Teboho Amelia Tiiti

Knowledge of human papillomavirus and self-sampling, including vaccination practices among female students in Free State, South Africa

Abstract Background and Aim Human papillomavirus (HPV)-related cancers, especially cervical cancer, remain highly prevalent in low- and middle-income countries, despite the availability of preventive measures such as vaccination and self-sampling screening, due to limited HPV awareness. The study aimed to assess the knowledge of HPV, HPV vaccination practices, and HPV self-sampling awareness and perceptions among female students at the University of the Free State in Bloemfontein, South Africa. Methods Data were collected from female university students through a self-administered questionnaire distributed via the secure web-based platform Research Electronic Data Capture (REDCap). HPV infection and vaccination knowledge were measured using a self-administered questionnaire. Knowledge was assessed by assigning one (1) point for each correct answer, while incorrect or “don't know” responses received a score of zero (0). A knowledge score above 75% was categorized as “good knowledge.” The data were analyzed using SAS version 9.4. Results The study included 381 participants with a median age (interquartile range, IQR) of 23.0 (20–26) years. The findings showed that while 40.9% of participants had good knowledge of HPV infection, only 9.7% demonstrated good knowledge of HPV vaccination, and 13.3% had good overall knowledge. Only 13.4% of participants reported having received the HPV vaccine, while 19.1% expressed unwillingness to receive the vaccine. Barriers to vaccine uptake included lack of information about the HPV vaccine (46.0%) and safety concerns (46.0%). The majority (78.2%) were unaware of HPV self-sampling. Having heard about HPV self-sampling was predictive for HPV knowledge (OR: 2.684, 95% CI: 1.389–5.188, p  = 0.003). Conclusion These findings suggest that while some participants are informed about HPV infection, the majority are not well-informed about HPV vaccination and are unaware of HPV self-sampling. Additionally, barriers to HPV vaccination persist. Targeted educational interventions are needed to address awareness and knowledge gaps and vaccine hesitancy. These interventions could significantly improve HPV and cervical cancer prevention outcomes.

Poor Performance of Applicator Tampon‐Based Self‐Collection for Liquid‐Based Cytology Among Women Attending a Tertiary Hospital in South Africa

ABSTRACT Background The South African Cervical Cancer Prevention and Control Policy was updated in June 2017, recommending liquid‐based cytology (LBC) as the preferred screening method and the investigation of self‐sampling for cervical cancer screening. Aim To compare the performance of the Self Collection Cervical Health Screening Kit [SelfCerv (applicator tampon)] to the Cervex‐Brush Combi for cytology screening. The study further aimed to compare high‐risk (hr‐) human papillomavirus (HPV) and LBC test results from both methods. Methods The study included 446 paired samples, comprising self‐collected (SelfCerv) and healthcare provider‐collected (Cervex‐Brush Combi) samples from women aged ≥ 18 years attending gynaecology outpatient clinics at a tertiary hospital in Pretoria, South Africa. LBC slides were prepared using the ThinPrep 5000 processor and manually stained with Hematoxylin and Eosin (H&E). Detection of 14 hr‐HPV types was performed using the Abbott RealTime HR‐HPV assay. Statistical analyses were performed using STATA version 17.0 (Stata Corp., College Station, Texas, USA). Results A statistically significant difference in cervical cytology detection between the two methods was observed ( p  = 0.0025). The Cervex‐Brush Combi was more effective in collecting endocervical cells (73.4%; 95% CI: 69.0–77.9) compared to the SelfCerv applicator tampon (7.3%; 95% CI: 4.7–9.9); ( p  < 0.001). Cytological abnormalities were detected in 65.4% (136/208) of participants who tested positive for hr‐HPV by healthcare provider sampling compared to 40.8% (84/206) by self‐sampling. A fair agreement ( κ : 0.35) with a concordance rate of 96.2% (95% CI: 94.4–98.0) was observed for specimen adequacy and diagnosis parameters [ κ : 0.34, with a concordance rate of 67.7% (95% CI: 63.2–72.1)] between the two methods. Conclusion The findings of this study do not support the implementation of applicator tampon‐based self‐collection as a method for cytology‐based cervical cancer screening.

Knowledge of Human Papillomavirus and Cervical Cancer among Women Attending Gynecology Clinics in Pretoria, South Africa

Background: Cervical cancer is mainly caused by human papillomavirus (HPV). Worldwide, knowledge of HPV and cervical cancer among women is reported to be inadequate. The study aimed to assess the knowledge and awareness of HPV and cervical cancer among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa. The study also intended to identify socio-demographic factors influencing women’s knowledge about HPV and cervical cancer risk factors. Methods: This was a clinic-based analytic cross-sectional study conducted among women aged 18 years and older. Participants were enrolled in the clinic waiting rooms while waiting to be attended to by the clinician. A self-administered questionnaire to assess knowledge of HPV, cervical cancer, and risk factors for developing cervical cancer was distributed to the participants. Results: A total of 527 women aged ≥18 years and older were randomly enrolled with a 99.8% response rate. Less than half (47.1%) of the participants had been previously screened for cervical cancer using a Papanicolaou (Pap) test. Few (18.8%) women correctly mentioned cervical cancer risk factors. Unemployed women were less likely to have correct knowledge of cervical cancer causes/risk factors (OR: 0.63; 95% CI 0.40–0.97) compared to employed women. Divorced/separated/widowed women were more likely to have good HPV knowledge compared to single participants (OR: 2.74; 95% CI 1.46–5.15). Conclusion: From this study, it is evident that cervical cancer screening is very low, and women lack knowledge of HPV and cervical cancer disease symptoms and its risk factors. There is a need for policies to prioritize providing accurate information to the public to reduce cervical cancer morbidity and mortality.