HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

Abstract

Introduction. Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.