High-risk human papillomavirus testing of physician- and self-collected specimens for cervical cancer screening among female sex workers in Nairobi, Kenya

Ting, Jie

High-risk human papillomavirus testing of physician- and self-collected specimens for cervical cancer screening among female sex workers in Nairobi, Kenya Public Deposited

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March 21, 2019

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Ting, Jie
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

A cervical cancer screening program based on high-risk human papillomavirus (hrHPV) testing of self-collected specimens (hrHPV self-testing) may help increase screening access in low-resource settings, thus reducing invasive cervical cancer (ICC) incidence in these regions. Little is known, however, about the performance of hrHPV testing with physician- collected versus self-collected specimens for cervical cancer screening among high-risk women in low-resource settings. In addition, to determine if a screening strategy is optimal for a given setting, the costs and benefits of each screening strategy must also first be compared. From 2009-2011, 344 female sex workers (FSW) in Nairobi participated in a study to compare hrHPV physician- versus self-testing for cervical cancer screening. Participants must have been between 18-50 years, had an intact uterus, and were not in the second trimester of pregnancy or later. HrHPV testing sensitivity for cytological high-grade squamous intraepithelial lesion or more severe (≥HSIL) was similar in physician- (86%) and self- collected specimens (79%). Specificity of hrHPV for ≥HSIL was also similar in physician- (73%) and self-collected (75%) specimens. To determine the optimal screening strategy for our FSW population, we compared screening efficiency (number of colposcopies required to detect one histological cervical intraepithelial neoplasia 2 or more severe, ≥CIN 2) of three strategies (conventional cytology, hrHPV physician- and self-testing) for a once-in-a-lifetime cervical cancer screening. At a lower willingness-to-pay upper limit (number of colposcopies willing to conduct to detect a case of ≥CIN2) of <15 colposcopies per case of ≥CIN 2 detected, conventional cytology was the optimal strategy for our FSW population, given the available information. Screening using hrHPV self-testing in high-risk populations such as our FSW can be a reliable tool for cervical cancer screening, comparing favorably with hrHPV physician-testing. HrHPV mRNA testing may still be more costly than cytology. However, a once-in-a-lifetime screening using highly sensitive hrHPV self-testing in a low-resource setting with infrequent screening may potentially increase the overall screening cost-effectiveness, compared with cytology. Our decision analysis nevertheless suggests that, given the current information, more data are still required to determine which screening strategy is most efficient for our FSW population.

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