Enhancing cervical cancer screening uptake through self-sampling for HPV DNA testing: insights and results from implementing in routine HIV clinics serving women living with HIV in Nairobi, Kenya, 2021–2024

Abstract

In sub-Saharan Africa (SSA), only 14% of women aged 30 to 49 years have been screened for cervical cancer even though the region accounts for a quarter of global cervical cancer deaths. Women living with HIV are six times more likely to develop cervical cancer as compared to HIV-uninfected women in SSA. Unlike traditional screening methods such as Visual Inspection with Acetic Acid (VIA), the self-sampling for Human Papillomavirus (HPV) DNA testing offers a promising alternative as it reduces stigma, fear, and discomfort associated with cervical screening. However, evidence on its implementation in Kenya is limited. This study examined the feasibility and adoption of integrating self-sampling for HPV DNA testing in routine HIV clinics. Between 2021 and 2024, HIV-infected women, aged 25 years and over, attending comprehensive care clinics in Nairobi, Kenya, were offered cervical cancer screening using self-sampling for HPV DNA testing. Data were abstracted from the Kenya electronic medical records (Kenya EMR) across 60 health facilities in Nairobi County. We present results, summary characteristics of the clients, and factors associated with testing HPV positive using self-sampling for HPV DNA testing. HPV DNA self-sampling accounted for 48.6% of cervical cancer screening tests. Of 14,227 women screened using self-sampling for HPV DNA testing, 3,111 (21.9%) were HPV positive. Nearly half of the women who tested HPV positive (n = 1,540; 49.6%) were eligible for rescreening using VIA; rescreening results showed that 133 (8.6%) were VIA positive. HPV genotyping showed HPV 16 and 18 positivity were 13.1% and 17.8%, respectively, with predominance of other high-risk types (31,33,35,39,45,51,52,56,58,59,66,68) at 66.6% positivity. HPV positivity was associated with shorter duration on ART. Women who reported engaging in commercial sex were less likely to test HPV positive compared to women in the general population (10.3% versus 22.4%, respectively); this difference could not be explained by chance alone (ρ = 0.002). Results show that integration of HPV self-sampling in routine clinics is both feasible and was readily adopted and integrated in HIV clinics in Kenya. It significantly increased overall cervical cancer screening rates and demand, reaching a larger proportion of women who were screened for the first time.