Abstract 2584: HPV prevalence and acceptability of HPV self-sampling for cervical cancer screening in the community of Santiago Atitlan, Guatemala
Authors: Gottschlich Anna , Meza Rafael , Rivera-Andrade Alvaro , Grajeda Edwin , Alvarez Christian , Mendoza Montano Carlos 
Published: July 2016

Abstract
BACKGROUND: Incidence and mortality rates of cervical cancer in Guatemala are considerably higher than rates in developed countries, potentially due to the extremely low rates of cervical cancer screening in many Latin American countries, specifically in indigenous populations. Current estimates suggest that less than 40% of women in Guatemala have ever been screened for cervical cancer, with much lower rates in indigenous communities. We therefore proposed that reliance on Pap and VIA screening might not be the most effective methods for controlling and preventing cervical cancer in indigenous communities in Guatemala, and thus investigated self-collection HPV tests as an alternative method of screening.
METHODS: A randomly selected group of women (N = 202), ages 18-60, residing in a predominantly indigenous community approximately 130 kilometers west of Guatemala City were surveyed during July 2015 to assess risk factors and knowledge of HPV and cervical cancer. Eligible women were then asked to self-collect a vaginal sample to be tested for HPV to assess the prevalence in the community, as well as the acceptability of HPV self-sampling as an option for cervical cancer screening. We further investigated the relationship between sexual history and past use of health services with two outcomes, positive HPV test and prior Pap or VIA screening, using logistic regression.
RESULTS: Of the 202 women who completed the survey, 188 (93%) were interested in providing a self-collected vaginal sample, and 178 (88%) were eligible for self-collection. After collection, 100% of these women stated that they would be willing to perform this test periodically as a method of cervical cancer screening, and 80% reported that they would prefer self-collection in the home to physician collected samples in a doctors office. Of the 178 self-collected samples, 37 (21%) women tested positive for any type of HPV, including 31 (17%) for high risk HPV.
We found a positive, statistically significant association between use of health services and prior Pap or VIA screening (OR = 4.845; 95% CI: 1.553, 15.120; p = 0.007), after adjustment for age, education, and HPV test result. We also found a positive, however non-significant, association between lifetime sexual partners and HPV infection (OR = 1.770; 95% CI: 0.606, 5.167; p = 0.267), after adjustment for age, education, age at first sexual experience, and age at first childbirth.
CONCLUSIONS: Self-collection HPV testing as a form of cervical cancer screening was very well accepted in this indigenous community. Further testing needs to be done to assess the rate at which women receive a follow-up Pap or VIA screening after receiving a positive result on their HPV test. Furthermore, past use of health services is significantly associated with prior cervical cancer screening, suggesting that comprehensive strategies to enhance healthcare access are critical to improve screening outcomes.
Citation Format: Anna Gottschlich, Rafael Meza, Alvaro Rivera-Andrade, Edwin Grajeda, Christian Alvarez, Carlos Mendoza Montano. HPV prevalence and acceptability of HPV self-sampling for cervical cancer screening in the community of Santiago Atitlan, Guatemala. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2584.