Experiences of Self-Collected Human Papilloma Virus (HPV) Testing Among Women Aged 20 to 65 Years in Ho Chi Minh City, Vietnam
1
General Gynecology Department, TuDu Hospital, Ho Chi Minh City 7000, Vietnam
2
OB-GYN Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 7000, Vietnam
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(8), 968; https://doi.org/10.3390/diagnostics15080968
Submission received: 28 February 2025
/
Revised: 25 March 2025
/
Accepted: 8 April 2025
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Published: 10 April 2025
(This article belongs to the Special Issue Recent Advances in Gynecologic Oncology: Diagnosis and Management, 2nd Edition)
Abstract
:Background/Objectives: To assess the correct sampling rates and self-collection satisfaction levels among female residents aged 25 to 64 years during first-time HPV testing in the communities of Ho Chi Minh City. Methods: An observational study was conducted on self-collection for HPV testing in communities from January to December 2024. The study employed a probability proportional to size sampling method, involving self-collected sampling and post-collection direct interviews. Results: The data show that 99.9% [95% CI = 0.99–1] of 775 women successfully collected their own samples during a first-time HPV testing process. The self-collection satisfaction rate was 80.4% [95% CI = 0.77–0.83]. Conclusions: Self-collected sampling for HPV testing has a very high success rate in communities. Moreover, women who feel confident in self-collection tend to have higher satisfaction rates with this new method. Therefore, self-collection sampling should be widely adopted for early cervical cancer screenings to test for high-risk HPV. It is essential to provide careful instructions and mobilization to encourage women’s confidence in performing self-collections.
1. Introduction
In 2020, cervical cancer ranked as the eighth leading cancer type in Vietnamese women, according to statistics from the International Agency for Research on Cancer (IARC) [1]. This ranking highlights the success of early screening and treatment programs for precancerous lesions.
High-risk strains of the human papillomavirus (HPV) cause most cervical cancer cases [2,3]. Although most individuals are clear of infection within two years, long-term exposure can lead to precancerous lesions and cervical cancer if left undiagnosed and untreated [4]. Highly sensitive high-risk HPV tests increase the likelihood of detecting precancerous lesions in the cervix compared to cytology testing [5,6,7]. Current cervical cancer screening programs primarily focus on HPV testing, with organizations such as the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), and the American Society for Colposcopy and Cervical Pathology (ASCCP) in the United States recommending HPV tests as the first line of screening for women aged 25 and above [8,9,10].
Samplers for HPV self-collection have been implemented in national screening programs worldwide [11]. The World Health Organization (WHO) recommended self-collection as a tool for cervical cancer screening globally in 2022 [2,12]. This method can effectively increase participation in global cervical cancer screening programs, with the potential to enhance screening coverage by up to 97% [13,14].
Ho Chi Minh City (HCMC) is the most populous city in Vietnam and a crucial hub for the country’s economic, cultural, and educational development. Due to its high population density, community healthcare, particularly women’s health, is a top priority in the city’s social policies.
Vietnam has approved the use of human papillomavirus (HPV) tests as a cervical cancer screening method. Since 2016, HPV testing has been the primary screening tool for women aged 30 and above [15]. We are in a transition period from a less developed country to a developed country, and most people do not have enough time or money to go to the hospital to test for high-risk HPV. The use of self-sampling in HPV testing will correct the above and help increase the rate of people being screened for early cervical cancer. Furthermore, to combat and eventually eradicate cervical cancer, Vietnam’s Ministry of Health has approved self-collection HPV tests as a cervical cancer screening tool since 2021 [16].
There is currently a lack of data on self-collection HPV testing in Vietnamese communities, particularly in HCMC. Therefore, a study was conducted to investigate the rate of valid samples obtained through self-collection HPV testing among women aged 25–65 from HCMC communities and their satisfaction with the sample self-collection process. The study aims to investigate the effectiveness of self-collection HPV testing in providing valid samples among women from HCMC communities, aged 25–65 years old, and to evaluate their satisfaction with the self-collection process.
2. Methods
2.1. Study Design and Participants
The study employed a non-participant observation method to collect data on self-collection human papillomavirus (HPV) testing from January to December 2024.
The study included female residents of HCMC who were between 25–65 years old, had participated in sexual activity, and were free from any vaginal issues within the past 24 h before sample collection. The participants did not have a history of cervical cancer, precancerous lesions, or abnormal cell readings from regular health check-ups. The study excluded women who were incapable of giving informed consent due to mental or cognitive impairments.
2.2. Sample Size
A formula was used to estimate with high precision the largest sample size in the population when the estimated prevalence is 50%. Because this prevalence fluctuates significantly, we choose p = 0.5 to ensure the best sample power for the main objective of the study. As the study focused on community settings, the sample size was doubled to mitigate design effects, resulting in a minimum sample size of 772 women to ensure sufficient power.
2.3. Data Collection Tools
Two tools were utilized, a pre-composed questionnaire administered before testing and a test result recorder following HPV sample self-collection. The questionnaire consisted of two sections, with Section 1 containing 36 questions that covered epidemiology, medical history, and knowledge about HPV testing prior to self-collection. Section 2 included 57 questions that explored women’s experiences and practices during self-collection steps and post-collection experiences.
“Self-collection samples”: The Medic Hoahao Hospital’s Department of Medical Genetics Testing notified the research team on the test sample’s compliance with the required criteria. Non-compliant samples were noted on a recorder. In cases where the self-collected sample was deemed invalid, a message was conveyed indicating the need for re-collection, citing “insufficient cells”.
“To gauge satisfaction”: the research team utilized a specific variable, which was defined by a single question querying the individual’s preference for self-collection during the next testing process. A positive response to this question, which favored self-collection, was used to determine the level of satisfaction.
2.4. Study Procedure
Step 1: Sampling.
The sampling process began with selecting clusters using the probability proportional to size (PPS) technique, as depicted in Figure 1. The definition of a cluster in the study was a commune.
Initially, 30 clusters of communes were randomly chosen from 312 communes in HCMC. Women participants were then selected from a list of 4,764,900 women provided by the Department of Population and Family Planning, which is under the management of the HCMC Department of Health. Each cluster was assigned a specific number of women to be selected, with the first cluster consisting of women with a random number of 68. Subsequent clusters included women with numbers 68 + 158,830, with subsequent numbers calculated by adding the product of (n − 1) and 158,830 to 68.
At the second stage, 26 women were randomly chosen from each selected commune. A total of 780 women were recruited into the study between January and December 2024. The percentage of women who provided informed consent was 99.4%, with 775 women participating in the study.
Step 2: Pilot study.
Ten women were randomly selected and interviewed to refine a questionnaire, ensuring it aligned with local customs and daily language. These 10 women were not part of the main study participant group.
Step 3: Data collection with interview questionnaire
We contacted the heads of the communal health station to gather information on the local area and finalize the plan and schedule for collecting test samples. We planned to send our research team to participant houses on Saturdays and Sundays, twice a day, from 8:00 to 11:30 in the morning and 15:00 to 19:00 in the afternoon, to collect test samples and gather related information alongside the health station staff.
To ensure a smooth self-collection process, we provided participants with illustrated instructions for the research subject at home on how to collect samples using cotton FLOQSwabs. These swabs are self-sampling kits from RocheR (Basel, Switzerland) (Figure 2). As soon as a participant provided the test sample, our team diluted it into a solvent liquid and stored it according to the recommended procedure to maintain the sample’s quality and minimize solvent waste. Each vial contains 20 mL methanol solution. To avoid errors during the collection process, the sample was then labeled with a study code. After collecting, the samples were stored in specialized containers, as specified by the manufacturer.
Upon completing the self-collection process, a collaborator conducted an interview with the participant using a pre-designed questionnaire to record their experiences. The interviews took approximately 5–10 min. To ensure accuracy, a midwife verified the test code on the participant’s record with the corresponding code on the test order sheet before transporting the sample to the Department of Medical Genetics at Medic Hoahao Hospital on the same day. The department received the samples within 24 h and analyzed them using the Roche Cobas Z480 system (Basel, Switzerland), which specializes in HPV analysis, in accordance with the hospital’s testing procedure. Once the test results were available, we contacted the participants to inform them of the outcome.
Step 4: Counseling and patient instructions
In cases where the initial self-collected test sample was deemed invalid, we reached out to the participant to advise on re-collection procedures. Upon confirmation of a positive result of high-risk HPV, we provided participants with the necessary health care guidance in accordance with MOH (Ministry of Health) recommendations.
2.5. Data Analysis
The data analysis was performed using STATA 17.0 software. The mean and standard deviation of continuous variables, as well as rates and percentages of categorical variables, were calculated and presented. To investigate the connection between self-collection satisfaction and other factors, univariate and multivariate logistic regression analyses were conducted. Prevalence odds ratios and corresponding 95% confidence intervals were calculated and documented.
2.6. Ethical Considerations
This study was conducted in accordance with the Declaration of Helsinki. Ethics approval for the study was obtained from the HCMC University of Medicine and Pharmacy Ethics Council on Bio-Medical Research via Decision No. 1257/HDDD-DHYD issued on 14 December 2023. Additionally, agreements were obtained from relevant District Health Centers and Communal Health Stations. Written informed consent for participation was obtained from all subjects involved in the study. Data was kept anonymous and confidential during all stages of the study.
3. Results
A total of 780 women were invited to participate in a self-sampling research project, with 775 ultimately completing the study. Five individuals opted out, stating that they were preoccupied with domestic duties as the reason for their non-participation. Given the very low decline rate of less than 1%, the group that declined to participate was not subject to further analysis.
The characteristics of the study’s participants are given in Table 1. The average age of the participants was 46 ± 10 years, ranging from 25 to 65 years. Most participants were over the age of 35, accounting for approximately 82.2%. Few participants were unmarried, comprising only 1.7% of the group. Most participants had established their own families. The mean age at which participants were married was 25 ± 5 years, ranging from 16 to 58 years.
Table 2 shows the rates of successful self-collected samples and post-collection satisfaction for HPV tests. The vast majority, 99.9% (95% CI: 99.6–100.0), of self-collected samples were valid at the initial collection. Most women, 80.4% (95% CI: 77.6–83.2), reported being satisfied with the self-collection process.
After univariate analysis with 31 variable pairs, we noted 10 related factors with statistical significance for POR of post-collection satisfaction, including occupation, educational level, average income, completion of eight self-collection steps, vulvo-vaginal burning sensation, vulvar pain, vaginal pain, confidence in correct self-collection, feelings regarding self-collection duration, and feelings regarding the process of self-collection. We combined the ten above-mentioned independent variables with two potential variables (lower abdominal discomfort and pain during urination, p ≤ 0.2) into multivariate regression equations to control for confounders and co-impact factors. Table 3 summarizes the 12 variables in the multivariate analysis.
After analysis with multivariate regression model, it was found that those who were confident in successful self-collection performance at the first collection had an adjusted POR for post-collection satisfaction of 2.68 times (95% CI: 1.51–4.75) higher than those without confidence (p < 0.05). Participants who felt shy or very shy about performing self-collection had an adjusted POR for post-collection satisfaction of 0.34 times (95% CI: 0.13–0.87) higher than those without shyness. In addition, after multivariate analysis, the relationship between post-collection satisfaction and other related factors (occupation, educational level, average income, completion of eight self-collection steps, vulvar or vaginal burning sensation, pain in vulva, pain in vagina, feelings regarding self-collection duration, lower abdominal discomfort, and pain during urination) turned out to be not statistically significant (adjusted p > 0.05).
4. Discussion
This study involving 775 women in HCMC communities found that 99.9% (774/775) achieved successful sample self-collection for HPV testing, with only one failure (0.1%)
As compared with other international studies (Table 4), we found that successful test sampling in our study has some differences. In the study by Bais et al. [17] conducted in The Netherlands in 2007, the sample size was equivalent to ours, but the self-collection failure was higher. It is possible that their self-collected samples were stored in solvent and transported by postal services, then processed by centrifuge at a laboratory while we ensured that sample transportation to laboratory occurred within 24 h after the samples were taken. Another study by Gok [18] in The Netherlands was conducted in 2010 with a larger sample size (7404 women), in which the failed sample rate was 0.3%—very similar to ours. Darlin et al. [19] recorded a rate of failed test samples of 1.4%, which was higher than ours, and this discrepancy might be the result of self-collection locations. The collections were carried out at a clinic in the Darlin study, while in our study, they took place in the participants’ homes, and participant shyness might affect the self-collection. Modibbo [20] and Brewer [21] recorded failed sample rates at 2.7% and 1.0%, respectively, which were similar to that of Bais et al. [17], and they did not control sample storage time. The length of time for sample storage may affect the quality of the self-collected samples. For instance, in the study by Gizaw et al. [22], the failed sample rate reached 19.2%; such a high failure rate might be due to a sample storage time after self-collection of up to 7 days. In general, failed sample rates after self-collection for HPV testing appeared very low, but more studies are needed to assess the effect of sample storage time after self-collection.
Our study found that post-collection satisfaction was 80.4% (95% CI: 77.6–83.2). Although there are not many studies in the world that examine participant experience during self-collection, in Enerly’s study [23], where 267 women underwent HPV screening either by sample self-collection or by medical staff, the former was preferred, with 63.3% choosing self-collection. In the study by Tranberg [24], among 1242 women who underwent cervical cancer screening, 51.1% selected self-collection HPV tests while 48.9% opted for cytology. A rare study by Winer [25] reported that among 1206 women who underwent self-collection for HPV testing, 91.0% accepted self-collection for repeated HPV tests. In general, the self-collection acceptance rate in women was high and was even higher if they had already experienced this method.
The factors influencing self-collection for future HPV testing included confidence in correct manipulation and shyness during first performance. This shows that the first self-collection experience will affect a woman’s decision regarding preference for future testing methods.
New applicability: Our research is a pioneering effort to evaluate the suitability of self-collected samples for HPV testing among community women in Ho Chi Minh City and Vietnam. This study aimed to gather data on the success rate and participant satisfaction with the self-collection method for HPV testing.
Limitations of the study: The storage and administrative process duration for samples self-collected by participants was 24 h, with medical staff collecting the samples and transporting them to the lab within this timeframe. However, if participants sent their samples via postal services, this timeline could be extended, potentially compromising sample quality. Several studies have demonstrated the reliability of dry self-collected swabs for a time period of several days [26]. This statement may raise questions about the application of this tool during screening.
5. Conclusions
We observed a high success rate for first-time HPV testing using self-collected samples, marking a significant milestone in community-based HPV testing studies in Ho Chi Minh City. Women who demonstrated confidence in the self-collection process reported higher satisfaction levels with this method. Implementing early cervical cancer screening through the self-collection method for high-risk HPV testing in communities could be an effective approach. To ensure the success of this approach, it is essential to provide women with thorough guidance and mobilize them to build their confidence regarding the self-collection process.
Author Contributions
Conceptualization, A.H.T.P. and T.M.V.; Methodology, T.M.V., T.Q.L. and D.Q.N.; Software, T.H.H. and D.Q.N.; Validation, A.H.T.P., T.M.V., T.Q.L. and D.Q.N.; Formal analysis, T.M.V., T.H.H., T.Q.L. and D.Q.N.; Investigation, A.H.T.P. and T.H.H.; Data curation, T.H.H.; Writing—original draft, A.H.T.P.; Writing—review & editing, T.M.V., T.Q.L. and D.Q.N.; Supervision, A.H.T.P. and T.M.V. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki. Ethics approval for the study was obtained from the HCMC University of Medicine and Pharmacy Ethics Council on Bio-Medical Research via Decision No. 1257 HDDD-DHYD issued on 14 December 2023.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.
Acknowledgments
The authors thank all participants for their involvement in this study and thank all doctors and staff of Hoahao Hospital, Medical Genetics Testing Department, for their support.
Conflicts of Interest
The authors declare no conflicts of interest.
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Figure 1.
Sampling process.
Figure 2.
Cotton FLOQSwabs for self-collection.
Table 1.
Characteristics of study participants (n = 775).
| Description | Number (n = 775) | Percent (%) |
|---|---|---|
| Age *: 46 ± 10 [25–65] | ||
| ≤35 yrs | 138 | 17.8 |
| >35 yrs | 637 | 82.2 |
| Occupation | ||
| Housework | 328 | 42.3 |
| Manual labor | 43 | 5.6 |
| Intellectual labor | 299 | 38.6 |
| Business | 105 | 13.6 |
| Marital status | ||
| Currently married | 701 | 90.5 |
| Divorced/separated/widowed | 61 | 7.9 |
| Unmarried | 13 | 1.7 |
| Age of marriage * (n = 762): 25 ± 5 [16–58] | ||
*: Mean ± standard deviation [min–max values].
Table 2.
Valid samples by self-collection for HPV tests and post-collection satisfaction (n = 775).
| Description | Number (n = 775) | Percent (%) | 95% CI |
|---|---|---|---|
| Sample at first self-collection | |||
| Valid | 774 | 99.9 | 99.6–100.0 |
| Invalid | 1 | 0.1 | 0.0–0.4 |
| Satisfaction | |||
| Yes | 623 | 80.4 | 77.6–83.2 |
| No | 152 | 19.6 | 16.8–22.4 |
Table 3.
Relationship between self-collection satisfaction and related factors.
| Characteristics | Self-Collection Satisfaction | POR | Adjusted POR | 95% CI | Adjusted p | |
|---|---|---|---|---|---|---|
| Yes n = 623 (%) | No n = 152 (%) | |||||
| Occupation | ||||||
| Manual labor | 37 (86.0) | 6 (14.0) | 1.89 | 1.54 | 0.61–3.89 | 0.36 |
| Intellectual labor | 250 (83.6) | 49 (16.4) | 1.57 | 1.20 | 0.67–2.14 | 0.54 |
| Business | 85 (81.0) | 20 (19.0) | 1.30 | 1.29 | 0.72–2.32 | 0.39 |
| Housework | 251 (76.5) | 77 (23.5) | 1 | 1 | ||
| Educational level | ||||||
| High school | 158 (80.6) | 38 (19.4) | 1.36 | 1.36 | 0.84–2.23 | 0.21 |
| Higher education | 281 (83.9) | 54 (16.1) | 1.70 | 1.31 | 0.72–2.40 | 0.37 |
| Lower school | 184 (75.4) | 60 (24.6) | 1 | 1 | ||
| Average income | ||||||
| Low (<VND5 mil) | 145 (73.6) | 52 (26.4) | 0.56 | 0.69 | 0.43–1.12 | 0.14 |
| High (VND10–20 mil) | 121 (80.7) | 29 (19.3) | 0.83 | 0.81 | 0.48–1.34 | 0.40 |
| Very high (>VND20 mil) | 33 (84.6) | 6 (15.4) | 1.10 | 0.89 | 0.35–2.28 | 0.81 |
| Medium (VND5–10 mil) | 324 (83.3) | 65 (16.7) | 1 | 1 | ||
| Completion of 8 self-collection steps | ||||||
| Yes | 589 (81.6) | 133 (18.4) | 2.47 | 1.81 | 0.95–3.48 | 0.07 |
| No | 34 (64.2) | 19 (35.8) | 1 | 1 | ||
| Vulvo-vaginal burning | ||||||
| Yes | 60 (71.4) | 24 (28.6) | 0.57 | 0.86 | 0.48–1.56 | 0.63 |
| No | 563 (81.5) | 128 (18.5) | 1 | 1 | ||
| Lower abdominal discomfort | ||||||
| Yes | 7 (63.6) | 4 (36.4) | 0.42 | 0.61 | 0.15–2.43 | 0.49 |
| No | 616 (80.6) | 148 (19.4) | 1 | 1 | ||
| Vulvar pain | ||||||
| Yes | 10 (58.8) | 7 (41.2) | 0.34 | 0.63 | 0.15–2.60 | 0.52 |
| No | 613 (80.9) | 145 (19.1) | 1 | 1 | ||
| Vaginal pain | ||||||
| Yes | 19 (57.6) | 14 (42.4) | 0.31 | 0.64 | 0.24–1.65 | 0.35 |
| No | 604 (81.4) | 138 (18.6) | 1 | 1 | ||
| Pain during urination | ||||||
| Yes | 10 (66.7) | 5 (33.3) | 0.48 | 1.24 | 0.29–5.38 | 0.77 |
| No | 613 (80.7) | 147 (19.3) | 1 | 1 | ||
| Confidence in correct collection | ||||||
| Yes | 584 (82.5) | 124 (17.5) | 3.38 | 2.68 | 1.51–4.75 | <0.01 |
| No | 39 (58.2) | 28 (41.8) | 1 | 1 | ||
| Feelings regarding collection duration | ||||||
| Long | 210 (75.8) | 67 (24.2) | 0.65 | 0.77 | 0.53–1.14 | 0.19 |
| Not long | 413 (82.9) | 85 (17.1) | 1 | 1 | ||
| Feelings regarding self-collection | ||||||
| Shy–very shy | 613 (81.2) | 142 (18.8) | 0.23 | 0.34 | 0.13–0.87 | 0.02 |
| Not shy | 10 (50.0) | 10 (50.0) | 1 | 1 | ||
Bold values mean statistical significance. Adjusted values by multivariate regression model. POR: proportional odds ratio.
Table 4.
Comparison of failed self-collected samples from various studies.
| Authors | Country | Sample Size | Percent of Failed Samples (%) |
|---|---|---|---|
| Bais [17] (2007) | The Netherlands | 736 | 1.2 |
| Gok [18] (2010) | The Netherlands | 7404 | 0.3 |
| Darlin [19] (2013) | Sweden | 147 | 1.4 |
| Modibbo [20] (2017) | Nigeria | 185 | 2.7 |
| Gizaw [22] (2019) | Ethiopia | 721 | 19.2 |
| Brewer [21] (2021) | New Zealand | 305 | 1.0 |
| Our study (2024) | Vietnam | 775 | 0.1 |
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Pham, A.H.T.; Ha, T.H.; Le, T.Q.; Nguyen, D.Q.; Vo, T.M. Experiences of Self-Collected Human Papilloma Virus (HPV) Testing Among Women Aged 20 to 65 Years in Ho Chi Minh City, Vietnam. Diagnostics 2025, 15, 968. https://doi.org/10.3390/diagnostics15080968
AMA Style
Pham AHT, Ha TH, Le TQ, Nguyen DQ, Vo TM. Experiences of Self-Collected Human Papilloma Virus (HPV) Testing Among Women Aged 20 to 65 Years in Ho Chi Minh City, Vietnam. Diagnostics. 2025; 15(8):968. https://doi.org/10.3390/diagnostics15080968
Chicago/Turabian StylePham, Ai H. T., Thao H. Ha, Thanh Q. Le, Dat Q. Nguyen, and Tuan M. Vo. 2025. "Experiences of Self-Collected Human Papilloma Virus (HPV) Testing Among Women Aged 20 to 65 Years in Ho Chi Minh City, Vietnam" Diagnostics 15, no. 8: 968. https://doi.org/10.3390/diagnostics15080968
APA StylePham, A. H. T., Ha, T. H., Le, T. Q., Nguyen, D. Q., & Vo, T. M. (2025). Experiences of Self-Collected Human Papilloma Virus (HPV) Testing Among Women Aged 20 to 65 Years in Ho Chi Minh City, Vietnam. Diagnostics, 15(8), 968. https://doi.org/10.3390/diagnostics15080968
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