After a one-day training, CHAs visited sexually active women, instructing each in the use of collection brush and the Universal Collection Medium tube. One week thereafter, a gynecologist collected cervical samples from, and performed colposcopies on, the same women. A single reference lab performed all HCs.
878 women (Age: 15–69 years) participated. Among self-collected samples, hrHPV prevalence was 33.9 % (95 % CI: 30.8 % –37 % ), compared with 28.6 % (95 % CI: 27 % –30 % ) among gynecologist-collected samples. However, 9.3 % of the patients were HPV HC II-positive in the self-collected sample and HPV HC II-negative in the gynecologist-collected samples (95 % CI: 7.38 % –11.22 % ), whereas 4 % tested positive in gynecologist-collected samples and negative in self-collected samples (95 % CI: 2.7 % –5.3 % ) (P < 0.01; kappa = 0.7). Of 9 cases of histologically-confirmed, high-grade squamous intraepithelial lesion, self-collected and provider-collected samples missed one each.
Self-collected vaginal sampling could be made an additional CHA function under existing program conditions, improving access to cervical cancer screening in poor rural settings.