Improving cervical cancer screening participation by introducing HPV vaginal self-sampling to women living with HIV in Denmark – a cross-sectional study

Background : Cervical cancer, despite being largely preventable through vaccination and screening, continues to pose a significant global health challenge. Women living with HIV (WLWH) are at a six-fold higher risk of developing cervical cancer, primarily due to persistent infection with high risk HPV (hrHPV). While effective screening methods have the potential to reduce this risk, WLWH remain inadequately screened. The aims of this study were fourfold: To estimate the proportion of WLWH who are not screened according to WHO guidelines; to establish the proportion of WLWH who accepted the self-sampling offer; to estimate the hrHPV DNA prevalence; and to estimate the compliance to follow-up among women with a hrHPV-positive vaginal self-sample. Methods : This single-centre, cross-sectional study was conducted from February to May 2022 at the Department of Infectious Diseases, Aarhus University Hospital, Central Denmark Region. Eligible women were contacted by phone and invited to participate. Participants were provided with a self-sampling kit and detailed instructions. The collected samples were analysed for hrHPV DNA. Demographic, clinical, and screening history data were obtained from medical records and the Danish Pathology Databank. Results : Of the 100 eligible participants, 50 (50%) accepted the offer of self-sampling, and 40 (80%) returned their samples for analysis. The prevalence of hrHPV among these women was 25%. Follow-up compliance among hrHPV-positive women was 40%. The analysis revealed that 42% of WLWH had not been screened in accordance with WHO guidelines, and 18% had never undergone screening. No significant differences were observed in demographic or clinical characteristics between participants and non-participants. Conclusions : Our study highlights a substantial gap in cervical cancer screening among WLWH. Although home-based hrHPV self-sampling was well-received, overall participation and compliance to follow-up HPV-screen positive were insufficient. To improve cervical cancer prevention, more personalized and clinic-based screening strategies, combined with enhanced follow-up procedures, are essential. Addressing these barriers is critical to improving health outcomes and reducing the incidence and mortality of cervical cancer among WLWH. Trial registration: The Central Denmark Region Committee on Health Research Ethics deemed this study as a quality improvement study on the 9 ^th of November 2021 (request approval j.no: 204/1-10-72-274-21). Clinical trial number: Not applicable.