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Comparability of Self-Collected Vaginal Swabs and Physician-Collected Cervical Swabs for Detection of Human Papillomavirus Infections in Rakai, Uganda

Safaeian, Mahboobeh PhD*; Kiddugavu, Mohammed MD§; Gravitt, Patti E. PhD*; Ssekasanvu, Joseph BSc§; Murokora, Dan MD§; Sklar, Marc MD; Serwadda, David MD; Wawer, Maria J. MD; Shah, Keerti V. MD, DrPH; Gray, Ron MD

Sexually Transmitted Diseases: July 2007 - Volume 34 - Issue 7 - p 429-436
doi: 10.1097/01.olq.0000243623.67673.22

Objective: The objective of this study was to compare human papillomavirus (HPV) DNA testing between self-administered vaginal swabs and physician-administered cervical swabs in women from rural Rakai District, Uganda.

Study Design: Between 2002 and 2003, women from a population-based cohort participated in an HPV study. Women collected self-administered vaginal swabs and were also offered a pelvic examination, which included physician-collected cervical samples.

Methods: Hybrid-capture 2 was used to determine carcinogenic HPV status. Polymerase chain reaction was used to determine HPV genotypes. Unweighted κ statistics were used to determine agreement.

Results: Compliance with self-collected swabs was ≥86%; however, only 51% accepted a pelvic examination. Carcinogenic HPV prevalence was 19% in self-collected and 19% in physician-collected samples. Agreement among paired observations was 92% with a κ of 0.75. Kappa between self- and physician-collected samples was similar in HIV strata (k = 0.71 and 0.75 for HIV-positive and HIV-negative, respectively).

Discussion: In this community-based setting, detection of carcinogenic HPV was comparable among self- and physician-administered samples. Self-collection is a feasible and accurate means of obtaining HPV samples from women in resource-poor settings or persons reluctant to undergo a pelvic examination.

This population-based study conducted among women in an HIV-endemic, rural district of Uganda found that detection of carcinogenic human papillomavirus was comparable among self- and physician-administered samples.

From the Departments of *Epidemiology, †Molecular Microbiology and Immunology, and ‡Population Health and Family Sciences, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; the §Rakai Health Sciences Program and Uganda Virus Research Institute, Entebbe; ¶Institute of Public Health, Makerere University, Kampala, Uganda; and ∥Mailman School of Public Health, Columbia University, New York, NY

The authors thank Roche Diagnostics for providing the reagents and line blots for the genotyping assays, Digene Corporation for providing the hc2 probe B kits at reduced cost.

Recipient of the Fagarty HIV Associated Malignancies. New and Minority Investigator Award, Fogarty AIDS Training and Research Program, Johns Hopkins University.

Supported by STI training grant NIH/NIAID T32AI50056.

Correspondence: Mahboobeh Safaeian, PhD, National Cancer Institute, 6120 Executive Boulevard, Executive Plaza South, Suite 550, Bethesda, MD 20852. E-mail:

Received for publication June 30, 2006, and accepted August 14, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association