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Background: Risk of anal cancer is high in certain populations and screening involves collection of anal swabs for HPV DNA and/or cytology testing. However, barriers exist, such as the need for an intimate examination, and stigma around HIV status, sexual orientation, and sexual practices. Self-collected anal swabs (SCA) are a proposed alternative to clinician-collected swabs (CCA) to overcome these barriers. Methods: Participants were order-randomised to undergo SCA or CCA first, with a second swab taken immediately afterwards. Sample adequacy was assessed for HPV DNA and cytology testing. CCA was used as the gold standard to calculate sensitivity and specificity of SCA for cytology and HPV results. Acceptability of swab collection was assessed following the procedure. Results: There was no significant difference in sample validity for HPV DNA testing between SCA and CCA (p = 0.564). Concordance was >90% for detection of any HR-HPV and HPV16. There was no significant difference in cellular adequacy for cytological testing between SCA and CCA, (p = 0.162). Concordance for cytologic prediction was 88.2% for any cytologic abnormality. Almost half (48.5%) of participants expressed no preference for SCA versus CCA; 15.2% preferred SCA and 35.4% CCA. Conclusions: SCA may be an acceptable and feasible alternative to CCA for detecting HPV and cytological abnormalities in a clinic population. [ABSTRACT FROM AUTHOR]

Anal squamous cell carcinoma (ASCC) incidence is increasing globally. International consensus guidelines published in 2024 include HPV and/or cytology testing of anal swabs in those at greatest risk of ASCC. Self‐collected anal swabs may be important for increasing screening uptake, but evidence is needed as to their equivalence to clinician‐collected swabs. We searched Medline, Embase, Cochrane Library, and CINAHL databases for publications to 13 June 2023. Studies were included if reporting data on HPV testing, cytology testing, or acceptability, for both self‐ and clinician‐collected anal swabs. Risk of bias was assessed using the QUADAS‐2 assessment tool. The primary outcome was HPV and cytology sampling adequacy. Secondary outcomes were HPV and cytology results, and acceptability of collection methods. Thirteen papers describing 10 studies were eligible. Sample adequacy was comparable between self‐ and clinician‐collected swabs for HPV testing (meta‐adequacy ratio: 1.01 [95% CI 0.97–1.05]) but slightly lower for cytology by self‐collection (meta‐adequacy ratio: 0.91 [95% CI 0.88–0.95]). There was no significant difference in prevalence (meta‐prevalence ratio: 0.83 (95% CI 0.65–1.07) for any HR‐HPV, 0.98 (95% CI 0.84–1.14) for any HPV, and 0.68 (95% CI 0.33–1.37) for HPV16), or any cytological abnormality (meta‐prevalence ratio 1.01 [95% CI 0.86–1.18]). Only three papers reported acceptability results. Findings indicate self‐collection gives equivalent sample adequacy for HPV testing and ~ 10% inferior adequacy for cytological testing. Meta‐prevalence was similar for HPV and cytology, but confidence intervals were wide. Larger studies are required to definitively assess use of self‐collected swabs in anal cancer screening programs, including acceptability. [ABSTRACT FROM AUTHOR]