Assessing the acceptability of a cervical self-sampling screening intervention in rural Haiti

BACKGROUND: The annual incidence of cervical cancer in Haiti is 93.9/100,000. Pap smear screening has been demonstrated to be an ineffective screening tool in resource-poor settings. Cervical self-sampling for high-risk human Papillomavirus (HR-HPV) is a proposed alternative. METHODS: Community health workers (CHWs) in Thomonde, Haiti recruited women 18 and older who were self-reported premenopausal. CHWs administered a questionnaire that assessed demographics, reproductive and sexual health history; participants then performed the cervical self-sampling. Women were asked about their impressions of the sampler to gauge acceptability. Results of the testing were provided to the women within six weeks of self-sampling and CHWs navigated women with positive results to appropriate and timely follow-up. RESULTS: 373 women completed the self-sampling and questionnaire. Of submitted samples, 8.6% contained insufficient material for analysis, 98.3% of women reported the self-sampler as “comfortable” or “very comfortable”, 59.9% reported “no pain” and 94.3% reported no bleeding after performing the self-sampling. 80.6% stated they prefer testing at home to at a clinic, and 99.7% would recommend the test to a friend or neighbor. CONCLUSIONS: Self-sampling is an acceptable alternative to Pap smear screening for women in rural Haiti. It circumvents individual and environmental barriers including modesty and access to clinic-based healthcare. Pairing this procedure with a routine CHW visit is feasible and necessary. CHWs can address cultural barriers such as cancer fatalism and the Haitian view of disease causality. Therefore, this intervention builds local community capacity to increase cancer prevention knowledge and increase screening rates in a culturally appropriate fashion.