J Gynecol Oncol.  2022 Aug;33(S1):S3. 10.3802/jgo.2022.33.S3.

The acceptability of vaginal self-sampling for human papillomavirus (HPV) testing among a multi-ethnic Asian female population

• Gunasagran Y
• Khoo SP
• Yam ML
• Woo YL

• KMID: 2537920
• DOI: http://doi.org/10.3802/jgo.2022.33.S3

Abstract

Objective
In Malaysia, a cytology based program for cervical screening was implemented in 1969. Unfortunately, pap smear uptake has been low. The most common barriers to screening were embarrassment, time constraint and poor awareness to screening. As Malaysia is transitioning from a cytology-based screening to self-sampling human papillomavirus (HPV) testing as the primary screening method, it is therefore important to assess the acceptability of this screening approach in this multiethnic setting.
Methods
This was a cross-sectional study which recruited women aged 30–65 from several community-based cervical screening programs using self-sampling HPV testing across urban and suburban areas in all over Malaysia from April 2018 to May 2022. All women were instructed to self-collect vaginal samples for HPV testing using a dry flocked swab. All samples were genotyped on a clinically validated platform which allowed the detection of any high-risk HPV DNA. Approximately 2,000 women were randomly selected and interviewed to document their screening experience after the self-sampling procedure.
Results
A total of 19,835 women participated in the community-based cervical screening program using self-sampling HPV testing. The major ethnic group was Malay (68.4%) followed by Chinese (16.4%) and Indians (9.9%). Of these, 1,113 (5.7%) were positive for any high-risk HPV infection whereas 371 (1.9%) did not yield valid HPV results due to insufficient human DNA. A total of 2,012 participants responded to an interview regarding their screening experience using self-sampling HPV testing. Among these women, 1,179 (58.5%) did not attend regular Pap smear screening. Out of those who had ever performed Pap smear, 83.2% of them indicated a preference towards self-sampling HPV testing over Pap smear. Furthermore, 99% of them were willing to repeat this screening test as a routine screening method in the future. More than 95% of women perceived self-sampling HPV testing as easy, convenient and not embarrassing. Additionally, more than 80% of women felt comfortable and confident collecting their vaginal samples. This implies that self-sampling HPV testing is highly acceptable in our setting.
Conclusion
HPV testing via self-collection method is highly acceptable and preferred over Pap smear in the Malaysian multiethnic population. It is a promising approach to increase screening coverage which is an essential key target to be achieved in order to eliminate cervical cancer in Malaysia.