To test whether self-taken vaginal specimens could be used with Xpert® HPV for primary screening prior to visual inspection with acetic acid (VIA) in Malawi
To compare HPV prevalence in self-taken versus clinician-collected cervical samples using Xpert® HPV.
Self-taken samples were obtained from women attending routine VIA clinics in Nkhoma Hospital, using cotton swabs suspended in 5ml of PreservCyt® solution. All samples were tested in the local laboratory using the Xpert HPV assay. Results were compared with Xpert® HPV results from 750 clinician-collected LBC samples in PreservCyt®, obtained from women attending the same clinics in the preceding year.
Overall HPV positivity in the LBC samples was 19.9%, compared with 24.5% in the self-taken samples. Of positive detections, HPV 16 and HPV 18/45 accounted for 24.2% each and HR-HPV ‘others’ for 64.4% in LBC, compared with 17.7%, 26.5% and 76.1% respectively in the self-taken samples. Multiple infections were also more frequently detected in self-taken samples. HPV prevalence in known HIV positive women was comparable (43.4% in LBC ; 45% in vaginal samples).
Self-taken vaginal samples using cotton swabs gave valid results with Xpert HPV and showed higher HPV positivity than clinician-collected cervical samples. HPV 16 was less frequently detected in vaginal samples, while HPV 18/45, ‘others’ and multiple infections were more common. Self-sampling was well accepted and satisfactorily collected by women. Sending only HR-HPV positive women to VIA would significantly reduce the burden on clinical staffing resources and skills.