Evaluation of the effectiveness and acceptability of samples self-collected at home to detect human papillomavirus, among Mexican women

Objectives. Human papillomavirus (HPV) testing of samples self-collected by women at home may help overcome technical and cultural barriers to cervical cancer screening in developing countries. This study aimed at evaluating the effectiveness and acceptability of samples self-collected by women at home, to identify HPV infection. Material and methods . A cross-sectional study was conducted between April 2000 and February 2002, among 1,213 women selected through Community sampling, in Morelos State, Mexico. Consenting women were asked to provide a self-collected specimen (SCS), a nurse-collected specimen (NCS), and a Papanicolaou (Pap) smear. All specimens were collected at home. The assay employed to detect HPV was Hybrid Capture-2 probe B. Sociodemographic, gynecologic, and sex behavior data were collected. Association estimates were obtained using logistic regression models and are presented as crude and adjusted odds ratios (OR) with 95% confidence intervals (CI). Results. The prevalence of HPV infection for the NCS was 12.8% (95% CI 10.9%, 14.6%), and that for the SCS was 16.5% (95% CI 14.4%, 18.6%). HPV infection was associated with older age at first intercourse (OR 0.93; 95% CI 0.89, 0.98), ever having a Pap test (OR 0.55; 95% CI 0.35, 0.88), and being married (OR 0.63; 95% CI 0.43, 0.93). The prevalence of CIN≥1 lesions was lower than expected (2.3%). Women preferred the Pap test (50%) to the self-collection method (43%), by a small margin. Preference for the SCS method by women increased with advancing age (OR 1.4; 95% CI 1.07, 1.89), higher education (OR 1.72; 95% CI 1.15, 2.58), and the presence of trichomonas in the Pap smear (OR 2.21) 95% CI 1.17, 4.17). Conclusions. HPV prevalence was higher for the SCS than for the NCS. Women older than 15 years at first sexual intercourse, married women, and those with at least one Pap test, were less likely to have HPV infection. Preference of the SCS method was associated with advancing age, higher education, and presence of trichomonas infection. Self-collection of specimens at home for HPV testing is technically feasible, may increase screening coverage, and may be a valuable tool for health education within cervical cancer screening programs.