HPV. To conduct the self-test, women were divided into two groups: 1) supported by written protocol and nurse explanation, and 2) supported by written protocol. The feasibility and acceptability of HPV self-sampling among participants were assessed.

Results: Twenty-one women (aged 26-52) were interviewed. Almost all women (n=19) needed some level of support from a nurse during self-sampling. 70% would prefer self-sampling as a future screening examination, however more than a half of them also preferred that a nurse was present. Privacy was one of the main factor in finding self-sampling acceptable. Almost all women (n=20) felt comfortable during the self-collection, two experienced bleeding and four a bit of pain. The majority (n=17) perceived self-collection as easy. Limitations of the self-sampling considered uncertainty of personal capabilites, strong trust in health professionals and experienced pain.

Conclusion: HPV self-sampling is generally well-perceived among women. However, it is only feasible and acceptable with the nurse being present. Therefore, to maximize feasibility and acceptability of self-sampling the nurse should be present and assist the woman during self-collection. Self-sampling can be considered as an alternative method to increase an uptake of cervical cancer screening but women´s concerns must also be addressed. Finally, further research regarding this method in Tanzania is needed.