Evaluating the Feasibility of Self-sampling using CareHPV™ and Treatment with Cryotherapy in Haiti

Abstract

Introduction: Cervical cancer is one of the leading causes of death for women in Haiti. The purpose of this study was to evaluate the feasibility of HPV self-sampling using CareHPV™ and subsequent treatment with cryotherapy in urban and rural areas of Haiti. CareHPV™ is a vaginal self-sample HPV testing kit used to detect 14 types of high-risk HPV and cryotherapy is a form of treatment that freezes precancerous lesions with CO2 or nitrous oxide. Methods: The study took place in Port-au-Prince and three rural communities within the suburban commune of Leogane. Screening took place at clinics, community centers, and churches. Participants were given consent forms to sign, as well as a demographic questionnaire and an acceptability survey. If their HPV test result was positive, they were called up to three times to go the community clinic for treatment. The number of women that returned for treatment following a positive HPV test result were compared in the urban and rural communities with a chi square test of association and a prevalence rate ratio. Acceptability was measured quantitatively on the Likert Scale. Results: Feasibility was defined as 80% acceptability and 80% treatment uptake. Other factors related to feasibility such as screening numbers and geographical barriers were discussed. Eighty percent acceptability was reached in both rural and urban communities. Eighty percent treatment uptake was only reached in the rural communities, with a treatment uptake of 83.3%. Eighty percent treatment uptake was not reached in the urban communities, with a treatment uptake of 42.1%. The prevalence rate ratio of 1.98 indicates that rural participants were found to be nearly twice as likely to return for treatment than urban participants. The chi square test of association shows that this difference in treatment uptake is significant with an estimated p-value of 0.01 at an alpha of 0.05. Further research is needed to investigate the reasons for higher loss to follow-up for treatment in urban communities to further efforts to establish a national HPV screening program in Haiti.