Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi
Abstract Introduction Despite being preventable, the cervical cancer burden remains high in Malawi and other low-income countries. The World Health Organization recommends cervical cancer screening (CCS) using human papillomavirus (HPV) testing. The coverage of HPV-based CCS is low but may increase...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23822-w |
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| author | Patani Mhango Andrew Kumitawa Monica Patricia Malata Jennifer H. Tang Effie Chipeta Bianca Kandeya Medrina Mtende Princess Kaira Razak Mussa Wanangwa Chimwaza Lameck Chinula Ireen Magongwa Jacqueline Mbendera Eneli Mhango Eunice Mwandira Lizzie Msowoya Jennifer S. Smith Mitch Matoga Agatha Bula Luis Gadama Victor Mwapasa |
| author_facet | Patani Mhango Andrew Kumitawa Monica Patricia Malata Jennifer H. Tang Effie Chipeta Bianca Kandeya Medrina Mtende Princess Kaira Razak Mussa Wanangwa Chimwaza Lameck Chinula Ireen Magongwa Jacqueline Mbendera Eneli Mhango Eunice Mwandira Lizzie Msowoya Jennifer S. Smith Mitch Matoga Agatha Bula Luis Gadama Victor Mwapasa |
| author_sort | Patani Mhango |
| collection | DOAJ |
| description | Abstract Introduction Despite being preventable, the cervical cancer burden remains high in Malawi and other low-income countries. The World Health Organization recommends cervical cancer screening (CCS) using human papillomavirus (HPV) testing. The coverage of HPV-based CCS is low but may increase with self-sampling of vaginal fluid. We assessed the acceptability, feasibility and appropriateness of two models for integrating HPV self-sampling for CCS into family planning (FP) services in Malawi. Methods We conducted a mixed-methods study nested within a 1:1 cluster randomized trial comparing two service delivery models in 16 health facilities in Lilongwe and Zomba Districts: Model 1 involved clinic-based vaginal self-sampling and HPV testing, whereas Model 2 included both clinic-based and community-based self-sampling and HPV testing facilitated by community health workers called Health Surveillance Assistants (HSAs). The study population were healthcare providers purposively selected from the facilities. We administered a survey using a 5-point Likert-scale tool at the Pre-, Mid-, and Final implementation phases of the study, supplemented by in-depth interviews and focus group discussions ( > = 1 per facility) to clarify survey findings. We audio-recorded qualitative interviews and then transcribed and analysed data using Nvivo 12 software and thematic content analysis. The quantitative survey data were analyzed using the Fisher exact test to test for association in Stata Version 16. Findings A total of 273 providers (nurses, clinicians, lab staff and HSAs) were recruited in the Pre- (n = 90), Mid- (n = 91), and Final-implementation (n = 92) phases. The majority of survey participants (> 90%) in both models agreed that integrating CCS into FP via HPV self-sampling was acceptable, appropriate, and feasible. Providers reported the following positive attributes of service integration and self-sampling: efficiency, reduction in workload (for clinicians and nurses), simplicity of self-sampling, cost-savings (for clients), promotion of women’s privacy and empowerment and reduction of negative myths and misconceptions associated with speculum vaginal examination. A minority of participants raised the following feasibility-related concerns: intermittent shortage of resources, increased workload for CHWs facilitating community-based sample collection, and lab personnel conducting HPV testing. Nevertheless, the availability of equipment and supplies, well-trained personnel, continuous mentorship, staff commitment, and teamwork facilitated the implementation of both models. Conclusions Both models of integrating CCS into FP were acceptable, feasible, and appropriate. They provide a platform to rapidly increase CCS uptake in Malawi. Nevertheless, strategies to optimize supply chain management and minimize the workload of CHWs and laboratory staff are needed to improve the scale-up of the models. |
| format | Article |
| id | doaj-art-cb10f22dce9745fe8c2aa86ed2f3f3f9 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-cb10f22dce9745fe8c2aa86ed2f3f3f92025-08-20T03:46:12ZengBMCBMC Public Health1471-24582025-08-0125111410.1186/s12889-025-23822-wAcceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in MalawiPatani Mhango0Andrew Kumitawa1Monica Patricia Malata2Jennifer H. Tang3Effie Chipeta4Bianca Kandeya5Medrina Mtende6Princess Kaira7Razak Mussa8Wanangwa Chimwaza9Lameck Chinula10Ireen Magongwa11Jacqueline Mbendera12Eneli Mhango13Eunice Mwandira14Lizzie Msowoya15Jennifer S. Smith16Mitch Matoga17Agatha Bula18Luis Gadama19Victor Mwapasa20Centre for Reproductive Health, Kamuzu University of Health SciencesDepartment of Community and Environmental Health, Kamuzu University of Health SciencesCentre for Reproductive Health, Kamuzu University of Health SciencesUniversity of North Carolina Project-MalawiCentre for Reproductive Health, Kamuzu University of Health SciencesCentre for Reproductive Health, Kamuzu University of Health SciencesCentre for Reproductive Health, Kamuzu University of Health SciencesCentre for Reproductive Health, Kamuzu University of Health SciencesCentre for Reproductive Health, Kamuzu University of Health SciencesCentre for Reproductive Health, Kamuzu University of Health SciencesUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiUNC Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiDepartment of Obstetrics and Gynaecology, Kamuzu University of Health SciencesDepartment of Community and Environmental Health, Kamuzu University of Health SciencesAbstract Introduction Despite being preventable, the cervical cancer burden remains high in Malawi and other low-income countries. The World Health Organization recommends cervical cancer screening (CCS) using human papillomavirus (HPV) testing. The coverage of HPV-based CCS is low but may increase with self-sampling of vaginal fluid. We assessed the acceptability, feasibility and appropriateness of two models for integrating HPV self-sampling for CCS into family planning (FP) services in Malawi. Methods We conducted a mixed-methods study nested within a 1:1 cluster randomized trial comparing two service delivery models in 16 health facilities in Lilongwe and Zomba Districts: Model 1 involved clinic-based vaginal self-sampling and HPV testing, whereas Model 2 included both clinic-based and community-based self-sampling and HPV testing facilitated by community health workers called Health Surveillance Assistants (HSAs). The study population were healthcare providers purposively selected from the facilities. We administered a survey using a 5-point Likert-scale tool at the Pre-, Mid-, and Final implementation phases of the study, supplemented by in-depth interviews and focus group discussions ( > = 1 per facility) to clarify survey findings. We audio-recorded qualitative interviews and then transcribed and analysed data using Nvivo 12 software and thematic content analysis. The quantitative survey data were analyzed using the Fisher exact test to test for association in Stata Version 16. Findings A total of 273 providers (nurses, clinicians, lab staff and HSAs) were recruited in the Pre- (n = 90), Mid- (n = 91), and Final-implementation (n = 92) phases. The majority of survey participants (> 90%) in both models agreed that integrating CCS into FP via HPV self-sampling was acceptable, appropriate, and feasible. Providers reported the following positive attributes of service integration and self-sampling: efficiency, reduction in workload (for clinicians and nurses), simplicity of self-sampling, cost-savings (for clients), promotion of women’s privacy and empowerment and reduction of negative myths and misconceptions associated with speculum vaginal examination. A minority of participants raised the following feasibility-related concerns: intermittent shortage of resources, increased workload for CHWs facilitating community-based sample collection, and lab personnel conducting HPV testing. Nevertheless, the availability of equipment and supplies, well-trained personnel, continuous mentorship, staff commitment, and teamwork facilitated the implementation of both models. Conclusions Both models of integrating CCS into FP were acceptable, feasible, and appropriate. They provide a platform to rapidly increase CCS uptake in Malawi. Nevertheless, strategies to optimize supply chain management and minimize the workload of CHWs and laboratory staff are needed to improve the scale-up of the models.https://doi.org/10.1186/s12889-025-23822-wCervical cancer screeningIntegrationSelf-samplingHPVImplementation |
| spellingShingle | Patani Mhango Andrew Kumitawa Monica Patricia Malata Jennifer H. Tang Effie Chipeta Bianca Kandeya Medrina Mtende Princess Kaira Razak Mussa Wanangwa Chimwaza Lameck Chinula Ireen Magongwa Jacqueline Mbendera Eneli Mhango Eunice Mwandira Lizzie Msowoya Jennifer S. Smith Mitch Matoga Agatha Bula Luis Gadama Victor Mwapasa Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi BMC Public Health Cervical cancer screening Integration Self-sampling HPV Implementation |
| title | Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi |
| title_full | Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi |
| title_fullStr | Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi |
| title_full_unstemmed | Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi |
| title_short | Acceptability, feasibility and appropriateness of integrating HPV self-sampling for cervical cancer screening into voluntary family planning services in Malawi |
| title_sort | acceptability feasibility and appropriateness of integrating hpv self sampling for cervical cancer screening into voluntary family planning services in malawi |
| topic | Cervical cancer screening Integration Self-sampling HPV Implementation |
| url | https://doi.org/10.1186/s12889-025-23822-w |
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