Self Sampling Hpv Testing As Cervical Cancer Screening Approach Among Women Living In Low-middle-income -countries Systematic Review And Meta-analysis.
Background: More than 85% of cervical cancer deaths occur in low-middle-income countries, rnand 90% of the mortality burden is primarily attributed to low coverage of cervical cancerrnscreening. Self-sampling HPV could increase the overall cervical screening and contribute tornalleviating the burden of cervical cancer in LMICs (low-middle-income countries) rnObjective: The general objective of this review and meta-analysis was to see if self-sampling HPVrnscreening method can increase uptake of cervical cancer screening in low-middle-incomerncountries. rnMethods: CENTRAL (Cochrane Central Registry of controlled trials), MEDLINE (throughrnPubMed), Clinicaltrial.gov, WHO Global Health Library, and EMBASE were searched. Referencernlists of the relevant studies found were assessed to further search for relevant studies. The MeSHrnterms for HPV (MeSH (DNA Probes, HPV) (Human Papillomavirus DNA Tests)) and cervicalrncancer MeSH term (uterine cervical neoplasms) were found and as for the term self-sampling,rnthere was no MeSH term found therefore method of text words/synonyms (Self-sampling, Selfcollection,rnrnSelf-obtained) for self-sampling was used. For the LMIC, LMIC filter prepared byrnCochrane from all LMIC countries listed by World bank was used. Where multiple studies reportedrnthe same comparable outcome of interest, we conducted a metaanalysis. Random-effects modelsrnwas used to generate pooled effect size of relative risk with a 95% confidence interval using RevManrn5.4. rnrnrnResults: Six RCTs (randomized control trials) were included in this review. The studies were fromrnEthiopia, Kenya, Nigeria, Uganda, Argentina, and Mexico. These studies included a total of 39,274rnparticipants with in the age group ranged from 25 – 65 years. All the studies compared anrninterventional group of HPV self-sampling method with a control group of a standard of care. HPVrnself-sampling was reported to be acceptable, and participants stated the device was easy to use andrnthey would use HPV self-sampling instead of the regular hospital screening in the future. There werernno adverse events associated with the self-sampling device. In the meta-analysis, uptake of cervicalrncancer screening services showed that the likelihood of participants to use self-sampling HPVrnscreening method was 75% higher than with standard of care (RR: 1.72, 95% CI 1.58 to 1.87, Isquared:rnrn72%) with insignificant I2, (MODERATE quality of evidence). However, there was norndifference between linkage to care between the two groups (RR=1.18, 95% CI 0.77 to 1.81, I2=rn87%) (VERY LOW quality of evidence).rnrnConclusion: Self-sampling HPV screening technique has the potential to increase the uptake ofrncervical cancer screening in LMICs, and is acceptable by women. Moreover, this technique helpsrnovercome many barriers to cervical cancer screening in LMICs such as lack of trained personnel,rnlack of laboratory supplies, infrastructure, socio-religious and cultural barriers to pelvic examination,rnlimited physical access to patient populations, and the need for spousal permission. As this can reduce social inequalities in access to cervical screening, it helps alleviate the cervical cancer burdenrnin LMICs.