STRENGTHS AND LIMITATIONS OF THIS STUDY

The review will involve a rigorous search and screening process aimed at maximising comprehensiveness and minimising bias.

The protocol followed a well-established methodological framework to ensure that the review would be of high quality.

The review will minimise bias by adhering to the inclusion and exclusion criteria in the protocol.

The review will be limited to publications in the English language only, potentially biasing studies published in other languages.

Introduction

Cervical cancer (CC) is the second most common cancer in women worldwide and one of the leading cause of cancer deaths in women in low- and middle-income countries.1 2 Despite the increasing awareness of CC regarding the importance of screening and early detection, the burden of CC continues to rise in sub-Saharan Africa (SSA). In 2018, an estimated 570 000 new cases of CC were reported worldwide, and 80% of these cases occurred in low- and middle-income countries.3 CC remains the leading cause of cancer-related death in women in eastern, western, middle and southern Africa.4 In addition, Ngcobo et al, in 2021, reported that SSA has the highest burden, accounting for 25% of the global mortality from CC.5 The reason is that many women only seek professional help when they are experiencing symptoms, which implies late-stage malignancy and higher mortality rates.6

CC is a preventable and curable disease when detected early. The prevention strategy includes human papillomavirus (HPV) vaccination and behavioural change communication as the primary approaches, while screening for precancer lesions is the secondary prevention method.7 8 As part of the global strategy for the elimination of CC, the WHO recommends that screening be conducted for 70% of women using high-quality tests at 35 years and again at 45 years.9 Organising screening programmes in SSA has been a challenge due to financial, logistical and sociocultural factors.1 Some of the reported barriers by women included feelings of embarrassment from exposing their private parts to strangers, fear of anticipated pain from the screening procedure, spousal disapproval, dislike for clinicians or healthcare providers touching their genital areas, a lack of time, a lack of understanding about the importance of screening and an underestimation of the potential risk associated with developing CC.10–13

Studies have shown that self-sampling can overcome some of the barriers associated with sample collection by a healthcare provider, thus improving the uptake of CC screening by women.10 14 Self-sampling or self-testing for HPV testing, refers to the collection of cervicovaginal samples needed for cervical screening by an individual. Evidence suggests that the pick-up rate and quality of samples collected for HPV testing from the self-sampling technique are comparable to samples collected by healthcare providers using the sample brush or PCR technique.15 16

A study aimed at increasing the uptake of CC screening among women in SSA showed that community-based self-sampling was the most effective screening method.17 The proportion of women who preferred self-sampling to clinician sampling in a systematic review was 86.3%, with 77.8% reporting that the samples were easy to obtain and 76.7% reporting that it would increase CC screening uptake.18 A South African study showed that women preferred self-sampling to clinician sampling methods because they felt less discomfort and were not embarrassed.19 Another study conducted in Uganda showed that the self-sampling method for HPV testing has the potential to dramatically increase access to CC screening for them.20

The increasing demand for self-sampling relative to healthcare provider sampling methods needs to be further explored in SSA. A recent scoping review that investigated the acceptability of self-sampling for HPV testing for CC screening among women in the SSA region included studies that collected cervicovaginal samples and studies that did not.21 However, the perception of women who experienced self-sampling for CC screening is yet to be comprehensively reviewed and synthesised in SSA. This scoping review will systematically review the published literature on the perception and attitude of women towards the collection of cervicovaginal samples for HPV testing for CC screening in SSA. This review will identify existing information and gaps in the literature on the perception and attitude of women who have experienced self-sampling of cervicovaginal samples for HPV testing and offer suggestions for future studies on this subject.

Methods and analysis

This systematic scoping review will use the Arksey and O’Malley framework.22 23 The review will use the following five stages: (1) identifying the research question, (2) identifying the relevant studies (search strategy), (3) selecting the eligible studies, (4) charting the data and (5) collating, summarising and reporting the results with or without consultation with experts in the specific field23 (table 1). The search criteria will be limited to published original research studies conducted in community or clinical settings in SSA within the last 10 years (2013–2023).

Table 1

Data analysis plan

Information sources and search strategy

The plan is to systematically search four online databases for articles published in English: PubMed (a medical/health-related journal), Cochrane (evidence that provides high-quality information to enhance your healthcare knowledge and decision-making), African Journals Online (rich in African journals) and Google Scholar (scholarly literature across an array of publishing formats and disciplines). Grey literature will be reviewed to complement the search of the databases. The following keywords will be used to search the databases to retrieve published and grey literature on the perceptions and attitudes of women on the methods of collecting cervicovaginal samples for CC screening: HPV/Human papillomavirus/papillomavirus, cervical cancer/cervical squamous/adenocarcinoma, sample collection/sample taking, self-sample, cervical cancer screening, perception/view, attitude and SSA using subregions within SSA (West Africa OR East Africa OR Central Africa OR Southern Africa) and by specific country names. Boolean terms AND/OR will be used to separate the keywords during the search. Medical Subject Headings terms will also be used in the search terms. We will also manually search for references and a bibliography of relevant articles on this subject. The search will be conducted between December and March 2023.

Eligibility criteria

The eligibility requirements for studies that will be included in this review will be created using the PICO format (population, intervention, comparator, and outcome). These will include (1) published peer-reviewed articles with observational or experimental design that reported on the perception or attitude of women towards methods of collecting samples for CC screening and (2) data that must have been collected in SSA among the indigenous black women population (table 2). We plan to include qualitative, quantitative or mixed-method design studies. This review will exclude published case reports, reviews, letters to editors or expert opinions without primary data on methods of collecting samples for HPV testing for CC screening in SSA.

Table 2

Inclusion and exclusion Criteria

Study selection process

EndNote X8.0 (Thomson Reuters) will be used to compile and review all titles retrieved from the four databases. Duplicate articles will be removed using the EndNote automated system and manually. Two independent reviewers (UIAB and DOO) will screen titles and abstracts following the inclusion and exclusion criteria. Next, the two reviewers will screen the full texts of selected articles to further assess the eligibility criteria. IOMB will serve as a tiebreaker for resolving any disagreement between the two independent reviewers if they are unable to achieve a consensus. The full-text articles that are included in the final selection will be reviewed and relevant data will be charted.

Charting data

The leading reviewer (UIAB) will enter the data into a prepared Microsoft Excel sheet using the following data charting fields: authors, date, country, study design, aim/objectives, sample size, recruitment strategy (probability or non-probability sampling), study settings (health facility/community/online), outcome measured (prevalence/incidence/proportion), analysis (descriptive/test of association/multivariable analysis) and summary of key findings. The second reviewer (DOO) will review all the data imputed into Excel to ensure completeness.

Collating, summarising and reporting the results

The summary description of the scoping review process will be displayed in a figure using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for scoping review flow chart diagram to summarise the process and the number of articles that were finally selected for data charting.24 25 A descriptive analysis of eligible studies will be displayed in a table. The table will show the total number of studies included, study designs and settings, publication years, the characteristics of the study populations, the outcomes reported and the countries where the studies were conducted. The scoping review result will not cover an assessment of the quality of the studies included in the analysis.

We will present results using different themes to explain the perceptions and attitudes of women towards HPV testing based on methods of collecting cervicovaginal samples. Attitude is subjective and it is the general evaluation of a situation.26 In literature, there are no clear distinctions between attitude and perception; thus, they are used interchangeably.19 27 28 Hence, perceptions and attitudes will be explained from the perspectives of pain, embarrassment, privacy and comfortability, willingness to self-sample, anxiety and confidence to use the methods.

We will disaggregate these themes based on the age of women, the settings (study location or country) where these studies were conducted and the design of the methods used to elicit perception and attitude as outcome measures. We will identify gaps in knowledge and offer recommendations for future research and policy direction on the choice of sample collection for HPV testing in SSA.

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Ethics and dissemination

This is a scoping review that will not require ethical approval. The findings from this review will be published in peer-reviewed journals, disseminated at local and international conferences and policy briefs developed to improve programmes and practices in SSA.

Ethics statementsPatient consent for publication

Not applicable.

Acknowledgments

We would like to thank the Pan African University Life and Earth Sciences Institute (including Health and Agriculture) (PAULESI) and the African Union Commission for funding the study. IOMB received support from the West Africa Self-Sampling HPV Based Cervical Cancer Control Program (WASS-HCCP) for WLWHA U01 CA275129 (MPIs: Hou, Holl, Maiga) and Epigenetic study of oral HPV infection-associated oral cancer in people living with HIV in Nigeria (EpOOCH) R01CA274952 (MPIs: Hou, Morhason-Bello, Murphy)