Human papillomavirus (HPV) infection remains a major health threat in sub-Saharan Africa (SSA). HPV self-sampling could help find and treat cervical cancer at an early stage. We aimed to evaluate the effectiveness of HPV self-sampling over the standard health facility-based clinician-sampling for cervical cancer screening through a systematic review and meta-analysis of available randomized controlled trials. We searched PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, and the WHO Global Health Library for articles in SSA published as of 31 May 2020. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for the design and reporting of the results. We included randomized control trials that compared HPV self-sampling with the standard of care. The primary endpoint was uptake of cervical cancer screening service. The secondary endpoints were linkage to care, acceptability, screening frequency, and adverse events. We used RevMan V.5.3 software for statistical analysis. We computed random-effect model to provide pooled estimates of available data and I-squared (I2) test to assess heterogeneity. Of 77 citations, we included four trials from Nigeria, Ethiopia, Kenya, and Uganda, encompassing 8200 participants with age ranging from 25 to 65 years. The pooled analysis showed significantly higher uptake of cervical cancer screening in women who used HPV self-sampling (risk ratio [RR] 1.72, 95% CI 1.58–1.87; p = 0.01), while this had a considerable heterogeneity as explained by subgroup analysis. Uptake was higher in women who were offered sampling kit at home or work (RR 2.05, 95% CI 1.80–2.33) and those who’s kit was mailed to or invited to a nearby health center (RR 1.65, 95% CI 1.58–1.72, I2 = 0%) than those screened with the standard of care. There was no difference between the two groups in the rate of linkage to care of positive cases (RR 1.30, 95% CI 0.90–2.74, I2 = 91%). HPV self-sampling was acceptable and easy to use. None of the trials compared the frequency of screening or adverse events. HPV self-sampling is an effective and feasible alternative to the standard health facility-based clinician-sampling for cervical cancer screening in SSA. It could improve the uptake of cervical cancer screening and harness the global strategy towards elimination of cervical cancer by 2030.

中文翻译：

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撒哈拉以南非洲地区宫颈癌筛查的人乳头瘤病毒自我采样与标准临床医生采样：随机对照试验的系统评价和荟萃分析

人乳头瘤病毒 (HPV) 感染仍然是撒哈拉以南非洲 (SSA) 地区的主要健康威胁。HPV 自我采样有助于早期发现和治疗宫颈癌。我们的目的是通过对现有随机对照试验的系统回顾和荟萃分析，评估 HPV 自我采样相对于基于标准医疗机构的临床医生采样进行宫颈癌筛查的有效性。我们检索了 PubMed、Cochrane 对照试验中央注册库、ClinicalTrial.gov 和 WHO 全球卫生图书馆，以查找截至 2020 年 5 月 31 日发表的 SSA 文章。我们遵循系统评价和荟萃分析方案的首选报告项目 (PRISMA-P) ) 2015 年结果设计和报告指南。我们纳入了随机对照试验，将 HPV 自我采样与护理标准进行比较。主要终点是宫颈癌筛查服务的使用情况。次要终点与护理、可接受性、筛查频率和不良事件有关。我们使用RevMan V.5.3软件进行统计分析。我们计算随机效应模型以提供可用数据的汇总估计和 I 平方 (I2) 测试以评估异质性。在 77 个引用中，我们纳入了来自尼日利亚、埃塞俄比亚、肯尼亚和乌干达的 4 项试验，涉及 8200 名年龄在 25 岁至 65 岁之间的参与者。汇总分析显示，使用 HPV 自我采样的女性接受宫颈癌筛查的比例显着较高（风险比 [RR] 1.72，95% CI 1.58–1.87；p = 0.01），而正如亚组分析所解释的，这具有相当大的异质性。在家或工作时获得采样套件的女性（RR 2.05，95% CI 1.80–2.33）以及将套件邮寄到或邀请到附近健康中心的女性（RR 1.65，95% CI 1.58–1.72， I2 = 0%）比那些用标准护理筛查的人要高。两组与阳性病例护理的关联率没有差异（RR 1.30，95% CI 0.90-2.74，I2 = 91%）。HPV 自我采样是可以接受的并且易于使用。没有一项试验比较筛查或不良事件的频率。HPV 自我采样是 SSA 宫颈癌筛查中基于标准医疗机构的临床医生采样的有效且可行的替代方案。它可以提高宫颈癌筛查的普及率，并利用全球战略在 2030 年消除宫颈癌。