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Saidu R, Kuhn L, Tergas A, Boa R, Moodley J, Svanholm-Barrie C, Persing D, Campbell S, Tsai WY, Wright TC, Denny L. Performance of Xpert HPV on Self-collected Vaginal Samples for Cervical Cancer Screening Among Women in South Africa. J Low Genit Tract Dis 2021; 25:15-21. [PMID: 33105451 PMCID: PMC7748046 DOI: 10.1097/lgt.0000000000000575] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Self-sampling may increase access to cervical cancer screening in low-resource settings. Using Xpert HPV, we compared test performance of self- and clinician-collected samples in HIV-positive and HIV-negative women in South Africa. MATERIALS AND METHODS Three hundred thirty HIV-positive and 375 HIV-negative women in the screening group and 202 HIV-negative and 200 HIV-positive women in the referral group, aged 30-65 years, participated in the study. All women self-collected a vaginal sample, and then, a cervical sample was collected by a clinician (both tested using Xpert HPV), followed by colposcopic examination and collection of histologic specimens. RESULTS There was good agreement between self- and clinician-collected samples for detection of any high-risk human papillomavirus (HPV, κ = 0.72 [95% CI = 0.669-0.771]). Prevalence of HPV and sensitivity of the test to detect cervical intraepithelial neoplasia 2+ was similar in self- and clinician-collected samples. Specificity was lower in self-collected than in clinician-collected samples in both HIV-negative (self: 77.5% [95% CI = 72.8-81.8] vs clinician: 86.9% [95% CI = 82.9-90.2]) and HIV-positive (self: 44.0% [95% CI = 38.0-50.1] vs clinician: 59.7% [95% CI = 53.6-65.6]) women. Restricting the definition of screen-positive to 3 of 5 channels on HPV Xpert improved specificity in both HIV-negative (self: 83.2% [95% CI = 78.8-87.0] vs clinician: 89.7% [95% CI = 86.1-92.7]) and HIV-positive (self: 54.2% [95% CI = 48.1-60.2] vs clinician: 67.4% [95% CI = 61.5-72.9]) women. CONCLUSIONS The self-collected sample had good agreement with the clinician-collected sample for the detection of HPV, and restricting the HPV types may improve the specificity in HIV-positive women.
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Affiliation(s)
- Rakiya Saidu
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Centre, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
| | - Ana Tergas
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
- Department of Obstetrics and Gynaecology, Vangelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
| | - Rosalind Boa
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
| | - Jennifer Moodley
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- Department of Public Health, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
| | - Thomas C. Wright
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
| | - Lynette Denny
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
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