Accuracy and acceptability of self-sampling HPV testing in cervical cancer screening: a population-based study in rural Yunnan, China

To evaluate the accuracy and acceptability of self-sampling samples for HPV testing for cervical cancer screening in rural Yunnan of China. In 2022, 3000 women aged 17-69 were recruited and provided self-sampling vaginal samples alongside provider-sampling samples for HPV DNA and E6/E7 mRNA testing, as well as artificial intelligence (AI)-assisted cytology. Women who tested positive for any high-risk HPV DNA or mRNA, or who displayed cytology abnormalities, were recalled for a colposcopy examination and biopsied when necessary. The accuracy of these tests in detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) and CIN3 + was evaluated. The sensitivity of the HPV DNA test for self-sampling was 96.2%, compared to 92.3% for provider-sampling, 73.1% for the mRNA test, and 53.9% for AI-assisted cytology in detecting CIN2 + . The specificity was 83.9% for self-sampling HPV DNA test, 86.4% for provider-sampling HPV DNA test, 91.4% for the mRNA test, and 94.2% for AI-assisted cytology. The area under the curve (AUC) values for these screening methods were 0.90, 0.90, 0.82, and 0.74, respectively. Only 37% of participants preferred the self-sampling model, with lower preference observed among older women, those from rare minority groups, those with lower education levels, and who displayed limited knowledge, attitudes, and practices regarding cervical cancer screening. Self-sampling HPV DNA testing demonstrated comparable clinical accuracy to provider-sampling test and were more accurate than that of mRNA test and AI-assisted cytology. Self-sampling HPV testing offers a promising screening strategy in rural Yunnan China. Applicable health education is urgently needed to improve the acceptability of 'self-sampling' model among the target population.