High-risk HPV-RNA screening of physician- and self-collected specimens for detection of cervical lesions among female sex workers in Nairobi, Kenya.

OBJECTIVE

To compare accuracy of detecting high-grade cervical lesions (squamous intraepithelial lesions or greater, HSIL+) by high-risk HPV messenger RNA (hrHPV-RNA) testing between physician- and self-collected specimens, and by conventional cytology.

METHODS

The present prospective longitudinal study included data collected among female sex workers (FSWs) in Nairobi, Kenya, between December 2, 2009, and February 15, 2013. Participants self-collected cervico-vaginal specimens for hrHPV-RNA testing, and a physician collected cervical specimens for hrHPV-RNA testing and conventional cytology. hrHPV-RNA testing was conducted every 3 months, and conventional cytology every 6 months.

RESULTS

Overall, 350 FSWs aged 18-50 years participated. hrHPV-RNA prevalence decreased slightly from 29.9% (103/344) at baseline to 24.3% (53/218) at 24 months for physician-collected, and 28.5% (98/344) to 24.3% (53/218) for self-collected specimens. Agreement between the sampling methods appeared to increase over time (baseline κ 0.55, 95% confidence interval [CI] 0.45-0.65; 24 months κ 0.83, 95% CI 0.74-0.91). Among 21 patients with HSIL+ over 24 months, 18 (86%) and 17 (81%) had hrHPV-RNA-positive results at baseline in physician- and self-collected specimens, respectively; and 20 (95%) had baseline hrHPV-RNA-positive results or cytology anomalies.

CONCLUSION

Overall agreement between physician- and self-collected hrHPV-RNA results was moderate and appeared to increase over time. Baseline physician- and self-collected hrHPV-RNA tests were similarly strong indicators of cumulative HSIL+ over 24 months.