Up to 55% of women living with HIV (WLHIV) are under-screened for cervical cancer, despite higher risk. Our objective was to examine HPV prevalence, compare home self-collected (SC) to clinician-collected (CC) HPV positivity, and measure acceptability of SC.
A prospective cohort study of WLHIV was conducted from February–September 2016 in Baltimore. IRB approval was obtained. Pregnant and hysterectomized women were excluded. HPV E6/E7 mRNA was detected from SC cervicovaginal and CC cervical cytobrushes using transcription mediated amplification. HPV DNA was detected from a 2nd CC cervical cytobrush using DNA nucleic acid hybridization. Descriptive and Cohen's kappa statistics were performed.
There were 68 participants with mean age 48 (SD 9.6). The majority (89%) were Black with median CD4 count of 623 (IQR 379-811). Among the 81% of subjects who returned the home SC kits, HPV E6/E7 mRNA prevalence was 50.9% and 41.8% for SC and CC samples, respectively, while DNA prevalence was 34%. Concordance between SC and CC E6/E7 was 76.4% (ĸ=.53, p < .001), and 95.7% (ĸ=.91, p < .001) between CC E6/E7 and DNA. Pap tests were normal among 81.5% of negative home SC tests. The majority (83.3%) would use the swab again and recommend the swab to family/friends (88.2%).
There was moderate agreement between home SC and CC HPV positivity. Home SC was acceptable. Most participants would use the swab again and recommend it to family/friends. Home SC could be used as an alternative method to screen WLHIV who do not regularly visit women's health clinics.