BACKGROUND: Cervical cancer is the second-leading cause of cancer incidence and leading cause of cancer deaths in Kenya. The World Health Organization has recommended human papilloma virus (HPV) testing as the primary screening method for cervical cancer. The Ministry of Health, Kenya, is assessing various approaches for HPV testing scale-up in Kenya. A HPV testing Rapid Results Initiative (RRI) was implemented to assess the feasibility of a sample referral mechanism from health facilities to central national laboratories. We present the findings from the RRI, focusing on screening approaches and outcomes.
METHODS: The RRI was implemented in two counties in Kenya in 2021-2022, targeting eligible women at HIV and key populations clinics. HPV samples were collected either by self or by a clinician. Samples were referred and analyzed at the Kenya Medical Research Institute and National Cancer Reference Laboratories. We compared screening statistics based on HIV status and sample collection approaches.
RESULTS: Of 3,123 samples analyzed, 50.0% (1,280) were from HIV positive women, 24.1% (752) were of unknown HIV status. The mean age of screened women was 38.9 (S.D 8.1) years. Sixteen percent (486/3,123) were self-collected samples while the rest were clinician collected. Uptake of self-collection was 3.6% (46/1,280) among HIV positive women, 23.9% (439/1,839) among women with negative or unknown HIV status (p<0.001). HPV positivity was 28.3% (362/1,280) among HIV positive women and 22.6% (416/1,839) among women with negative/unknown HIV status (p<0.001). Invalid sample rate was 3.0% (74/2,506) among the clinician-collected samples and 2.9% (14/486) among the self-collected samples (p = 0.906).
CONCLUSIONS: Uptake of self-sample collection was higher among women with negative/unknown HIV status compared to HIV positive women. We found no significant difference in sample quality between self-collected and clinician-collected HPV samples. Since self-sample collection is more acceptable among women, understanding reasons for low uptake by HIV positive women can inform future program interventions.