Objective
To compare the performance and acceptability of self-collected vaginal wall swabs with provider-collected cervical swabs for detecting high-risk human papillomavirus (hr-HPV) infection among female-to-male transmasculine adults
Study Design
| Design Element |
Description |
| Design |
Observational: cross-sectional study |
| Population |
131 transmasculine adults ages 21–50 years with a cervix |
Interventions/
Comparators |
- Self-collected vaginal wall hr-HPV DNA swabs
- Provider-collected cervical hr-HPV DNA swabs
|
| Outcomes |
Primary: concordance and performance of self-collected vaginal wall hr-HPV DNA swabs
Secondary: participants’ acceptability of self-collected hr-HPV DNA swabs
|
| Timeframe |
Not applicable |
This cross-sectional observational study compared two collection methods for detecting hr-HPV infection among transmasculine adults: self-collected vaginal wall hr-HPV DNA swabs and provider-collected cervical hr-HPV DNA swabs, which are the gold standard.
The study included 131 adults who identified as a gender different from their female sex assigned at birth, had a cervix, and were sexually active in the past three years. Researchers recruited participants from the general population and clinical care sites around Boston, Massachusetts. Their mean age was 27 years (range 21–50 years), and 74% were taking masculinizing hormones. Of the study participants, 76% were white, 10% were Hispanic, 5% were Asian, and 3% were African American.
Researchers collected both swabs during a single visit to a community health clinic that provides care to the lesbian, gay, bisexual, and transgender community. To minimize ordering effects, researchers randomized participants to undergo the self-collected or provider-collected method first. At the end of the visit, researchers interviewed participants about the two collection methods.
To determine the presence of 13 types of hr-HPV in the swab samples, researchers used DNA hybridization assays. They determined the performance characteristics, including sensitivity and specificity, of the self-collected method using the provider-collected method as a reference.
People who were transmasculine, healthcare providers, and leaders from organizations providing support to the transgender community worked with researchers to develop and conduct the study.
Results
Concordance and performance. Among the 131 transmasculine adults, provider-collected tests detected 21 cases of hr-HPV, a 16% hr-HPV prevalence rate. Of these 21 cases, the self-collected tests accurately detected 15, representing 71% concordance between the two methods (p<0.01). The self-collected method had a sensitivity of 71% (p=0.0495) and specificity of 98% (p<0.0001).
Acceptability. More than 90% of participants preferred the self-collected to the provider-collected test. Participants reported positive aspects of self-collection, including ease of use, privacy, and a sense of self-empowerment. They noted several concerns, including uncertainty about performing the procedure correctly, genital dysphoria or psychological distress during self-collection, and difficulty angling the swab.
Limitations
Most participants in this study were white and relatively young; results may not generalize to transmasculine adults who are older or of other races. The study took place at a single center serving the lesbian, gay, bisexual, and transgender community. Results may be different in other geographic regions or healthcare settings. Participants were willing to undergo cervical swab testing by healthcare providers, and, as a result, they may not be representative of the general transmasculine population, many of whom avoid pelvic examinations because of emotional and physical discomfort.
Conclusions and Relevance
The results of this study suggest that self-collected swabs may be a good, patient-centered alternative to provider-collected swabs for testing for hr-HPV for transmasculine adults who prefer to avoid provider-collected testing.
Future Research Needs
Future studies could enroll transmasculine adults from a variety of age groups, races, geographic locations, and healthcare setting to make study findings generalizable to a wider population.
