通过国家指南,评估在未满宫颈癌筛查的女性中在家自我采集检测高危型人乳头瘤病毒(HPV)和性传播感染的有效性和可接受性。
低收入人群,我们从北卡罗来纳州的普通人群中招募了不经常接受筛查的女性参加一项观察性研究.参与者提供了两个自我收集的宫颈阴道样本(一个在家里,一个在诊所)和一个临床医生收集的宫颈样本。样本进行了高危型HPV检测,沙眼衣原体,淋病奈瑟菌,阴道毛滴虫,和生殖支原体.宫颈样品也通过液基细胞学检测。
总的来说,193名女性对所有三个样本和细胞学结果都有明确的高危型HPV结果。自我家庭样本(12.4%)中高风险HPV的患病率与临床医生样本(11.4%;P=0.79)和自我临床样本(15.5%;P=0.21)中的高危型HPV的患病率没有差异。所有样本类型的高危型HPV阳性随着宫颈异常等级的增加而增加(P<.001)。自我家庭样本在所有确定的高级别鳞状上皮内病变和2或更严重的宫颈上皮内瘤变病例中检测到高危型HPV。阴道T的检测在不同类型的样本中具有可比性(范围10.2-10.8%),生殖M(3.3-5.5%),沙眼衣原体(1.1-2.1%),和淋病N(0-0.5%)。对于高危HPV,样本类型之间的Kappa值范围为0.56至0.66,0.86-0.91阴道T,生殖器M为0.65-0.83。大多数参与者报告理解自我收集说明没有困难(93.6%),并且愿意在将来使用自我收集(96.3%)。
基于邮件的,在我们的研究中,家庭自我收集高危型HPV和性传播感染检测在不频繁筛查的女性中是有效的,并且被广泛接受.这些发现支持未来使用高危HPV自我收集来提高美国高危女性的宫颈癌筛查率。
To evaluate the validity and acceptability of at-home self-collection to test for high-risk human papillomavirus (HPV) and sexually transmitted infections among women overdue for cervical cancer screening by national guidelines.
Low-income, infrequently screened women were recruited from the general population in North Carolina to participate in an observational study. Participants provided two self-collected cervicovaginal samples (one at home and one in the clinic) and a clinician-collected cervical sample. Samples were tested for high-risk HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. Cervical samples were also tested by liquid-based cytology.
Overall, 193 women had conclusive high-risk HPV results for all three samples and cytology results. Prevalence of high-risk HPV within self-home samples (12.4%) was not different from that within clinician samples (11.4%; P=.79) and from that within self clinic samples (15.5%; P=.21). Positivity for high-risk HPV in all sample types increased with increasing grades of cervical abnormality (P<.001). Self-home samples detected high-risk HPV in all identified cases of high-grade squamous intraepithelial lesions and of cervical intraepithelial neoplasia 2 or worse. Detection was comparable across sample types for T vaginalis (range 10.2-10.8%), M genitalium (3.3-5.5%), C trachomatis (1.1-2.1%), and N gonorrhoeae (0-0.5%). Kappa values between sample types ranged from 0.56 to 0.66 for high-risk HPV, 0.86-0.91 for T vaginalis, and 0.65-0.83 for M genitalium. Most participants reported no difficulty understanding self-collection instructions (93.6%) and were willing to use self-collection in the future (96.3%).
Mail-based, at-home self-collection for high-risk HPV and sexually transmitted infection detection was valid and well accepted among infrequently screened women in our study. These findings support the future use of high-risk HPV self-collection to increase cervical cancer screening rates among higher risk women in the United States.