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J Low Genit Tract Dis. 2015 Apr;19(2):119-23. doi: 10.1097/LGT.0000000000000081.

Preference for human papillomavirus-based cervical cancer screening: results of a choice-based conjoint study in Zambia.

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1Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; 2Institute of Economic and Social Research, University of Zambia; 3Centre for Infectious Disease Research in Zambia; and 4Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia; and 5Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.



The objective of this study was to assess the conditions under which Zambian women with a history of cervical cancer screening by visual inspection with acetic acid might switch to human papillomavirus-based testing in the future.


We conducted a choice-based conjoint survey in a sample of women recently screened by visual inspection in Lusaka, Zambia. The screening attribute considered in hypothetical-choice scenarios included screening modality, sex and age of the examiner, whether screening results would be presented visually, distance from home to the clinic, and wait time for results.


Of 238 women in the sample, 208 (87.4%) provided responses sufficiently reliable for analysis. Laboratory testing on a urine sample was the preferred screening modality, followed by visual screening, laboratory testing on a self-collected vaginal specimen, and laboratory testing on a nurse-collected cervical specimen. Market simulation suggested that only 39.7% (95% CI = 33.8-45.6) of the respondents would prefer urine testing offered by a female nurse in her 30s over visual inspection of the cervix conducted by a male nurse in his 20s if extra wait time were as short as 1 hour and the option of viewing how their cervix looks like were not available.


Our study suggests that, for some women, the level of preference for human papillomavirus-based screening strategies may depend highly on the process and conditions of service delivery.

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