HPV self‐sampling acceptability and preferences among women living with HIV in Botswana

Objective: To assess the acceptability and preferences of HPV screening with self- sampling and mobile phone results delivery among women living with HIV (WLWH) in Botswana, as an alternative to traditional speculum screening.Methods: WLWH aged 25 years or older attending an infectious disease clinic in Gaborone were enrolled in a cross- sectional study between March and April 2017.Women self- sampled with a flocked swab, had a speculum exam, and completed an interviewer- administered questionnaire about screening acceptability, experiences,and preferences.Results: Of the 104 WLWH recruited, 98 (94%) had a history of traditional screening. Over 90% agreed self- sampling was easy and comfortable. Ninety- five percent were willing to self- sample again; however, only 19% preferred self- sampling over speculumexam for future screening. Preferences differed by education and residence with self- sampling being considered more convenient, easier, less embarrassing, and less painful. Speculum exams were preferred because of trust in providers’ skills and women's low self- efficacy to sample correctly. Almost half (47%) preferred to receive results via mobile phone call. Knowledge of cervical cancer did not affect preferences.Conclusion: HPV self- sampling is acceptable among WLWH in Botswana; however, preferences vary. Although self- sampling is an important alternative to traditional speculum screening, education and support will be critical to address women's low self- efficacy to self- sample correctly

Performance of vaginal self-sampling for human papillomavirus testing among women living with HIV in Botswana

In Botswana, where human immunodeficiency virus (HIV) prevalence remains high, cervical cancer is the leading cause of cancer deaths in women. Multiple organizations recommend high-risk human papillomavirus (hr-HPV) testing as a screening tool; however, high coverage may not be feasible with provider-collected samples. We conducted the first assessment of self- versus provider-collected samples for hr-HPV testing in HIV-positive women in Botswana and report prevalence of hr-HPV and histological outcomes. We recruited HIV-positive women ≥25 years attending an HIV clinic in Gaborone. Self- and provider-collected samples from participants were tested for hr-HPV using Cepheid GeneXpert. Women testing positive for any hr-HPV returned for colposcopy. We used unweighted κ statistics to determine hr-HPV agreement. We report that 31 (30%) of 103 women tested positive for any hr-HPV. The most common genotypes were HPV 31/33/35/52/58. Overall agreement between self- and provider-collected samples for any hr-HPV was 92% with a κ of 0.80. Ten of the 30 hr-HPV-positive women attending colposcopy had CIN2+ (33%). In conclusion, in this HIV-positive population, there was excellent agreement between self and provider samples, and self-sampling may play an important role in screening programs in high HIV burden settings with limited resources like Botswana