RESULTS
Sociodemographic characteristics of the study participants is in Table
1. Among the participants, the median age was 39 (IQR: 32-45), while the
median monthly income was 5,000 INR (IQR: 3,000-10,000). The highest
percentage of respondents (41.7%, n=50) had secondary or higher
education, while the majority (n=113, 95.0%) were Hindu, married
(87.5%, n=105), and never smokers (n=113, 94.2%). About three-fifths
of respondents (57.1%) reported having never been screened for cervical
cancer, 70.8% had a negative VIA result, and 67.5% had a vaginal pH
greater than 4.5. All of the respondents who had a VIA positive result
had only a mild severity, and more than half had a negative cytology
result (57.7%) (S1. Figure).
Overall prevalence of HPV DNA positivity in the clinician collected
endocervical swab samples was 12.6% (95%CI: 7.7, 19.9). The
self-collected vaginal swab, when compared to the gold standard of the
physician-collected endocervical swab for HPV DNA testing, had a greater
specificity (98.1%, 95% CI: 95.5, 100) than it did sensitivity
(66.7%, 95% CI: 42.8, 90.6). The overall agreement between the two
tests was 94.1% (95% CI: 88.1, 97.3). The Cohen’s kappa value was
0.735 (95% CI: 0.342, 1.0) (Table 2).
The vast majority (84.8%) of respondents preferred to have a provider
of the same gender for their pelvic examinations, while about
three-in-five (59.3%) preferred to self-collect for their HPV DNA test.
All said that they would test with self-collection again and recommend
self-collection to a friend (Table 3). For each of the five measures of
acceptability of self-collection versus physician-collection,
self-collection was significantly more favorable than was physician
collection (all p-values were less than 0.05). The smallest difference
was in how well cared for the participants felt (mean of 3.57 for
self-collected versus 3.46 for physician-collected), while the largest
difference was in whether the test caused genital pain (mean of 3.42 for
self-collection versus 2.85 for clinician-collected). (Table 4)