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Original Research
The preference of women living with HIV for the HPV self-sampling of urine at a rural HIV clinic in Uganda
Submitted: 10 February 2022 | Published: 02 December 2022
About the author(s)
Agnes Nyabigambo, Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and, Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda; and, Health Economics and HIV/AIDS Division (HEARD), University of KwaZulu-Natal, Durban, UgandaRoy W. Mayega, Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and, Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
Hilbert Mendoza, Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
Aslam Shiraz, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
John Doorbar, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
Lynn Atuyambe, Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
Themba G. Ginindza, Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and, Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Abstract
Background: Women living with HIV have a double risk of acquiring cervical cancer (CC) due to repeated human papilloma virus (HPV) infections resulting from reduced immunity, with CC screening being low at 46.7%.
Objectives: To determine the factors associated with the preference for HPV self-sampling using urine as well as establish its feasibility among women living with HIV attending a rural HIV clinic in Uganda.
Method: A cross-sectional study design using quantitative data collection methods was used at the HIV clinic, Luweero District Hospital, among 426 women aged between 30 and 65 years. Data were analysed using descriptive statistics and modified Poisson regression. Urine samples were analysed using a Liferiver high-risk HPV genotyping real-time polymerase chain reaction (PCR) kit to determine the prevalence of the 15 HPV subtypes. Cervical intraepithelial neoplasia 2 (CIN2) was determined by visual inspection under acetic acid (VIA) using the nurse-led approach.
Results: Most women (296/426, 70%) preferred nurse-led screening. Preference for HPV self-sampling using urine was associated with older age (46–65 years) (adjusted prevalence risk ratios [aPRR] 1.59; 95% confidence interval [CI]: 1.13–2.24), history of sexually transmitted infections (aPRR 0.74: 95% CI: 0.55–0.98) and acquisition of CC information from the television (aPRR 1.48: 95% CI: 1.09–2.02). Approximately 97% (68/70) of women living with HIV tested HPV positive with one or more subtypes. The most prevalent subtype of HPV was HPV 58 (87.1%). Only one woman tested positive with VIA.
Conclusion: Nurse-led CC screening is preferred among women living with HIV, and HPV self-sampling using urine is feasible at the HIV clinic. Therefore, educational programmes to reassure the masses about urine HPV self-sampling need to be designed.
Contribution: This study’s findings provide early insights into the merits and demerits of the current HPV sample collection approaches. Hence, HPV testing should be tailored to routine HIV care in rural communities.
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