Feasibility and acceptability of an HPV self-testing strategy : lessons from a research context to assess for ability to implement into primary care at a national level in Botswana

dc.contributor.authorLuckett, Rebecca
dc.contributor.authorRamogola-Masire, Doreen
dc.contributor.authorHarris, Devon A.
dc.contributor.authorGompers, Annika
dc.contributor.authorGaborone, Kelebogile
dc.contributor.authorMochoba, Lorato
dc.contributor.authorNtshese, Lapelo
dc.contributor.authorMathoma, Anikie
dc.contributor.authorKula, Maduke
dc.contributor.authorShapiro, Roger
dc.contributor.authorLarson, Elysia
dc.date.accessioned2024-06-13T09:52:22Z
dc.date.available2024-06-13T09:52:22Z
dc.date.issued2024-01
dc.descriptionDATA AVAILABILITY STATEMENT : The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.en_US
dc.description.abstractBACKGROUND : The WHO strategy for cervical cancer elimination strives to achieve 70% coverage with high-performance cervical screening. While few low- and middle-income countries have achieved this, high-risk human papillomavirus (hrHPV) self-testing creates the possibility to rapidly upscale access to highperformance cervical screening across resource settings. However, effective hrHPV screening requires linkage to follow-up, which has been variable in prior studies. This study developed and tested an implementation strategy aimed at improving screening and linkage tofollow-up care in South EastDistrict in Botswana. METHODS : This study performed primary hrHPV self-testing; those with positive results were referred for a triage visit. Withdrawals for any reason, loss-to follow-up between hrHPV test and triage visit, and number of call attempts to give hrHPV results were also documented. Acceptability of the program to patients was measured as the proportion of patients who completed a triage visit when indicated, meeting the a priori threshold of 80%. Feasibility was defined as the proportion of participants receiving the results and attending follow-up. To assess the associations between participant characteristics and loss-to-follow-up we used log-binomial regressions to estimate risk ratios and 95% confidence intervals (CI). RESULTS : Enrollment of 3,000 women occurred from February 2021 to August 2022. In total, 10 participants withdrew and an additional 33 were determined ineligible after consent, leaving a final cohort of 2,957 participants who underwent self-swab hrHPV testing. Half (50%) of participants tested positive for hrHPV and nearly all (98%) of participants received their hrHPV results, primarily via telephone. Few calls to participants were required to communicate results: 2,397 (82%) required one call, 386 (13%) required 2 calls, and only 151 (5%) required 3–5 calls. The median time from specimen collection to participant receiving results was 44 days (IQR, 27–65). Of all hrHPV positive participants, 1,328 (90%) attended a triage visit. DISCUSSION : In a large cohort we had low loss-to-follow-up of 10%, indicating that the strategy is acceptable. Telephonic results reporting was associated with high screening completion, required few calls to participants, and supports the feasibility of hrHPV self-testing in primary care followed by interval triage.en_US
dc.description.departmentObstetrics and Gynaecologyen_US
dc.description.librarianam2024en_US
dc.description.sdgSDG-03:Good heatlh and well-beingen_US
dc.description.sponsorshipThe Young Investigator Award from the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center, the National Cancer Institute, National Institutes of Health Award.en_US
dc.description.urihttps://www.frontiersin.org/journals/global-womens-healthen_US
dc.identifier.citationLuckett, R., Ramogola-Masire, D., Harris, D.A., Gompers, A., Gaborone,, K., Mochoba, L., Ntshese, L., Mathoma, A., Kula, M., Shapiro, R. & Larson, E. (2024) Feasibility and acceptability of an HPV self-testing strategy: lessons from a research context to assess for ability to implement into primary care at a national level in Botswana. Frontiers in Global Women's Health 4:1300788. DOI: 10.3389/fgwh.2023.1300788.en_US
dc.identifier.issn2673-5059 (online)
dc.identifier.other10.3389/fgwh.2023.1300788
dc.identifier.urihttp://hdl.handle.net/2263/96471
dc.language.isoenen_US
dc.publisherFrontiers Mediaen_US
dc.rights© 2024 Luckett, Ramogola-Masire, Harris, Gompers, Gaborone, Mochoba, Ntshese, Mathoma, Kula, Shapiro and Larson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).en_US
dc.subjectHuman papillomavirus (HPV)en_US
dc.subjectHPV testing implementationen_US
dc.subjectCervical cancer screeningen_US
dc.subjectAcceptabilityen_US
dc.subjectFeasibilityen_US
dc.subjectLow- and middle-income countries (LMICs)en_US
dc.subjectHigh-risk human papillomavirus (hrHPV)en_US
dc.subjectSDG-03: Good health and well-beingen_US
dc.titleFeasibility and acceptability of an HPV self-testing strategy : lessons from a research context to assess for ability to implement into primary care at a national level in Botswanaen_US
dc.typeArticleen_US

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