Explore the vast range of titles available.

Background In the context of WHO’s “task shifting” project and growing global consensus on primary HPV-based cervical cancer screening, self-sampling is a promising new tool to expand screening access, uptake and coverage for women worldwide. We aimed to explore perceptions and acceptability of HPV self-sampling-based cervical cancer screening among community members and health professionals in rural northwest Ethiopia and to identify preferences and socio-cultural barriers regarding self-sampling in order to design a suitable high-coverage screening intervention for a rural African setting. Methods Four community-based focus group discussions (FGD) were conducted in the rural district of Dabat, Northwest Ethiopia, each comprising 8 to 14 female participants, counting a total of 41 participants. The groups were homogenously composed in terms of their socio-economic status in the community. They included health centre attendees, community members, nurses and health development army leaders (HDAL). Two qualitative data collection experts conducted the interviews in the local language, using a FGD guide with several thematic areas. All participants granted written informed consent prior to the conduct of the interviews. As a concrete example of an existing self-sampling approach for cervical cancer screening we used the Evalyn® Brush. Results Emerging themes included (i) misconceptions and low awareness about cervical cancer among community residents and primary health care providers in rural northwest Ethiopia, (ii) stigmatization and social exclusion of affected women, (iii) delay in seeking of health care due to poor access and availability of services, and lacking of a concept of early cancer prevention, (iv) need of spousal permission, (v) fear of financial burden and (vi) fear of social marginalization. The self-sampling device was regarded to be acceptable and was judged to be easy to use for most women. The existing Ethiopian health care structure could facilitate a community approach. Conclusion Home-based self-sampling for cervical cancer screening is a socially acceptable and feasible “task shifting” method that will increase cervical cancer screening access and coverage in the Ethiopian study community. Education, awareness creation, community mobilization and family inclusion are identified as key activities to promote, implement and facilitate “task shifting” approaches like self-sampling.

Annika Linde,Amelie Plymoth Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenIt was with great interest that we noticed that other researchers are also interested in participant-collected nasal swabs to detect pathogens in acute respiratory infections, and we welcome the findings presented in the study by Vargas et al.1 Of importance is that already in the beginning of 2015, we showed in our research work that nasal self-sampling is feasible in large-scale surveillance of respiratory infections.2View the original paper by Vargas and colleagues.

Background : Female genital schistosomiasis (FGS) is a neglected and disabling gynaecological disorder that is difficult to diagnose and is part of the wider spectrum of urogenital disease caused by the waterborne parasite  Schistosoma haematobium . Over 90% of human schistosomiasis cases are found in sub-Saharan Africa with 3.8 million people infected with schistosomes in Zambia. Reported FGS prevalence ranges from 33-75% of those with urinary schistosomiasis in endemic areas, suggesting a potentially high FGS burden in Zambia alone. The Bilharzia and HIV (BILHIV) study evaluated home self-sampling genital collection methods for the diagnosis of FGS. Methods : Eligible participants included non-pregnant, sexually active women aged 18-31 who were previously recruited for the HPTN 071 (PopART) trial in Livingstone, Zambia. Household demographic and symptom questionnaires were administered by community workers. Participants were offered vaginal and cervical self-swabs and a urine cup. Cervicovaginal lavage (CVL) was performed in clinic by midwives. Information was collected from participants on the acceptability and feasibility of genital self-sampling. Results : From January-August 2018, 603 women were enrolled, and 87.3% (527/603) completed clinic follow up. A high proportion of participants indicated that self-collection of specimens was “easy” or “very easy” on a 5-point Likert scale. A high proportion of women would be willing to self-collect all three specimens again in future: vaginal swab 96.7% (583/603), cervical swab 96.5% (582/603), and urine 96.2% (580/603). Overall, 90.0% (543/603) preferred to self-collect samples at home, compared with sampling in the clinic Home-based self-sampling was preferred over provider-based sampling in the clinic due to greater privacy 65.0% (353/543), convenience 51.4% (279/543) and lack of needed transportation 17.7% (96/543). Conclusions : Home based genital self-sampling for FGS diagnosis is highly acceptable. This scalable method may inform future efforts for community-based diagnosis of FGS

Cervical cancer is a major public health concern in India, hampered by limitations in traditional screening methods and healthcare infrastructure. This study aimed to evaluate the feasibility and challenges of implementing Human Papillomavirus self-sampling (HPV) self-sampling, conducted by ASHA workers (Accredited Social-Health Activists) in Sikkim, India, using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. In-depth interviews were conducted between February and May 2023 with ASHA workers involved in HPV self-sampling implementation within Sikkim. The data was analysed using qualitative methods and tagged under relevant RE-AIM categories. Twenty ASHA workers participated in the study. Facilitators included participant autonomy, positive community attitudes, and logistical advantages of home-based testing. ASHA workers’ efforts in health education, counselling, and community engagement were crucial. Successful implementation was supported by adequate training, community trust, and mobile technology for result transmission. Barriers included poor health literacy, logistical challenges for ASHA workers, and inadequate incentives. The study highlights the importance of tailored screening procedures, community engagement, and programmatic support in enhancing acceptance of HPV self-sampling. Addressing barriers requires multifaceted interventions at individual, community, and systemic levels.

BACKGROUND: Human papillomavirus (HPV) self-sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self-sampling. OBJECTIVE: The aim of this study was to describe how women (>60 years old) experience the offering of self-sampling of HPV, compared to having a sample collected by a healthcare professional. DESIGN AND PARTICIPANTS: The study had a qualitative explorative design. Four focus group discussions were conducted with women 60-69 years old (n = 22). Data were analysed using principles of interpretive description. RESULTS: Five themes were identified: self-sampling-convenient and without pain, lack of knowledge, worries related to HPV self-sampling, need for information and taking a societal perspective. CONCLUSION: Women aged >60 years found that HPV self-sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self-sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer. PUBLIC CONTRIBUTION: Women who had performed HPV self-sampling participated in the focus group discussion.

Background We assessed experiences of human papillomavirus (HPV) vaginal self‐sampling and future screening preferences in an ethnically and socio‐economically diverse group of women overdue for cervical screening. Setting and Participants A postal questionnaire was embedded in the YouScreen self‐sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non‐completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow‐up test if HPV‐positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self‐sampling. Results Most kit‐completers reported high confidence in self‐sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free‐text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self‐sampling in the future (71.3% vs. 10.4% for a clinician‐taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self‐tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. Conclusions Kit‐completers were confident, found the test easy to complete, and trusted the self‐sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self‐sampling in the future, but it was not a universal preference, so offering a choice will be important. Patient or Public Contribution We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). Trial Registration This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.

Background Cervical screening for high‐risk Human Papillomavirus subtypes is offered to those eligible in the UK via the NHS cervical screening programmes. However, uptake of cervical screening continues to remain below the national target of 80%. Groups less likely to participate include people from low socioeconomic groups, ethnic minority backgrounds, younger/older age and/or LGBTQ group identity. The cervical screening‐eligible population could soon, for the first time in the UK, have a choice of mode between clinician taken or self‐sampling. Aims To understand information and decision‐support needs of diverse cervical screening‐eligible individuals when presented with a choice of cervical screening mode and develop recommendations for a communication strategy to support informed decision‐making. Methods Qualitative co‐production explored communication preferences and decision‐support needs in a diverse sample of cervical screening‐eligible individuals using semi‐structured interviews with individuals eligible for cervical screening (n = 30) and stakeholders (n = 23). Interviews were transcribed, thematically analysed and mapped to behavioural and decision‐making theories to inform a communication strategy for offering choice in cervical screening mode in the UK. Results Four main themes across both participant groups were identified: misunderstanding of clinician screening, attitudes towards choice, communication launch preferences and decision‐support needs. Logic models to inform a communication strategy in preparation for the future launch of choice in cervical screening mode in the UK were developed. Implications The communication launch strategy can inform interventions to support informed decision‐making if HPV self‐sampling is incorporated into UK cervical screening programmes. Patient and Public Contribution Two public partners were involved in the study from inception to completion. They advised on recruitment, participant facing documents and were involved in analysis.

The corrected caption appears below: “Timeline of study recruitment, HPV testing, gynaecological follow-up and semi-structured interviews/focus groups. The corrected sentence appears below: “This article describes the protocol for a randomised trial in which we will assess the efficacy of two experimental invitation strategies (including self-sampling) to reach under-screened populations and compare them with the current invitation strategy in three rural departments (low medical density and low rate of smear participation) in France.” The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way.

IntroductionHuman papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic review and meta-analysis of HPV self-sampling among adult women on cervical (pre-)cancer screening uptake, screening frequency, social harms/adverse events and linkage to clinical assessment/treatment.MethodsThe included studies compared women using cervical cancer screening services with HPV self-sampling with women using standard of care, measured at least one outcome, and were published in a peer-reviewed journal. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CNIAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase through October 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR).Results33 studies in 34 articles with 369 017 total participants met the inclusion criteria: 29 RCTs and 4 observational studies. All studies examined HPV self-sampling; comparison groups were standard of care (eg, Pap smear, visual inspection with acetic acid, clinician-collected HPV testing). 93% of participants were from high-income countries. All 33 studies measured cervical cancer screening uptake. Meta-analysis found greater screening uptake among HPV self-sampling participants compared with control (RR: 2.13, 95% CI 1.89 to 2.40). Effect size varied by HPV test kit dissemination method, whether mailed directly to home (RR: 2.27, 95% CI 1.89 to 2.71), offered door-to-door (RR: 2.37, 95% CI 1.12 to 5.03) or requested on demand (RR: 1.28, 95% CI 0.90 to 1.82). Meta-analysis showed no statistically significant difference in linkage to clinical assessment/treatment between arms (RR: 1.12, 95% CI 0.80 to 1.57). No studies measured screening frequency or social harms/adverse events.ConclusionA growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment.Systematic review registration numberPROSPERO CRD42018114871.

Introduction Research indicates disproportionately low cervical screening uptake by diverse ethnic groups in England. If acceptable, self‐sampling might address population‐specific barriers and improve screening uptake. The Alternative CErvical Screening (ACES) Diversity study aimed to explore the prospective acceptability of self‐sampling (urine sampling and self‐swabbing), as an alternative to current cervical screening, among women from diverse ethnic groups. Methods A qualitative study design was employed using focus groups. Forty‐eight women from diverse ethnic groups were recruited via community partners in Northwest England and a cross‐sectional survey. Eight focus groups were conducted (one online and seven in‐person; four with interpreters for Mandarin, Cantonese, Polish and Urdu). Data were transcribed, translated and analysed in English using thematic framework analysis guided by the Theoretical Framework of Acceptability. Results Three themes were identified. ‘Cultural considerations’ explored how aspects of culture and faith influenced perceptions of self‐sampling. ‘Desire for comfort and control’ reflected views of how self‐sampling increases autonomy by maintaining privacy, potentially reducing both pain and tension associated with screening. ‘Confidence in testing’ illustrates beliefs about self‐sampling, around ease of use, practical challenges and accuracy concerns. Conclusions Self‐sampling for cervical screening was considered highly acceptable. If introduced, self‐sampling could increase cervical screening uptake amongst women from diverse ethnic groups. Having a choice in how to interact with the screening programme and continuing to raise awareness of cervical screening were considered important. Future research should explore the concurrent or retrospective acceptability of urine self‐sampling for cervical screening. Patient or Public Contribution Multiple public involvement discussion sessions in Northwest England‐based community centres were arranged with women to explore and build understanding about cervical screening and speak about the ACES Diversity study. A further session was held, with an interpreter, to discuss the focus group topic guide and study design with women and create an opportunity for any feedback. Written feedback was provided for the recruitment poster from seven women (two East Asian, two Central and Eastern European, two African‐Caribbean and one South Asian).