Abstract / Summary
Human papillomavirus (HPV) self-sampling is recommended by the World Health Organization as a primary screening strategy for cervical cancer and may help overcome barriers associated with provider-taken sampling. However, evidence on women’s experiences with both methods and factors influencing preferences in low- and middle-income countries (LMICs) remains limited. This study compared women’s experiences with self-sampling and provider-taken sampling and examined factors associated with preference for self-sampling across four LMICs. A cross-sectional study was conducted among 455 women in Cambodia, Ethiopia, Mozambique and Uganda. All participants underwent both self-sampling (vaginal swab) and provider-taken sampling and subsequently completed a questionnaire assessing experiences across multiple domains (comfort, privacy, speed, pain, trust and ease of use) and future screening preferences. Paired comparisons were conducted using Wilcoxon signed-rank tests. Multivariable logistic regression analyses were used to identify factors associated with preference for self-sampling, using country-specific and pooled models. Across countries, self-sampling was generally rated more favorably than provider-taken sampling, particularly in terms of pain, with self-sampling consistently perceived as less painful. Differences in comfort, privacy and speed varied by setting and were most pronounced in Uganda and Mozambique. Preferences for self-sampling were higher in Uganda and Mozambique, while most women in Cambodia and Ethiopia reported no clear preference. In country-specific models, perceived comfort (Uganda) and privacy (Cambodia) were associated with preference for self-sampling. In the pooled model, perceiving self-sampling as more comfortable, younger age (25–39 years) and country of residence were associated with preference for self-sampling, whereas higher income was associated with a lower likelihood of preference. HPV self-sampling was widely acceptable and often preferred across diverse LMIC settings, although preferences varied by context. Self-sampling may be particularly beneficial for specific population groups but should be integrated into cervical cancer screening programs in a context-appropriate manner rather than considered a universal replacement for provider-based screening.