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Acceptability of Women Self-Sampling versus Clinician-Collected Samples for HPV DNA Testing

A Systematic Review

Morgan, Karen PhD1,2; Azzani, Meram PhD3; Khaing, Si Lay MMed (O&G)4; Wong, Yut-Lin DrPH5; Su, Tin Tin PhD5,6

Journal of Lower Genital Tract Disease: July 2019 - Volume 23 - Issue 3 - p 193–199
doi: 10.1097/LGT.0000000000000476
Original Research Articles: Cervix and HPV

Objectives Female self-sampling for human papillomavirus (HPV) DNA testing is an alternative screening method that can potentially increase cervical cancer screening coverage. This review addresses the acceptability of HPV DNA testing using self-sampling compared with conventional clinician-collected sampling. Barriers to and others factors associated with acceptability of either method were also examined.

Methods The following electronic resources were searched: Medline @EBSCOHOST(Medline), Embase, PubMed, and CINAHL databases. Manual searches were also conducted. The main outcome of interest was the acceptability of HPV DNA testing by self-sampling in comparison with clinician-collected sampling.

Results In total, 23 articles were included in this systematic review. The majority (19 studies) were quantitative intervention studies and 4 studies were qualitative observational studies. Eleven studies reported a preference for self-sampling by women compared with clinician-collected sampling (64.7%–93%). The remaining studies found that women preferred clinician-collected sampling because mainly of respondents' lack of confidence in their ability to complete self-sampling correctly. In most articles reviewed, the studied associated factors, such as demographic factors (age, marital status, and ethnicity), socioeconomic factors (income, education level), reproductive factors (condom use, number of children, current use of contraception, and number of partners), and habits (smoking status) were not found to be significantly associated with preference.

Conclusions Both methods of sampling were found to be acceptable to women. Self-sampling is cost-effective and could increase the screening coverage among underscreened populations. However, more information about the quality, reliability, and accuracy of self-sampling is needed to increase women's confidence about using to this method.

1Perdana University Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia;

2Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland;

3Community Medicine Department, Faculty of Medicine, MAHSA University, Saujana Putra Campus, Selangor, Malaysia;

4Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;

5Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and

6South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Malaysia

Reprint requests to: Meram Azzani, PhD, MAHSA University Faculty of Medicine and Biomedical Sciences, Jenjarom, Selangor, Malaysia. E-mail:

The authors have declared they have no conflicts of interest.

The study was supported by University Malaya Research Grant RP004A-13HTM. The grant is an internal grant from the University.

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Online date: April 1, 2019

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology