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PLoS One. 2018 Mar 14;13(3):e0190172. doi: 10.1371/journal.pone.0190172. eCollection 2018.

Test performance and acceptability of self- versus provider-collected swabs for high-risk HPV DNA testing in female-to-male trans masculine patients.

Author information

1
Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America.
2
Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America.
3
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
4
The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America.
5
Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California, United States of America.
6
UCSF Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, California, United States of America.
7
Department of Population, Family, and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America.
8
Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America.
9
Transgender Health Program, Fenway Health, Boston, Massachusetts, United States of America.
10
Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
11
Department of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America.
12
Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, United States of America.
13
Center for Health Equity Research (CHER), Brown University, Providence, Rhode Island, United States of America.
14
Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.

Abstract

BACKGROUND:

High-risk human papillomavirus (hrHPV) causes virtually all cervical cancers. Trans masculine (TM) people (those assigned female at birth who identify with a gender other than female) have low uptake of conventional cervical cancer screening. Self-collected hrHPV DNA testing has high levels of acceptability among cisgender (non-transgender) females and may support increased cervical cancer screening uptake in TM individuals.

OBJECTIVE:

To assess the test performance and acceptability of self-collected vaginal specimens in comparison to provider-collected cervical swabs for hrHPV DNA detection in TM individuals ages 21-64 years.

METHODS:

Between March 2015-September 2016, 150 TM participants with a cervix (mean age = 27.5 years; SD = 5.7) completed a one-time study visit comprised of a self-report survey, self-collected vaginal HPV DNA swab, clinician-administered cervical HPV swab, and brief interview on acceptability of clinical procedures. Participants were randomized to complete either self- or provider-collection first to minimize ordering effects. Self- and provider-collected samples were tested for 13 hrHPV DNA types using a DNA Hybridization Assay. The primary outcome variable was the concordance (kappa statistic) and performance (sensitivity, specificity) of self-collected vaginal HPV DNA specimens versus provider-collected cervical HPV swabs as the gold standard.

RESULTS:

Of the 131 participants completing both the self- and provider-collected HPV tests, 21 cases of hrHPV were detected by the provider cervical swab (gold standard; 16.0% hrHPV prevalence); 15 of these cases were accurately detected by the self-collected vaginal swab (71.4% concordance) (Kappa = 0.75, 95% Confidence Interval [CI]: 0.59, 0.92; p<0.001). Compared to the provider-collected cervical hrHPV DNA sample (gold standard), the self-collected vaginal hrHPV DNA test demonstrated a sensitivity of 71.4% (95% CI: 0.52, 0.91; p = 0.0495) and specificity of 98.2% (95% CI: 0.96, 1.00; p<0.0001). Over 90% of participants endorsed a preference for the self-collected vaginal swab over provider-collected cervical swab.

CONCLUSION:

Self-collected vaginal swabs are highly acceptable to TM as a means to test for hrHPV DNA. Test performance of this self-collection method for hrHPV detection in TM is consistent with previous studies in cisgender females. Self-collected vaginal swab testing for hrHPV DNA represents a reasonable and patient-centered strategy for primary cervical cancer screening in TM patients unwilling to undergo provider collection of specimens via speculum exam.

PMID:
29538411
PMCID:
PMC5851532
DOI:
10.1371/journal.pone.0190172
[Indexed for MEDLINE]
Free PMC Article

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