Self- versus physician-collected samples for the follow-up of human papillomavirus-positive women in sub-Saharan Africa

Manuela Viviano,1,* Phuong Lien Tran,1,* Bruno Kenfack,2 Rosa Catarino,1 Mohamed Akaaboune,1,† Liliane Temogne,2 Eveline Tincho Foguem,2 Pierre Vassilakos,3 Patrick Petignat1 1Gynecology Division, Geneva University Hospitals, Geneva, Switzerland; 2Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon; 3Geneva Foundation for Medical Education and Research, Geneva, Switzerland *These authors contributed equally to the work †MA passed away on July 31, 2017 Introduction: Human papillomavirus (HPV) testing is a suitable tool for primary cervical cancer (CC) screening and follow-up in low-resource settings. Vaginal samples taken by women themselves (Self-HPV) are an interesting alternative to physician-performed sampling (Dr-HPV). Our aim was to assess the performance of Self-HPV and Dr-HPV at 6 and 12 months following a CC screening campaign. Methods: This study was carried out at the Dschang District Hospital, Cameroon. Women aged 30–49 years were recruited in a CC screening campaign. HPV-positive women, of whom 2/3 were treated with thermoablation because of abnormal results at baseline screening, were invited to participate in a follow-up study. Self- and Dr-HPV, as well as cytology, were performed at 6 and 12 months. HPV samples were analyzed using the Xpert HPV assay. Sensitivity and specificity for the detection of low-grade squamous intraepithelial lesion or worse and of high-grade squamous intraepithelial lesion or worse were calculated for Self-HPV and Dr-HPV, using cytology as the reference diagnosis. Results: Overall, 188 HPV-positive women were invited to attend follow-up. The obtained follow-up visits’ attendance was 154 (81.9%) and 131 (69.7%) at 6 and 12 months, respectively. While the overall performance of Dr-HPV at 6 months was slightly superior, Self-HPV showed an improved sensitivity for HSIL+ detection at 12 months when compared with