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HPV risk factors and screening among Malawian women

Esber, Allahna Lauren
http://rave.ohiolink.edu/etdc/view?acc_num=osu1458645591

Abstract Details

2016, Doctor of Philosophy, Ohio State University, Public Health.
Introduction: Malawi has the highest age-adjusted incidence of cervical cancer in the world and a case-fatality rate of over 60%. Virtually all cases of cervical cancer are caused by the human papillomavirus (HPV). Most women will have an HPV infection during their lifetime but the majority will clear the infection without any symptoms or lasting impact. Several risk factors are associated with increased risk of progression from initial HPV infection to cervical cancer. Our study examined a potential risk factor for HPV infection and evaluated self-collection of samples for HPV testing. Specifically, we examined intravaginal practices (IVP) as a risk factor for HPV infection and abnormal cervical lesions among rural Malawian women. Second, we examined the validity and feasibility of self-collected sampling for HPV testing in a clinic setting. Last, we assessed the acceptability and identified correlates of acceptability for self-collection of samples for HPV testing in a community setting. Methods: We used data from the baseline wave of a cohort study on sexual and reproductive health and a cross-sectional, clinic-based study examining sexual and reproductive tract infections. In our first aim, we used generalized linear models with a binomial distribution and log link and fisher’s exact test to examine the associations between the type of intravaginal practices (IVP) (cleansing with soap and water, cleansing with cotton, cloth, or tissue, and inserting other substances) and frequency of IVP and HPV in 193 women presenting for care at a rural clinic in Lilongwe District, Malawi. Using this same population, we examined the feasibility, validity, and acceptability of self-collected sampling for HPV testing. In order to make these assessments we calculated a kappa statistic, sensitivity and specificity of self-collected samples compared to clinician-collected samples. Last, we used data from the baseline wave of a representative community-based cohort study among women of reproductive age (n=824) to examine correlates of willingness (developed based on the theory of planned behavior) to utilize self-collection of samples for HPV testing. Results: In our first analysis, we found that intravaginal practices are common and frequently performed. When we examined the relationship between type and frequency of IVP with high-risk (hr) HPV or abnormal cervical lesions we did not find any significant associations. In our second analysis, when comparing self-collected to clinician-collected samples, we found high agreement in detection of hr-HPV (kappa 0.70-0.90) and high specificity (98%-100%) but varied sensitivity (50%-90%) by hr-HPV type. Last, in our third analysis, 67% of women reported being willing to self-collect a vaginal sample for HPV testing in their homes. Awareness of cervical cancer, supportive subjective norms, perceived behavioral control, and clinician recommendations were all positively associated with increased willingness to self-collect samples for HPV testing. Conclusions: We did not find a significant association between IVP and hr-HPV or abnormal cervical lesions. However, our study population, and the high frequency with which IVP were reported, may have limited our ability to assess associations. We did find that self-collection in a clinic setting performed comparably to clinician-collected samples and care-seeking women found the procedure acceptable. Last, we found that among a random sample of rural Malawian women, self-collection of samples for HPV testing is acceptable, and modifiable factors, like clinician recommendations, can help to facilitate the acceptability of the screening method.
Alison Norris, MD PhD (Advisor)
Abigail Norris Turner, PhD (Committee Member)
Annie-Laurie McRee, PhD (Committee Member)
Abigail Shoben, PhD (Committee Member)
149 p.
Epidemiology; Public Health
Human papillomavirus; cervical cancer; screening; Malawi;

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Citations

  • Esber, A. L. (2016). HPV risk factors and screening among Malawian women [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1458645591

    APA Style (7th edition)

  • Esber, Allahna. HPV risk factors and screening among Malawian women. 2016. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1458645591.

    MLA Style (8th edition)

  • Esber, Allahna. "HPV risk factors and screening among Malawian women." Doctoral dissertation, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1458645591

    Chicago Manual of Style (17th edition)

osu1458645591
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This open access ETD is published by The Ohio State University and OhioLINK.