Acceptability of home-based HPV self-sampling for cervical cancer screening among users and providers in the West region of Cameroon: a cross-sectional study.

Abstract

Background: The World Health Organization's 90-70-90 goal aims to eliminate cervical cancer (CC) as a public health issue, with a target of up to 70% of women screened by 2030. However, many countries, including Cameroon, are far from achieving this goal. Home-based human papillomavirus (HPV) self-sampling is a promising approach to improve participation rates. The main objective of this study was to explore the acceptability and feasibility of home-based HPV self-sampling in the West region of Cameroon.

Methods: A quantitative, descriptive, cross-sectional study conducted between January 11 and February 05, 2024, was embedded in a cluster-randomised controlled trial comparing home- vs. hospital-based CC screening. Women eligible for CC screening, male partners or close relatives, community leaders, and healthcare professionals (HCPs) living in Dschang health district responded to a structured questionnaire. Simple and multivariate analyses were performed to assess the association between acceptability of home-based HPV self-sampling, CC screening practices, and sociodemographic factors such as education, professional status, residence, and income. Preferences for implementation (e.g., seasonal timing) were also explored.

Results: A total of 556 participants (300 women, 70 male partners, 153 HCPs, and 33 community leaders) were recruited. Overall, 77.5% of participants expressed favourable attitudes toward home-based HPV self-sampling, with acceptability rates of 73.7% for women, 65.7% for men, 90% for community leaders, and 87.6% for HCPs. Previous CC screening was reported by 33% of women, and was significantly associated with being over 40 years old (aOR = 2.1, p = 0.007), with a monthly income of > 50,000 XAF (aOR = 2.2, p = 0.049), and having good knowledge of CC (aOR = 2.6, p = 0.001). Morning screening implementation was preferred by most participants, with 60% favouring year-round screening. More than 70% preferred face-to-face communication of HPV test results from SMS or phone calls, at hospitals for women (63%), men (50%), and HCPs (65.4%); while community leaders preferred home disclosure.

Conclusion: Home-based HPV self-sampling was highly accepted across all study groups and was unaffected by sociodemographic factors. Previous screening practices were associated with age, income, and knowledge. Home-based HPV self-sampling screening can address access disparities to CC screening. Community involvement in planning and implementing these programs is essential to ensure their success.

Trial registration: Ethical Cantonal Board of Geneva, Switzerland (CCER, N°202100085), (ClinicalTrials.govID NCT06166420 / 20231204) and the National Ethics Committee for Human Health Research in Cameroon (N°2023/09/1579/CE/CNERSH/SP).