Primary healthcare centers as key partners in HPV self-sampling: a mixed-methods study on feasibility and acceptance in rural areas near Quito, Ecuador

Cervical Cancer (CC), preventable through vaccination and screening, is the second most common cancer among Ecuadorian women. Access to screening is unequal, with rural populations disproportionally affected by limited healthcare resources, transportation, and poverty. While human papillomavirus (HPV) self-sampling has shown promise in Ecuador, evidence remains limited on its feasibility and acceptability when implemented at scale within public primary healthcare services. This study evaluated the acceptability and feasibility of HPV self-sampling for CC screening in rural Ecuador, focusing on participants’ perceptions and experiences. A mixed-methods intervention was conducted in ten primary healthcare centers near Quito (January–September 2023). Women aged 25–65 were instructed to collect cervical samples in a private space at a clinic/work or at home. HPV 16, 18, and 12 other strains were detected using the Roche Cobas® 4800 system. Healthcare personnel communicated results and arranged follow-up for positive cases. Perceptions and experiences were explored through seven focus groups with users, one with research staff (medical student interns), and seven key informant interviews. Of 2,052 invited women, 97.6% participated, indicating high uptake. While most were up-to-date with screening, 30% had not been tested in the last three years. Among 1,899 samples, 74.8% were HPV negative, while 5.5% and 17.2% tested positive for HPV 16/18 and other strains, respectively. Only 2.3% of samples were invalid, underscoring feasibility even among women with limited formal education. Qualitative data highlighted the comfort, privacy, and ease of self-sampling compared with Papanicolaou tests, often described as painful and uncomfortable. Women were satisfied with result delivery and follow-up. HPV self-sampling is a highly acceptable and feasible CC screening strategy in rural Ecuador, with strong potential to expand coverage and reduce healthcare disparities. Cervical cancer is the second most common cancer among women in Ecuador. It is caused mainly by long-lasting infection with certain types of human papillomavirus (HPV), a virus passed through sexual contact. Most HPV infections clear on their own, but some high-risk types can cause cervical cancer. Although cervical cancer can be prevented through vaccination and screening, many women in rural areas face barriers such as limited health services, long travel, and poverty. Because there is limited experience using HPV self-sampling through public health services in Ecuador, this study examined whether women in rural areas would accept and use this method for screening. Between January and September 2023, nearly 2,000 women aged 25–65 were invited through ten primary healthcare centers near Quito. Women were shown how to collect their own cervical sample privately at a clinic, work, or home. Samples were tested for high-risk HPV types in a standard laboratory. PHC staff communicated results and arranged follow-up care for women who tested positive. The study also gathered women’s and providers’ opinions about this method compared with past experiences. Participation was very high: 97.6% agreed to participate, and only 2.3% of samples were invalid. Most samples were HPV negative, while 22.7% showed infection with HPV. Women described self-sampling as more comfortable, private, and less painful than Pap tests, and they appreciated clear communication of results. Providers saw the approach as workable within the primary healthcare system. Overall, the study shows HPV self-sampling is both acceptable and feasible in rural Ecuador. It could expand screening, reduce inequalities, and strengthen women’s access to cancer prevention services.