HPV self‐sampling as primary screening test in sub‐Saharan Africa: Implication for a triaging strategy

Our objective was (i) to assess if a self‐collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low‐resource setting, (ii) to evaluate its implication in a screen and treat approach and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health‐care professional to carry out an unsupervised self‐collected HPV‐test (Self‐HPV), followed by a physician‐collected cervical sample for HPV testing (Physician‐HPV) and cytology. Differences in performance between Self‐HPV versus Physician‐HPV and their ability to detect abnormal cytology results (ASC‐US+) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self‐HPV and Physician‐HPV, respectively (Cohen's kappa = 0.74). HPV positivity by cytological diagnosis for ASC‐US+ was similar with the two tests. positive predictive value of the Self‐HPV for ASC‐US+ was 20.4; odds ratio and number needed to treat were 6.5 (3.2–13.4) and 6 (4.2–10.9), respectively. We observed a trend of increasing cytological abnormalities in 30–49 year‐old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self‐HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer.