Patient Perspectives on HPV DNA Self-Sampling: Acceptability, Barriers, and Willingness for Cervical Cancer Screening
Main Article Content
Cervical cancer remains a major public health problem, especially in low- and middle-income countries where screening coverage is limited. HPV DNA self-sampling has emerged as a potential strategy to improve participation; however, patient acceptance is essential for its successful implementation. This study aimed to evaluate patient perspectives on HPV DNA self-sampling, including acceptability, perceived barriers, cost considerations, and willingness for future screening. A cross-sectional study was conducted among 48 women with abnormal Pap smear results at a tertiary referral hospital. Participants completed a structured questionnaire assessing concerns, ease of use, preferred sampling method, screening barriers, acceptable cost, and willingness for routine testing. Most participants (60.4%) reported no concerns, while 39.6% expressed apprehension, mainly related to fear of pain (20.8%) and uncertainty regarding sample adequacy (14.6%). All participants (100%) found the method easy to use, although 60.4% preferred clinician-based sampling. Major barriers included fear of cancer diagnosis (87.5%) and financial concerns. More than half (54.1%) considered a cost below IDR 300,000 acceptable, and 95.8% were willing to undergo routine screening. HPV DNA self-sampling is highly acceptable and feasible, with strong potential to improve screening uptake.
Keywords:
HPV DNA self-sampling, Cervical cancer screening, Patient perspective, Acceptability
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Ronco, G., Dillner, J., Elfström, K. M., Tunesi, S., Snijders, P. J. F., Arbyn, M., Kitchener, H., Segnan, N., Gilham, C., Giorgi-Rossi, P., Berkhof, J., Peto, J., & Meijer, C. J. L. M. (2014). Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. The Lancet, 383(9916), 524–532. https://doi.org/10.1016/S0140-6736(13)62218-7
Smith, M. A., Burger, E. A., Castanon, A., de Kok, I. M. C. M., Hanley, S. J. B., Rebolj, M., Hall, M., Jansen, E., Killen, J., O’Farrell, X., Kim, J. J., & Canfell, K. (2021). Impact of disruptions and recovery for established cervical screening programs across a range of high-income country program designs, using COVID-19 as an example: a modelled analysis. Preventive Medicine, 151, 106623. https://doi.org/10.1016/j.ypmed.2021.106623
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
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Waller, J., McCaffery, K., & Wardle, J. (2004). Beliefs about the risk factors for cervical cancer among women attending a cervical screening clinic. British Journal of Cancer, 91(2), 310–314. https://doi.org/10.1038/sj.bjc.6601957
Yeh, P. T., Kennedy, C. E., de Vuyst, H., & Narasimhan, M. (2019a). Self-sampling for human papillomavirus testing: a systematic review and meta-analysis. BMJ Global Health, 4(3), e001351. https://doi.org/10.1136/bmjgh-2018-001351
Yeh, P. T., Kennedy, C. E., de Vuyst, H., & Narasimhan, M. (2019b). Self-sampling for human papillomavirus testing: a systematic review and meta-analysis. BMJ Global Health, 4(3), e001351. https://doi.org/10.1136/bmjgh-2018-001351
Arbyn, M., Smith, S. B., Temin, S., Sultana, F., & Castle, P. (2018). Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ, 363, k4823. https://doi.org/10.1136/bmj.k4823
Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., & Bray, F. (2020). Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health, 8(2), e191–e203. https://doi.org/10.1016/S2214-109X(19)30482-6
Bruni, L., Saura-Lázaro, A., Montoliu, A., Brotons, M., Alemany, L., Diallo, M. S., Afsar, O. Z., LaMontagne, D. S., Mosina, L., Contreras, M., Velandia-González, M., Pastore, R., Gacic-Dobo, M., & Bloem, P. (2021). HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019. Preventive Medicine, 144, 106399. https://doi.org/10.1016/j.ypmed.2020.106399
Burger, E. A., Smith, M. A., Killen, J., Sy, S., Simms, K. T., Canfell, K., & Kim, J. J. (2020). Projected time to elimination of cervical cancer in the USA: a comparative modelling study. The Lancet Public Health, 5(4), e213–e222. https://doi.org/10.1016/S2468-2667(20)30006-2
Campos, N. G., Tsu, V., Jeronimo, J., Mvundura, M., Lee, K., & Kim, J. J. (2015). When and how often to screen for cervical cancer in three low- and middle-income countries: a cost-effectiveness analysis. Papillomavirus Research, 1, 38–58. https://doi.org/10.1016/j.pvr.2015.05.003
Canfell, K., Kim, J. J., Brisson, M., Keane, A., Simms, K. T., Caruana, M., Burger, E. A., Martin, D., Nguyen, D. T. N., Bénard, É., Sy, S., Regan, C., Drolet, M., Gingras, G., Laprise, J. F., Torode, J., & Smith, M. A. (2020). Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet, 395(10224), 591–603. https://doi.org/10.1016/S0140-6736(20)30157-4
Chorley, A. J., Marlow, L. A. V, Forster, A. S., Haddrell, J. B., & Waller, J. (2017). Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis. British Journal of Cancer, 117(11), 1613–1622. https://doi.org/10.1038/bjc.2017.55
Dzuba, I. G., Díaz, E. Y., Allen, B., Leonard, Y. F., Lazcano-Ponce, E., Shah, K. V, Bishai, D., Lorincz, A., Ferris, D., & Turnbull, B. (2002). The acceptability of self-collected samples for HPV testing vs. the Pap test as alternatives in cervical cancer screening. Journal of Women’s Health & Gender-Based Medicine, 11(3), 265–275.
Gupta, S., Palmer, C., Bik, E. M., Cardenas, J. P., Nuñez, H., Kraal, L., Bird, S. W., Batzoglou, S., Dethlefsen, L., & Relman, D. A. (2018). Self-sampling for human papillomavirus testing: increased cervical cancer screening participation and incorporation in international screening programs. Journal of Clinical Microbiology, 56(10), e01064-18. https://doi.org/10.1128/JCM.01064-18
Koliopoulos, G., Nyaga, V. N., Santesso, N., Bryant, A., Martin-Hirsch, P. P. L., Mustafa, R. A., Schünemann, H., Paraskevaidis, E., & Arbyn, M. (2017). Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database of Systematic Reviews, (8), CD008587. https://doi.org/10.1002/14651858.CD008587.pub2
Maver, P. J., & Poljak, M. (2020). Primary HPV-based cervical cancer screening in Europe: implementation status, challenges, and future plans. Clinical Microbiology and Infection, 26(5), 579–583. https://doi.org/10.1016/j.cmi.2019.09.006
Nelson, E. J., Maynard, B. R., Loux, T., Fatla, J., Gordon, R., & Arnold, L. D. (2017). The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis. Sexually Transmitted Infections, 93(1), 56–61. https://doi.org/10.1136/sextrans-2016-052609
Ronco, G., Dillner, J., Elfström, K. M., Tunesi, S., Snijders, P. J. F., Arbyn, M., Kitchener, H., Segnan, N., Gilham, C., Giorgi-Rossi, P., Berkhof, J., Peto, J., & Meijer, C. J. L. M. (2014). Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. The Lancet, 383(9916), 524–532. https://doi.org/10.1016/S0140-6736(13)62218-7
Smith, M. A., Burger, E. A., Castanon, A., de Kok, I. M. C. M., Hanley, S. J. B., Rebolj, M., Hall, M., Jansen, E., Killen, J., O’Farrell, X., Kim, J. J., & Canfell, K. (2021). Impact of disruptions and recovery for established cervical screening programs across a range of high-income country program designs, using COVID-19 as an example: a modelled analysis. Preventive Medicine, 151, 106623. https://doi.org/10.1016/j.ypmed.2021.106623
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
Walboomers, J. M. M., Jacobs, M. V, Manos, M. M., Bosch, F. X., Kummer, J. A., Shah, K. V, Snijders, P. J. F., Peto, J., Meijer, C. J. L. M., & Muñoz, N. (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. Journal of Pathology, 189(1), 12–19. https://doi.org/10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F
Waller, J., McCaffery, K., & Wardle, J. (2004). Beliefs about the risk factors for cervical cancer among women attending a cervical screening clinic. British Journal of Cancer, 91(2), 310–314. https://doi.org/10.1038/sj.bjc.6601957
Yeh, P. T., Kennedy, C. E., de Vuyst, H., & Narasimhan, M. (2019a). Self-sampling for human papillomavirus testing: a systematic review and meta-analysis. BMJ Global Health, 4(3), e001351. https://doi.org/10.1136/bmjgh-2018-001351
Yeh, P. T., Kennedy, C. E., de Vuyst, H., & Narasimhan, M. (2019b). Self-sampling for human papillomavirus testing: a systematic review and meta-analysis. BMJ Global Health, 4(3), e001351. https://doi.org/10.1136/bmjgh-2018-001351
