EFFECTIVENESS OF HUMAN PAPILLOMAVIRUS SELF-SAMPLING INTERVENTIONS FOR INCREASING CERVICAL CANCER SCREENING UPTAKE IN LOW- AND MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Cervical cancer remains a major public health problem in low- and middle-income countries (LMICs), where screening coverage is often inadequate and contributes substantially to disease burden and mortality. Human papillomavirus (HPV) self-sampling has emerged as a promising strategy to overcome barriers associated with conventional facility-based screening methods. This systematic review and meta-analysis evaluated the effectiveness of HPV self-sampling interventions in increasing cervical cancer screening uptake among women residing in LMICs. A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and regional databases up to December 2023. Randomized controlled trials comparing HPV self-sampling with standard cervical cancer screening methods were included. Two reviewers independently screened studies, extracted data, assessed risk of bias, and synthesized evidence. Pooled odds ratios (ORs) were calculated using a random-effects meta-analysis. Five randomized controlled trials involving 9,746 women met the inclusion criteria. Screening uptake was significantly higher among women offered HPV self-sampling compared with those receiving standard screening approaches (pooled OR 4.24; 95% CI: 3.88–4.65). Overall screening completion rates were 81.0% in the self-sampling group and 50.1% in the standard screening group, representing a substantial absolute improvement. Moderate heterogeneity was observed across studies (I²=29.9%). Findings remained consistent across subgroup and sensitivity analyses, and no significant publication bias was detected. The available evidence demonstrated that HPV self-sampling markedly improved cervical cancer screening uptake in LMICs. Incorporation of self-sampling strategies into national cervical cancer screening programs may substantially enhance screening coverage and contribute to reductions in cervical cancer-related morbidity and mortality in resource-constrained settings.