| The objective was to compare the sensitivity, specificity, and relative acceptability of patient-collected soft brush and swab vs. clinician-collected cervical specimens for Human papillomavirus (HPV) testing in a developing country.A cross-sectional study design was employed with a convenience sample of women identified by the Nicaraguan Ministry of Health. Nonpregnant women (n=250) from Leon, Nicaragua between the ages of 25--60 years with intact uteri were enrolled. Subjects attended an educational session and subsequently self-collected vaginal swabs and soft brushes to indicate their HPV status. Each subject underwent a pelvic examination by a physician assistant, who collected liquid-based cytology and reflex HPV specimens. Each subject also underwent colposcopy, with biopsy if needed. Following the examination, each subject completed a questionnaire regarding her demographic characteristics, medical history, gynecologic history, and perceptions about self-collection vs. clinician-collection methods. Sensitivity and specificity were calculated and compared for self-collected swabs and soft brushes vs. clinician-collected HPV and cytology, using the colposcopy results as the gold standard.Acceptability scores for self-collected swabs and soft brushes were calculated from the questionnaire data. The sensitivities of self-collected brushes, self-collected swabs and clinician-collected HPV tests (in order) were 25%, 16.7%, and 16.7% with colposcopy as the gold standard and 30%, 22.2%, and 40% when the cytology results were the gold standard. Agreement between self-collection methods was significant (kappa=.84, p<.001). Overall acceptability indices were significantly higher for self-collected brushes (M=18.40, SD=2.73) and self-collected swabs (M=18.48, SD=2.41) compared with clinician collection (M=17.56, SD=2.92), p<.001. In addition, more than 80% of subjects reported they would be willing to self-collect a specimen in the future if a test were delivered to their homes. Though the utilization of colposcopy in every subject resulted in lower sensitivities across the board, the self-collected tests were superior to cytology and were in significant agreement with the clinician-collected HPV results. In addition, the self-collections were highly acceptable to women, suggesting that with further confirmation of the accuracy, self-collection is a viable option to extend screening in low resource areas. |
