Community-Based HPV Self-Sampling to Enhance Access to Cervical Cancer Prevention: A Continuum-of-Care Model from...

Cervical cancer remains the leading cause of cancer-related mortality among women in Nepal, where national screening coverage is approximately 16%. This study evaluated the feasibility of a community-based, door-to-door self-sampling strategy for high-risk human papillomavirus (hrHPV) detection in an urban municipality of central Nepal and assessed hrHPV prevalence, genotype distribution, screening outcomes, and associated demographic factors. A cross-sectional study was conducted between September 2023 and May 2024 in Ward No. 3 of Lalitpur Metropolitan City. Women aged 30-60 years were recruited through trained community health workers, provided education and home-based self-sampling kits, and completed a demographic questionnaire. Dry cervical swabs from 418 participants were tested for hrHPV. Women with positive results underwent visual inspection with acetic acid (VIA), followed by colposcopy, biopsy when indicated, and thermal ablation for confirmed precancerous lesions. Overall participation was 64.1%, and hrHPV prevalence was 10.3%. Non-16/18 hrHPV genotypes predominated (55.8%), followed by HPV16 (20.9%). Women aged > 50 years were more likely to be hrHPV- and VIA-positive (OR = 7.39, p = 0.02). Six pre-cancer cases were identified: five cervical intraepithelial neoplasia (CIN1) and one CIN3 case. Community-based hrHPV self-sampling was found to be feasible and achieved effective linkage to triage and treatment, supporting its consideration for strengthening cervical cancer screening in Nepal.