A Randomized Controlled Trial Comparing Self-Collected HPV Testing To VIA for Cervical Cancer Screening In Uganda: Uptake And Preliminary Results

Ogilvie GINA, University of British Columbia, Canada
MITCHELL S. 2 , MOSES E. 1 , PEDERSEN H. 2 , SEKIKUBO M. 3 , MWESIGWA D. 4 , JOEL S. 2 , BIRYABAREMA C. 3 , BYAMUGISHA J. 3 , MONEY D. 1,2

1 Women's Health Research Institute
2 The University of British Columbia
3 Makerere University
4 Kisenyi Health Unit

Purpose: Although visual inspection with acetic acid (VIA) is standard for cervical cancer screening in many low resource settings, self collected samples for high risk human papillomavirus (HR-HPV) DNA has emerged as a promising alternative. In this randomized controlled trial we compared community based self-collection of HR-HPV testing to VIA to determine the optimal screening method for cervical cancer screening in Kisenyi, Uganda.
 
Methods: 500 women recruited by outreach workers in the community between April-June 2014 in Uganda were randomized to self-collection or VIA. Women randomized to HPV self-collection were given a swab, completed screening and returned it immediately to the worker. Women who tested HPV positive were referred to VIA. Women randomized to VIA were referred for VIA at the local health unit where VIA positive women were provided cryotherapy at time of screening. Women in both arms were referred to colposcopy when indicated. Uptake rates were compared with Fisher’s exact test.
 
Results: Uptake in HR-HPV arm was 99.2% (248/250), compared to 48.4% (121/250) in VIA arm (p<0.01). In HR-HPV arm 29.4% (73/248) tested positive for HR-HPV, 45.2% (33/73) of whom attended VIA for follow up. Of those, 7 screened positive and 5 received treatment. In the VIA arm, 13.2% (N=16/121) screened positive; 7 received cryotherapy, 3 refused treatment, 5 were referred to colposcopy, and 1 woman was suspected of cervical cancer and received treatment after confirmatory testing.
 
Conclusions: Self collection-based high risk HPV testing had a significantly higher uptake rate compared to VIA alone in a low resource setting. This suggests that self-collection based screening is both feasible and acceptable among women in this setting.
 
Funding Source: University of British Columbia, BC Centre for Disease Control Foundation, Women’s Health Research Institute