Rural women's preferences for cervical cancer screening via HPV self-sampling : a discrete choice experiment study in Chidamoyo, Hurungwe District, Zimbabwe

Abstract

BACKGROUND : Cervical cancer screening via HPV self-sampling holds great promise for increasing access to underserved and never-screened women. We aimed to understand the preferences of rural Zimbabwean women for different characteristics of an HPV self-sampling intervention for cervical cancer screening by using the discrete choice experiment (DCE) methodology. METHODS : A DCE was administered to women in the Hurungwe Rural District. Women were asked to choose between two hypothetical screening choices defined by education, location of services, supervision of self-sampling, comfort of sampling device, results notification and care after HPV results. Data were analysed using fixed and mixed logistic regression models. FINDINGS : Results indicated that the comfort of the sampling device had the most significant impact on women's preferences for HPV self-sampling. Women prioritised facility-based self-sampling, female-supervised self-sampling, and face-to-face education on cervical cancer and screening methods. The methods of results notification and care after HPV results did not significantly impact women's choices. The mixed effects results showed preference heterogeneity in some of the attributes. Interaction analyses suggested that preferences were largely homogenous across the following subgroups: never-screened, previously screened, young and older women. The stratified analysis also showed that preferences were consistent among the four subgroups. INTERPRETATION : Our findings highlight the importance of face-to-face education, comfortable and user-friendly sampling devices, female health worker supervision and health facility-based self-sampling for cervical cancer screening via HPV self-sampling. These insights could guide the design of patient-centric interventions to ensure high uptake and increased screening coverage.