# Feasibility and acceptability of human papillomavirus self-sampling compared with clinician sampling in urban areas of western China: a cross-sectional survey

## TL;DR

This study shows that self-collected urine and vaginal samples are effective and well-accepted alternatives to clinician-collected samples for HPV and cervical cancer screening in western China.

## Contribution

The study evaluates the feasibility and acceptability of self-sampling methods for HPV and cervical cancer screening in a specific low-resource region.

## Key findings

- Self-collected urine and vaginal samples showed high diagnostic accuracy for detecting hrHPV and CIN2+.
- Participants found self-sampling methods to be less uncomfortable and embarrassing than clinician sampling.
- Self-sampling methods could improve screening accessibility and compliance in low-resource areas.

## Abstract

Cervical cancer, driven by persistent high-risk human papillomavirus (hrHPV) infection, remains a global health challenge, especially in low- and middle-income areas such as western China. Despite the critical role of HPV testing in early detection, coverage in China remains low due to cultural, psychological, and other barriers. Self-collected urine and vaginal samples offer alternative methods for sample collection. This study aimed to evaluate the feasibility and acceptability of detecting hrHPV and cervical intraepithelial neoplasia grade 2 or worse (CIN2+) via urine and vaginal self-sampling compared with clinician sampling in urban areas of western China.

A cross-sectional survey was conducted from November 2022 to March 2023 in urban areas of western China. The participants provided self-collected urine and vaginal samples for hrHPV testing and completed questionnaires on acceptability of self-sampling. The HPV positivity, agreement, and kappa value were calculated to assess concordance between self- and clinician sampling. The sensitivity, specificity, agreement, predictive values, and likelihood ratios were used to evaluate the clinical performance of both methods for detecting CIN2+.

A total of 2,228 female subjects aged 21–71 years were recruited, and self-collected urine samples, vaginal samples, and clinician-collected cervical samples were obtained. The sensitivity of clinician sampling, urine self-sampling and vaginal self-sampling were 80.00% (95% CI: 44.22–96.46), 70.00% (95% CI: 35.37–91.91) and 90.00% (95% CI: 54.12–99.48) for CIN2+; the specificity for <CIN2 were 98.33% (95% CI: 97.68–98.81), 98.23% (95% CI: 97.56–98.72) and 98.50% (95% CI: 97.87–98.95%); and the agreements for CIN2+ were 98.25% (95% CI: 97.59–98.74), 98.83 (95% CI: 98.26–99.22) and 98.82 (95% CI: 98.25–99.21). All methods yielded high negative predictive values, high positive likelihood ratios, and low negative likelihood ratios. Additionally, participants reported high acceptability of self-sampling, citing less discomfort and embarrassment than clinician sampling.

Self-collected urine and vaginal samples for the detection of hrHPV and CIN2+ demonstrate high diagnostic accuracy and acceptability, making them viable alternatives to clinician-collected samples. Self-sampling methods may improve screening accessibility and compliance, especially in resource-limited settings, thereby supporting the prevention and early detection of CIN2+.