Acceptability of home-based HPV self-sampling for cervical cancer screening among users and providers in the West region of Cameroon: a cross-sectional study
Abstract
Background
The World Health Organization’s 90-70-90 goal aims to eliminate cervical cancer (CC) as a public health issue, with a target of up to 70% of women screened by 2030. However, many countries, including Cameroon, are far from achieving this goal. Home-based human papillomavirus (HPV) self-sampling is a promising approach to improve participation rates. The main objective of this study was to explore the acceptability and feasibility of home-based HPV self-sampling in the West region of Cameroon.
Methods
A quantitative, descriptive, cross-sectional study conducted between January 11 and February 05, 2024, was embedded in a cluster-randomised controlled trial comparing home- vs. hospital-based CC screening. Women eligible for CC screening, male partners or close relatives, community leaders, and healthcare professionals (HCPs) living in Dschang health district responded to a structured questionnaire. Simple and multivariate analyses were performed to assess the association between acceptability of home-based HPV self-sampling, CC screening practices, and sociodemographic factors such as education, professional status, residence, and income. Preferences for implementation (e.g., seasonal timing) were also explored.
Results
A total of 556 participants (300 women, 70 male partners, 153 HCPs, and 33 community leaders) were recruited. Overall, 77.5% of participants expressed favourable attitudes toward home-based HPV self-sampling, with acceptability rates of 73.7% for women, 65.7% for men, 90% for community leaders, and 87.6% for HCPs. Previous CC screening was reported by 33% of women, and was significantly associated with being over 40 years old (aOR = 2.1, p = 0.007), with a monthly income of > 50,000 XAF (aOR = 2.2, p = 0.049), and having good knowledge of CC (aOR = 2.6, p = 0.001). Morning screening implementation was preferred by most participants, with 60% favouring year-round screening. More than 70% preferred face-to-face communication of HPV test results from SMS or phone calls, at hospitals for women (63%), men (50%), and HCPs (65.4%); while community leaders preferred home disclosure.
Conclusion
Home-based HPV self-sampling was highly accepted across all study groups and was unaffected by sociodemographic factors. Previous screening practices were associated with age, income, and knowledge. Home-based HPV self-sampling screening can address access disparities to CC screening. Community involvement in planning and implementing these programs is essential to ensure their success.
Trial registration
Ethical Cantonal Board of Geneva, Switzerland (CCER, N°202100085), (ClinicalTrials.govID NCT06166420 / 20231204) and the National Ethics Committee for Human Health Research in Cameroon (N°2023/09/1579/CE/CNERSH/SP).