Evaluation of cervical cancer screening uptake, HPV genotyping and self-sampling collection techniques in Ethiopia

Although 20 million women are eligible for cervical screening in Ethiopia, less than 1% of women have been screened. The reasons for the low uptake of cervical cancer (CC) screening may also be due to health beliefs and lack of knowledge regarding the primary risk factors causing cervical cancer; the collection method of the cervical samples as well as the distance to travel in order to reach a health facility which provides cervical cancer screening. The general purpose of this research study is: •to endeavor to improve the uptake of cervical cancer screening service by evaluating the feasibility of self-sampling as well as HPV testing as alternative screening options in Ethiopia, •to investigate the cervical cancer screening uptake where women's health beliefs and risk factors lead them to decide whether to be part of the cervical cancer screening program, •to do a systematic review of the self-sampling HPV detection rate by comparing results from samples collected by clinicians in Africa, and •to explore HPV genotype distribution as well as cervical cytology abnormality prevalence rates. Seventy-three women (87.9%) of the participants felt that nurse assisted self-sampling (NASS), using the ThinPrep plastic spatula and endocervical brush rinsed in Preservecyt Solution vial, was comfortable to use. An overall HPV, HR (High Risk) HPV, and LR (Low Risk) HPV prevalence was 22.7% (15/66), 18.2% (12/66) and 6.1% (4/66) respectively. The overall HR HPV prevalence was 17.2% (NASS) and 15.5% Clinician-taken (CT). The most prevalent HR-HPV type was HPV 51, and the overall measurement agreement between NASS- and clinician-taken samples was moderate with a kappa value of 0.576 (p <0.001). Only 6.8% (28/412) women reported that they had visited a health facility (HF) previously for cervical cancer (CC) screening. Among those, thirteen, (3.2% in total) had undergone screening tests either by VIA or Pap test method. More than a third of the women (38.3%) recognized the need to go for regular Pap or VIA tests for early detection of CC. However, only 11.2% were aware that the first sexual intercourse at earlier age is associated with increased risk of CC. There was a significant association between the educational background of the women and cervical cancer health facility visits (CCHF) (p<0.05). Women who had a family history of CC, showed an increase interest to visit the CCHF for check-up purposes (p<0.05). Eight research articles from six countries in the African continent with a total of 3,476 women included in these studies, formed part of the systemic review. On average the high risk (HR)-HPV detection rate was 36% (7.2 -84.8%) and 35% (6.8 - 87.8%) for self- and clinician-collected sampling, respectively. The average differences and variation of HPV rates between sampling methods were 2.6% (SD =1.7). There was correlation (r=0.997) between the HR-HPV detection of the two sampling methods. The moderate kappa agreement 0.71(0.47 to 0.89) between the two sampling techniques was found. The overall HR HPV burden of 13.7% and the abnormal cytology prevalence rate of 13.1% respectively were confirmed. The majority of HR HPV types were other than types 16 and 18. Of the total abnormal cytology results, 81.3% of the smears collected were diagnosed as low-grade squamous intraepithelial lesions (LSIL), 12.5% and 6.3% of the smears collected were diagnosed as atypical squamous cells of undetermined significance (ASCUS) and high-grade squamous intraepithelial lesions (HSIL), respectively. Self-sampling HPV test is promising and although comparable results to that of doctor collected samples were found in our study, we recommend studying its effectiveness and feasibility with expanded population-based studies before deploying HPV testing assays and machines throughout the country. To redirect from where we are now, expressions of women`s lower screening coverage, biological science and vaccination are not enough. Social, psychological, and cultural health behavioral change studies are required now on a large scale in Ethiopia. Most eligible women are not visiting health facility regularly because of misperception or altered health beliefs about cervical cancer. Detailed studies on women`s health beliefs and perceptions might assist to convert fear of developing cervical carcinoma and the treatment thereof into an opportunity that leads to reduced late-stage cancer presentation, reduced treatment cost, less government investment as well as reduced family problems.

Publication year:2022

Keywords:Doctoral thesis

Accessibility:Open