Feasibility of human papillomavirus self-sampling to combat COVID-19-related disruptions to cervical cancer screening: a cross-sectional survey

BACKGROUND: The prevalence of human papillomavirus (HPV) infection among Chinese women in Hong Kong has been reported to range between 7% and 11%, and high-risk HPV genotypes accounted for about 90% of cases of cervical cancer. The COVID-19 pandemic has had a major impact on a wide range of health outcomes because of limitations to the functioning of health services, including cervical cancer screening. The aim of this study was to assess HPV self-sampling as an alternative option for cervical cancer screening during the COVID-19 pandemic. METHODS: A cross-sectional household survey was conducted with a residential mailing sampling approach. Under the sampling frame, addresses would be geographically randomly selected in each group and mailing invitation letters were sent to selected households. All sexually active adult household members would be eligible to join the survey. The study comprises two parts: first, a self-administrated standardised web-based questionnaire; and second, laboratory testing of HPV in self-collected cervical samples. In part one of the study, a survey link was included in the invitation letter and a telephone survey was also offered to those who were unable to complete the web-based questionnaire. Participants were asked about their lifestyle and sexual behaviour, history of cervical cancer screening and infections, acceptability of HPV self-sampling, COVID-19-related health-care disruption, and sociodemographic factors. Interested participants who completed part one study were then invited to join part two of the study by taking a self-sample to be tested for sexually transmitted infections (namely HPV, Neisseria gonorrhoeae, and Chlamydia trachomatis) for estimation of the prevalence of sexually transmitted infections among the Hong Kong population. FINDINGS: 39 815 invitation letters were sent to selected households between May 1, 2021, and Dec 31, 2021. The response rate was 924 (2%) respondents who completed the web-based survey. 557 (60%) of 924 respondents were women aged 19–76 years (median 39 IQR 32–51). The overall willingness to undergo self-sampling was 364 (65%) of 557 participants, with a response rate of 166 (30%) of 557 who successfully completed part two of the study (self-sampling procedure). The overall HPV infection rate was 10% (17 of 166 self-tested participants), three (18%) of whom had never been screened. Among the 557 respondents, 144 (26%) who had never been screened for cervical cancer accepted HPV self-sampling. Among the 413 women who had ever been screened, 328 (80%) reported previously attending regular screenings. 129 (39%) of these 328 respondents indicated that their screening behaviour was affected by the health-care disruptions caused by the COVID-19 pandemic, and 93 (72%) of these 129 were willing to receive the self-sampling kit for testing, with a response rate of 34% (44 of 129) successfully completing the self-sampling procedure. INTERPRETATION: Our findings show that most women were willing to uptake self-sampling, both among those who had never been screened and especially those who previously adhered to regular screening but were affected by the COVID-19 pandemic. HPV self-sampling not only can help to tackle the barriers to cervical screening, but can also a feasible and acceptable option as an alternative cervical cancer screening during the pandemic. FUNDING: This study was supported by the Commissioned Health and Medical Research Fund of Food and Health Bureau of HKSAR Government (reference number CID-CUHK-E).