Nepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women, since data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. Mr. Derek C. Johnson, graduate assistant in the department of epidemiology at the University of Alabama at Birmingham, aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening. Co-investigators include department colleagues Dr. Eric Chamot, associate professor, and Dr. Sadeep Shrestha, associate professor; Dr. Mirjam Kempf, assistant professor in the department of health behavior; Dr. Thomas R. Broker, professor in the department of biochemistry and molecular genetics; and Ms. Pema Lhaki, deputy executive director of the Nepal Fertility Care Center (NFCC) in Achham District of rural far western Nepal.
[Photo: Mr. Derek C. Johnson]
Study participants were recruited during a health camp conducted by the NFCC. Women of reproductive age completed a socio-demographic and clinical questionnaire. In addition, they provided two specimens: one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA.
Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6 percent. The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62, indicating a “good” level of agreement. Abnormal cytology was reported for eight women. One woman identified with squamous cell carcinoma (SCC) and seven women with high grade squamous intraepithelial lesions (HSIL). Seven of the eight women tested positive for HR-HPV in clinician-collected samples and six in self-collected samples.
This is the first study to assess HR-HPV among rural Nepali women. Dr. Shrestha, senior author and principal investigator of the project, recommends that self-collected sampling methods be the subject of additional research in Nepal for screening HR-HPV—associated with pre-cancer lesions and cancer — in women in rural areas with limited access to health services. “Assessment of High-Risk Human Papillomavirus Infections Using Clinician- and Self-Collected Cervical Sampling Methods in Rural Women from Far Western Nepal” was published in June in PLOS One.