Feasibility and Acceptability of Human Papillomavirus Self-Sampling Compared with Clinician Sampling in Urban Areas of Western China: A Cross-sectional Survey

Shaolong Xue ^1,2 Xi Zeng ^1,2 Jing Li ³ Leni Kang ⁴ Mingrong Xi ^1,2 Lian Xu ^2,5 Ping Fu ⁶ Min Zhou ⁶ Mengyin Ao ^1,2 Xiaoxi Yao ^1,2 Dongmei Li ^1,2 Guangdong Liao ^1,2*

• ¹ Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
• ² Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
• ³ West China School of Public Health and West China Fourth Hospital, Sichuan University,, Chengdu, Sichuan Province, China
• ⁴ National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
• ⁵ Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
• ⁶ Chengdu Shuangliu District Maternity and Child Healthcare Hospital, Chengdu, Sichuan Province, China

Introduction: Cervical cancer, driven by persistent high-risk human papillomavirus (hrHPV) infection, remains a global health challenge, especially in low- and middle-income areas such as western China. Despite the critical role of HPV testing in early detection, coverage in China remains low due to cultural, psychological, and other barriers. Self-collected urine and vaginal samples offer alternative methods for sample collection. This study aimed to evaluate the feasibility and acceptability of detecting hrHPV and cervical intraepithelial neoplasia grade 2 or worse (CIN2+) via urine and vaginal self-sampling compared with clinician sampling in urban areas of western China.Methods: A cross-sectional survey was conducted from November 2022 to March 2023 in urban areas of western China. The participants provided self-collected urine and vaginal samples for hrHPV testing and completed questionnaires on acceptability of self-sampling. The HPV positivity, agreement, and kappa value were calculated to assess concordance between self- and clinician sampling. The sensitivity, specificity, agreement, predictive values, and likelihood ratios were used to evaluate the clinical performance of both methods for detecting CIN2+. Results: A total of 2228 female subjects aged 21–71 years were recruited, and self-collected urine samples, vaginal samples, and clinician-collected cervical samples were obtained. The sensitivity of clinician sampling, urine self-sampling and vaginal self-sampling were 80.00% (95% CI: 44.22–96.46), 70.00% (95% CI: 35.37–91.91) and 90.00% (95% CI: 54.12–99.48) for CIN2+; the specificity for