{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:51:44Z","timestamp":1753883504921,"version":"3.41.2"},"reference-count":30,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"11","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n            <jats:title>PURPOSE<\/jats:title>\n            <jats:p>Human papillomavirus (HPV) testing on self-collected samples may increase coverage of cervical cancer screening, but previous studies have observed lower specificity of HPV testing in self- versus clinician-collected samples. Here we investigate strategies to improve the sensitivity-specificity balance of a round of HPV testing on self-collected samples.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>MATERIALS AND METHODS<\/jats:title>\n            <jats:p>Women living with and without HIV, age 30-65 years, were recruited in South Africa. Self-collected vaginal samples and clinician-collected cervical samples were tested with Xpert HPV, an assay that detects the 14 high-risk HPV types in five separate channels: (P1) HPV 16; (P2) HPV 18, 45; (P3) HPV 31, 33, 35, 52, 58; (P4) HPV 51, 59; and (P5) HPV 39, 56, 66, 68. All women underwent colposcopy with histology sampling, and diagnosis of cervical intraepithelial neoplasia grade 2 or greater (CIN2+) was determined by adjudicated pathology. The AUC and related performance parameters were calculated using logistic regression with the cycle threshold (Ct) values of the channels as predictors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>\n              HPV prevalence in women without and with HIV was higher in self-collected (25.1%\n              <jats:italic>v<\/jats:italic>\n              61.5%) than in clinician-collected samples (16.2%\n              <jats:italic>v<\/jats:italic>\n              48.4%). The optimal model to predict CIN2+ used Ct values from the three channels that detect HPV 16, 18, 45, 31, 33, 35, 52, and\/or 58. AUC was superior for testing on clinician-collected (0.908) than on self-collected samples (0.878;\n              <jats:italic>P<\/jats:italic>\n              = .0261) in women without HIV, as well as for women living with HIV (0.868\n              <jats:italic>v<\/jats:italic>\n              0.819; clinician\n              <jats:italic>v<\/jats:italic>\n              self;\n              <jats:italic>P<\/jats:italic>\n              = .0002). Alternate approaches to handling multiple types and sequential testing approaches did not allow self-testing to achieve equivalent performance to testing on clinician-collected samples.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>Using more stringent Ct cutoffs on the three channels that detect the eight highest-risk HPV types can improve the sensitivity-specificity balance of a round of screening in both self- and clinician-collected samples. Although performance of HPV testing on self-collected samples is excellent, performance parameters are better on clinician-collected samples.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/go-25-00037","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T19:59:13Z","timestamp":1745870353000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Improving the Sensitivity-Specificity Balance of Human Papillomavirus Testing on Self- and Clinician-Collected Samples in South Africa"],"prefix":"10.1200","author":[{"given":"Gbenankpon M.","family":"Houvessou","sequence":"first","affiliation":[{"name":"Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakiya","family":"Saidu","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"},{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, South African Medical Research Council Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalind","family":"Boa","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"},{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, South African Medical Research Council Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8826-5182","authenticated-orcid":true,"given":"Nomonde","family":"Mbatani","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"},{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, South African Medical Research Council Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9398-5202","authenticated-orcid":true,"given":"Jennifer","family":"Moodley","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynaecology, Faculty of Health Sciences, South African Medical Research Council Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa"},{"name":"Faculty of Health Sciences, Cancer Research Initiative and School of Public Health, University of Cape Town, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2305-8665","authenticated-orcid":true,"given":"Louise","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Gertrude H. 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