Self-collected cervical samples for detection of high-risk human papillomavirus: A community outreach approach in a remote region

Background and objectives Self collection of cervical samples is evolving as a potential screening approach to overcome cultural, geographical and logistical barriers that contribute to poor screening uptake. We conducted a study to compare performance of self and physician-collected cervical samples for high-risk human papillomavirus (hr-HPV) detection through community outreach approach in the hilly terrains of Sikkim. Methods A prospective longitudinal study was conducted for 2 y, sampling 210 sexually active women aged 18-65 y attending Central Referral Hospital and 3 district hospitals in Sikkim. Paired self and physician collected cervical samples were taken from consenting women for HPV DNA and pap test. Women who had total hysterectomy, diagnosed with cancer or were pregnant were excluded. Colposcopy was done among those positive for HPV infection. Result Prevalence of HPV (HPV DNA ± pap) was 17% (36/210) in this study of which HPV 16 was the most common variant (n=4,15%). Physician collected samples had the highest HPV detection rate (n=26,12%). Sensitivity and specificity were highest with physician-collected samples (71.4%, and 76.9%, respectively). Concordance between physician and self-sampling was good (Kappa 0.7). Women lost to follow up for colposcopy was 36% (n=13). Interpretation and conclusions Performance of physician-sampling was better than self-sampling and pap in the detection of hr-HPV. Physician-sampling should be used for HPV DNA detection when feasible.