Is there a difference in sample adequacy when vaginal HPV DNA samples are self-collected at home, a health post, or a primary care health center in rural Ethiopia? Implications for community cervical cancer screening

TL;DR

The study found that self-collected HPV DNA samples at home had more issues than those collected at health centers in rural Ethiopia, suggesting health posts may be a good middle ground for cervical cancer screening.

Contribution

This study compares sample adequacy of self-collected HPV DNA samples in home, health post, and health center settings in rural Ethiopia for the first time.

Findings

Home self-collection had the highest sample inadequacy rate (15%) compared to health post (7%) and health center (5%).

HPV prevalence was lowest in home-collected samples (6%) compared to health post (20.4%) and health center (15.9%).

Self-sampling at health posts was associated with more positive views and less embarrassment than home sampling.

Abstract

Self-collection of HPV DNA samples is recommended as a cervical cancer screening method in areas with high barriers to clinical examination, such as Ethiopia. Self-collected sample adequacy in clinical settings is high compared to clinician collection, but less is known about self-collected sample adequacy in community settings. We evaluated sample adequacy differences when samples were taken at women’s homes, a local health post, or a primary care health center in rural Ethiopia.

Women either self-collected vaginal samples for HPV DNA at home (Arm 1, n = 100), at a health post (Arm 2, n = 100), or at a health center (Arm 3, n = 200). Women received identical sample collection kits and illustrated instruction pamphlets; all samples were treated the same way once collected. HPV DNA testing was performed using Ampfire Multiplex High-Risk HPV (Atila, Mountain View, California).

Thirty-two (8%) of the 399 samples were inadequate (negative β-globin gene). Sample inadequacy frequency was highest in Arm 1-Home (15%) compared to Arm 2-Health Post (7%) and Arm 3-Health Center (5%) (p < 0.05)). Arm 1 had significantly higher odds of inadequacy than Arm 3 (aOR: 2.8, 95% CI 1.2–6.8, p = 0.02) when adjusted for age, education, and marital status. There was no difference in adequacy between Arms 2 and 3. HPV prevalence was lowest in Arm 1 (6%) and significantly higher in Arms 2 and 3 (20.4% and 15.9%, respectively, p = 0.02). More women in Arm 2 reported positive views of self-sampling, and fewer reported embarrassment when using the self-test compared to Arm 1.

Collecting self-samples at home yielded more inadequate samples than collecting at a health center; however, self-samples collected at the health post were not significantly different from those collected at the health center. In rural areas, self-sampling at locations proximal to women’s residences but providing privacy may increase screening campaigns’ success. While more work is needed to confirm this finding, home sampling may miss women who should be referred for diagnostic testing.

The online version contains supplementary material available at 10.1186/s12905-025-04226-9.

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