Performance and acceptability of self-collected human papillomavirus testing among women living with HIV

Objective: To assess the validity, reliability, and acceptability of self-collected human papillomavirus (HPV) tests in women living with HIV (WLHIV) in the United States. Methods: WLHIV >= 30 years of age underwent self-collected (clinic and home) and clinician-collected HPV tests. Sensitivity and specificity analyses were performed using the clinician-collected HPV tests as the comparator. The unweighted kappa statistic was used to evaluate the validity and reliability of self-collected HPV testing, and the level of agreement between the clinician-collected mRNA test and a DNA test that was used for routine care. A 13-question survey was used to assess acceptability. Results: Among the 70 participants, the median age was 50 years, 75% had an undetectable HIV RNA, and 11% had a CD4 count of <200 cells/mu l. Nearly 63% had at least one positive HPV test. The sensitivity and specificity of the self-collected HPV test were 84.6% (95% confidence interval (CI) 65.1-95.6%) and 62.9% (95% CI 44.9-78.5%), respectively (kappa = 0.5, 95% CI 0.2-0.7). The agreement between the two self-collected tests was good (kappa = 0.8, 95% CI 0.5-1.0). There was good agreement between clinician-collected mRNA tests and DNA tests (kappa = 0.8, 95% CI 0.7-1.0). Self-collection was highly acceptable. Conclusions: Among WLHIV, self-collected HPV tests had good sensitivity and moderate specificity compared to clinician-collected HPV tests. The reliability between self-collected testing locations was good. Self-collected HPV testing had high acceptability. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.