Bringing Care Into The Hands Of The Users: Closing Cervical Cancer Screening Coverage Gap Through HPV DNA Self-Sample Collection

According to the World Health Organization (WHO), Cervical cancer is the fourth most common cancer among women globally, with an estimated 604 000 new cases and 342 000 deaths in 2020.?Every year cervical cancer kills nearly 350 000 women globally, 90% of whom live in low- and middle-income countries (LMICs).??

Despite being preventable and curable,?Cervical cancer is?the most common cancer among women in Zimbabwe and accounts for most cancer deaths among females in the country.?More than 95% of cervical cancer cases are caused by oncogenic types of human papillomavirus (HPV) which is transmitted through skin-to-skin contact, including sexual activity.?Women living with Human Immuno-deficiency Virus (HIV) are 4 to 10 times more likely to develop cervical cancer and more likely to develop it at a younger age.??

Population Solutions for Health (PSH) currently provides integrated sexual and reproductive health (SRH) and HIV prevention and treatment services (including cervical cancer screening and treatment of pre-cancerous lesions) in Zimbabwe using a one-stop shop model through both static and outreach service delivery. Cervical cancer screening (secondary prevention) is targeted at preventing invasive cervical cancer by detecting and treating precancerous lesions of the cervix before they progress to cancer.??

In Zimbabwe, the recommended cervical cancer screening methods include HPV DNA test, Visual Inspection with Acetic acid and Cervicography (VIAC) and cervical cytology-based screening (Pap smear). Among these, HPV DNA screening is a more sensitive and specific screening option which provides an opportunity to test women who are above 50 years.??

Funded by the Embassy of Sweden through?Population Services International (PSI), Population Solutions for Health (PSH) in collaboration with the Ministry of Health and Child Care carried out the HPV DNA acceptability and feasibility study in 3 districts between November 2019 and June 2020. The goal of this study was to assess the acceptability and feasibility of?HPV cervical self-sampling as a?cervical cancer screening method and HPV DNA testing as an effective approach for the early detection of cervical cancer?among?women?in Zimbabwe.?

?Study findings revealed that?HPV self-sampling is generally a highly accepted method of cervical cancer screening?in Zimbabwe.?Over 54% of women in the study chose to privately collect their samples for HPV screening following instructions provided by a healthcare worker. For the women?the most appealing features were?ease and?convenience of use, privacy, less anticipated discomfort and value of their direct participation and involvement in healthcare. At the end of the study?97.6% recommended it, 90.6% will use it again in the future, and 88.8% trust the results.?

HPV DNA sample collection is certainly a game-changer in the prevention and treatment of cervical cancer. Women are often diagnosed with cervical cancer at a more advanced stage, where the opportunity for cure is low.??PSI through implementing partner PSH are offering an alternative screening choice and extending access to underserved communities, a highlight of their dedication to the global policy of the World Health Organization to eradicate cervical cancer and lower the overall mortality rate. To date, more than?33,729 women have screened for cervical cancer using HPV DNA testing through the New Start Centre service delivery network.?

Indeed, PSI and PSH are bringing care into the hands of its users?to be in control of their sexual reproductive health. Though?lack?of self-confidence in collecting a reliable sample was the most cited reason for preferring clinician-collected samples, there was no significant difference in the acceptability and relative ease in self-sample collection between women in?rural versus?those in urban locations.??

Following this huge success, PSH will support the Ministry of Health and Child Care (MOHCC) to develop communication interventions to address the perceptions and barriers identified to improve uptake of HPV DNA self-sample collection and access to HPV DNA testing countrywide.?