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Self-Sampling for Human Papillomavirus in a Community Setting: Feasibility in Hispanic Women

¹ Department of Medicine, School of Medicine, ² Department of Epidemiology, and ³ Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California and ⁴ Latino Health Access, Santa Ana, California

Requests for reprints: Israel De Alba, 111 Academy, Suite 220, Irvine, CA 92697-5800. Phone: 949-824-9371; Fax: 949-824-3388. E-mail: idealba{at}uci.edu

Background: The aim of the study was (a) to assess sensitivity and specificity of self-sampling in a community setting for identifying high-risk human papillomavirus (HPV) infection and abnormal Papanicolaou (Pap) smears and (b) to assess satisfaction with this collection method among Hispanic women.

Methods: Lay health workers distributed self-collection kits to Hispanic women in the community. Participants collected an unsupervised vaginal sample at home or in the place and time of their preference.

Results: A total of 1,213 Hispanics were included and provided a self-sample for HPV testing and were invited for a Pap smear; 662 (55%) of them had a Pap smear and the first 386 of these also had a physician-collected sample for HPV retesting. Using physician collection as the gold standard, unsupervised self-collection had a sensitivity of 90% and specificity of 88% for identifying high-risk HPV. Compared with physician sampling, self-sampling in a community setting had comparable sensitivity for identifying a low-grade lesions or greater in the Pap smear (50% versus 55%; P = 0.45) but lower specificity (94% versus 79%). Overall experience with self-sampling was reported as excellent or very good by 64% and only 2.6% reported a poor or fair experience.

Conclusions: Unsupervised self-collection of vaginal samples for HPV testing in a community setting has a high sensitivity for identifying high-risk HPV and a high satisfaction among Hispanics. This approach may benefit populations with limited access to health care or with cultural barriers to cervical cancer screening. (Cancer Epidemiol Biomarkers Prev 2008;17(8):2163–8)