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Impact of HPV Self-Sampling on Cervical Cancer Screening Uptake among Women in Nigeria

Abstract

Cervical cancer remains a major public health concern among women in Nigeria and is largely associated with persistent infection with high-risk human papillomavirus (HPV). Although cervical cancer is preventable through HPV vaccination, screening, early identification of precancerous lesions, and appropriate treatment, cervical cancer screening uptake remains inadequate among many women. Barriers to conventional screening may include limited availability of screening services, geographical distance, financial costs, concerns about privacy and discomfort, fear of examination, lack of awareness, and shortages of trained healthcare personnel. HPV self-sampling provides an alternative approach that allows women to collect samples for HPV testing themselves, potentially improving privacy, convenience, accessibility, and acceptability of cervical cancer screening. However, limited awareness, concerns about self-sampling procedures, availability of HPV testing services, cost, inadequate follow-up systems, and limited integration into routine healthcare services may affect its effectiveness. Against this background, this study investigates the impact of HPV self-sampling on cervical cancer screening uptake among women in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Health Promotion Model. The Health Belief Model explains how women's perceptions of cervical cancer susceptibility, perceived severity, perceived benefits of HPV self-sampling, perceived barriers, and cues to action may influence participation in cervical cancer screening. The Theory of Planned Behavior explains how attitudes toward HPV self-sampling, subjective norms, perceived behavioural control, and behavioural intentions may influence women's willingness to use self-sampling for cervical cancer screening. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in preventive health services. Collectively, these theoretical perspectives provide a suitable framework for explaining how HPV self-sampling may influence cervical cancer screening uptake among women in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women aged 18 years and above residing in selected communities or attending selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible women. HPV self-sampling will be assessed using indicators such as awareness of HPV self-sampling, availability of self-sampling kits, receipt and accessibility of kits, instructions provided to participants, ease of sample collection, privacy, convenience, acceptability, perceived discomfort, support from healthcare providers, cost, completion of sample collection, and availability of laboratory testing and follow-up services. Cervical cancer screening uptake will be assessed using indicators such as participation in HPV testing, completion of HPV self-sampling, submission of samples for laboratory analysis, receipt of screening results, previous screening history, repeat screening where appropriate, and linkage to follow-up services for women with positive results. Data will be collected using structured questionnaires, HPV self-sampling records, laboratory registers, cervical cancer screening registers, healthcare facility records, and relevant cervical cancer prevention programme documents. Descriptive statistics will be used to summarize participants' characteristics, awareness and utilization of HPV self-sampling, and cervical cancer screening patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of HPV self-sampling on cervical cancer screening uptake. Where a quasi-experimental design is adopted, screening uptake before and after the introduction of HPV self-sampling may be compared, while relevant demographic, socioeconomic, educational, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that HPV self-sampling has a significant positive impact on cervical cancer screening uptake among women in Nigeria. Women offered accessible HPV self-sampling are expected to demonstrate higher participation in cervical cancer screening than women relying solely on conventional provider-collected screening approaches. The privacy, convenience, reduced need for pelvic examination, and ability to collect samples outside conventional clinical settings may reduce some barriers to screening and encourage women who have never participated in screening to utilize the service. Effective communication and clear instructions may further improve women's confidence and willingness to use self-sampling. However, inadequate availability of HPV testing laboratories, cost of testing, limited awareness, concerns about sample collection accuracy, inadequate follow-up, and weak referral systems may reduce the overall impact of HPV self-sampling programmes. The study therefore expects accessible, affordable, well-supported, and properly integrated HPV self-sampling programmes to contribute significantly to improved cervical cancer screening uptake among women in Nigeria. The study is expected to contribute to the literature on HPV self-sampling, cervical cancer screening uptake, HPV screening, cervical cancer prevention, women's health, early cancer detection, reproductive health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, cancer control programmes, hospitals, primary healthcare centres, healthcare professionals, women's health organizations, development partners, and policymakers regarding strategies for expanding cervical cancer screening. The study will also provide evidence-based recommendations for integrating HPV self-sampling into cervical cancer prevention programmes, improving access to affordable self-sampling kits and HPV testing, strengthening community education, providing clear instructions and counselling, improving laboratory capacity, establishing effective referral and follow-up systems, and expanding screening services to underserved and hard-to-reach populations across Nigeria.

Keywords: HPV self-sampling, cervical cancer screening uptake, human papillomavirus, cervical cancer prevention, HPV testing, women, cancer screening, early detection, women's health, Nigeria, public health.