Using Human Papillomavirus (HPV) detection tests for cervical cancer screening and managing HPV-positive women – a practical guide / Activity 5

A woman may collect a sample herself from her upper vagina either at the clinic or at home. The steps can be demonstrated to the woman by a health provider using visual aids (e.g. flipcharts, posters, flyers, models, or animated videos). In many settings, the self-collection kit (which contains the sampling device, a tube containing the specimen transport medium, and the requisition form) is mailed to the woman. A leaflet describing the self-collection process step-by-step is also included in the kit. The leaflet may contain links to websites with further information.

In 2021 a research study on home testing for HPV was carried out by King’s College London, in collaboration with the NHS Cancer Alliances in north central and north east London, UK. This video provided instructions to anyone who participated in using the test kit. The study is now complete, and these self-sampling kits are not currently available. (Copyright: North Central London Cancer Alliance)

Steps to be explained to the woman:
If the woman visits a clinic to provide the self-collected sample and you are the health provider guiding her, please follow the steps of pre-screening counselling and history taking as described previously.

Use a flipchart with visuals or a teaching video to demonstrate the steps for self-collection of samples for HPV testing. Give the sample collection kit to the woman and explain about the following steps of sample collection at home or at the clinic:

• Wash your hands with soap and water, and dry them with a clean towel.
• Open the package of the HPV sample collection kit and keep it on a table or other flat surface. Do not touch the sampling device (either a brush or a swab) at the end that contains the bristles or the swab. This end should also not touch the surface of the table or the ground.
• You may collect the sample in either of the following two positions in the privacy of your room or toilet:
• Standing position with your left leg raised and supported on a bed, a chair, or the toilet seat (or with your right leg raised if you are left-handed)
• Lying on a bed on your back with your legs bent at the knees
• Gently open the cap of the sample collection tube, and keep the open tube and the cap on a table or other flat surface. Do not touch the inside of the cap.
• Undress from the waist down, and remove your underwear.
• Hold the brush with its end in your right hand, and open the skin folds at the entrance to the vagina (the labia) with your left land (or use the opposite hands if you are left-handed).
• Insert the brush or swab into the vagina gently until some resistance is felt. Insert the brush or swab at least up to half of its length or up to the mark (if shown).
• When the brush or swab is inserted up to an adequate length, rotate it 5 or 6 times. There may be slight discomfort, but there should be no pain.
• Gently remove the brush or swab from the vagina, and push the end with the bristles or the swab into the bottom of the sample collection tube while holding the tube with the other hand.
• Rinse the swab or the bristles gently in the fluid contained in the tube. Use gentle pressure to snap off the brush near the handle. The end with the bristles or the swab will be left inside the tube.
• Replace the cap of the tube, and tighten it securely.
• Throw the broken end of the brush into the dustbin.
• Apply the pre-printed label to the tube (if such a label is provided).
• Return the tube to the clinic, or mail it to the laboratory (depending on the local arrangement).

Please note that some collection devices do not require snapping off the brush. For such devices, instruct the woman to throw away the brush after thoroughly rinsing it. If the woman agrees to collect the sample at home, advise her to return the tube as soon as possible after sample collection (and definitely within 7 days). She can store the tube at ambient temperature at home.

The woman may collect the sample herself at the clinic by following the same steps. Direct her to the room or toilet where she will be able to collect the sample. Collect the tube from her after she has taken the sample. Make sure that the cap of the tube is securely tightened. Apply the pre-printed label or write the woman’s identity number and name on the tube with a permanent marker pen.

Inform the woman when (day and time) and where to collect the test report, or whether the report will be delivered to her by post or by other means (email, website, etc.). Provide the details of the clinic or the health provider to be contacted if the test result is positive.

Please note that the steps for self-collection of samples may vary depending on the HPV test, the sample collection device, and the local arrangements for distribution of the kit and return of samples. Please familiarize yourself with the relevant process and advise women accordingly.

Click here to download the step-by-step checklist for counselling a woman to provide self-collected vaginal samples for HPV testing, which serves as a reminder in the clinic. The checklist is also useful during a training programme, to assess the trainee’s skill..