HPV self‐sampling acceptability and preferences among women living with HIV in Botswana

Objective: To assess the acceptability and preferences of HPV screening with self- sampling and mobile phone results delivery among women living with HIV (WLWH) in Botswana, as an alternative to traditional speculum screening.Methods: WLWH aged 25 years or older attending an infectious disease clinic in Gaborone were enrolled in a cross- sectional study between March and April 2017.Women self- sampled with a flocked swab, had a speculum exam, and completed an interviewer- administered questionnaire about screening acceptability, experiences,and preferences.Results: Of the 104 WLWH recruited, 98 (94%) had a history of traditional screening. Over 90% agreed self- sampling was easy and comfortable. Ninety- five percent were willing to self- sample again; however, only 19% preferred self- sampling over speculumexam for future screening. Preferences differed by education and residence with self- sampling being considered more convenient, easier, less embarrassing, and less painful. Speculum exams were preferred because of trust in providers’ skills and women's low self- efficacy to sample correctly. Almost half (47%) preferred to receive results via mobile phone call. Knowledge of cervical cancer did not affect preferences.Conclusion: HPV self- sampling is acceptable among WLWH in Botswana; however, preferences vary. Although self- sampling is an important alternative to traditional speculum screening, education and support will be critical to address women's low self- efficacy to self- sample correctly.