{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T13:21:26Z","timestamp":1771075286665,"version":"3.50.1"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T00:00:00Z","timestamp":1619395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["D43TW010137"],"award-info":[{"award-number":["D43TW010137"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Letten Foundation Norway"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background &amp; aim<\/jats:title><jats:p>Women with HIV\/HPV coinfection and cervical lesions are at increased risk of developing HPV related anal cancer. Self-collection of anal swabs may facilitate HPV molecular testing in anal cancer screening, especially in high-risk groups, and yet it is not adequately studied. We evaluated level of agreement between self-collected anal swabs (SCAS) and clinician-collected anal swabs (CCAS) when used for HPV genotyping. We also described the anal HPV genotype distribution and HIV\/HPV coinfection.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>We performed a cross sectional study with participants from a visual-inspection-with-acetic-acid and cervicography (VIAC) clinic, in Harare, Zimbabwe. In a clinic setting, the women aged \u226518 years provided anal swabs in duplicate; first CCAS and then SCAS immediately after. HPV detection and genotyping were performed using next generation amplicon sequencing of a 450bp region of the HPV L1 gene. Level of agreement of HPV genotypes between CCAS and SCAS was calculated using the kappa statistic. McNemar tests were used to evaluate agreement in the proportion of genotypes detected by either method.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Three-hundred women provided 600 samples for HPV genotyping. HPV genotypes were detected in 25% of SCAS and in 22% of CCAS. The most common genotypes with CCAS were HPV52, HPV62 and HPV70 and with SCAS were HPV62, HPV44, HPV52, HPV53 and HPV68. Total HPV genotypes detected in CCAS were more than those detected in SCAS, 32 versus 27. The agreement of HPV genotypes between the two methods was 0.55 in kappa value (k). The test of proportions using McNemar gave a Chi-square value of 0.75 (p = 0.39). Multiple HPV infections were detected in 28\/75 and 29\/67 women for CCAS and SCAS respectively.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>SCAS and CCAS anal swabs showed moderate agreement, with no statistically significant difference in the proportion of genotypes detected by either methods. Although the differences between the two methods were not statistically significant, CCAS detected more HPV genotypes than SCAS and more HPV infections were detected in SCAS than in CCAS. Our data suggest that self-collected anal swabs can be used as an alternative to clinician-collected anal swabs for HPV genotyping.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0250426","type":"journal-article","created":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T19:35:32Z","timestamp":1619465732000},"page":"e0250426","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Self-collected and clinician-collected anal swabs show modest agreement for HPV genotyping"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1154-6829","authenticated-orcid":true,"given":"Racheal S.","family":"Dube Mandishora","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-2722","authenticated-orcid":true,"given":"Trine B.","family":"Rounge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Fitzpatrick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene Kraus","family":"Christiansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole Herman","family":"Ambur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonja","family":"Lagstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babill","family":"Stray-Pedersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Tommasino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Palefsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zvavahera M.","family":"Chirenje","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,26]]},"reference":[{"key":"pone.0250426.ref001","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.virol.2008.11.046","article-title":"Papillomaviruses in the causation of human cancers\u2014a brief historical account","volume":"384","author":"H zur Hausen","year":"2009","journal-title":"Virology"},{"key":"pone.0250426.ref002","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13027-015-0008-y","article-title":"Global availability of data on HPV genotype-distribution in cervical, vulvar and vaginal disease and genotype-specific prevalence and incidence of HPV infection in females","volume":"10","author":"M Wagner","year":"2015","journal-title":"Infectious Agents and Cancer"},{"key":"pone.0250426.ref003","unstructured":"Cervical cancer statistics. World Cancer Research Fund. 2018. https:\/\/www.wcrf.org\/dietandcancer\/cancer-trends\/cervical-cancer-statistics. Accessed 20 Aug 2020."},{"key":"pone.0250426.ref004","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1086\/651620","article-title":"Sequential Acquisition of Human Papillomavirus Infection of the Anus and Cervix: The Hawaii HPV Cohort Study","volume":"201","author":"MT Goodman","year":"2010","journal-title":"J Infect Dis"},{"key":"pone.0250426.ref005","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.ygyno.2009.05.008","article-title":"Anal human papillomavirus infection and abnormal anal cytology in women with genital neoplasia","volume":"114","author":"IU Park","year":"2009","journal-title":"Gynecologic Oncology"},{"key":"pone.0250426.ref006","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/QCO.0000000000000337","article-title":"Human papillomavirus as a cause of anal cancer and the role of screening","volume":"30","author":"KCM Gosens","year":"2017","journal-title":"Curr Opin Infect Dis"},{"key":"pone.0250426.ref007","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/S1473-3099(19)30296-8","article-title":"Anal cancer risk: HPV-based cervical screening programmes","volume":"19","author":"U Wieland","year":"2019","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0250426.ref008","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/jnci\/djz219","article-title":"Recent Trends in Squamous Cell Carcinoma of the Anus Incidence and Mortality in the United States, 2001\u20132015","volume":"112","author":"AA Deshmukh","year":"2020","journal-title":"J Natl Cancer Inst"},{"key":"pone.0250426.ref009","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/COH.0000000000000336","article-title":"HPV-associated anal and cervical cancers in HIV-infected individuals: Incidence and prevention in the antiretroviral therapy era","volume":"12","author":"JM Palefsky","year":"2017","journal-title":"Curr Opin HIV AIDS"},{"key":"pone.0250426.ref010","unstructured":"ZWE_2018_countryreport.pdf. http:\/\/www.unaids.org\/sites\/default\/files\/country\/documents\/ZWE_2018_countryreport.pdf. Accessed 4 Mar 2019."},{"key":"pone.0250426.ref011","unstructured":"Zimbabwe National cancer registry. Pattern of cancer in Zimbabwe. National. Zimbabwe: ZNCR; 2016."},{"key":"pone.0250426.ref012","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1136\/sextrans-2011-050346","article-title":"Association of genital human papillomavirus infection with HIV acquisition: a systematic review and meta-analysis","volume":"89","author":"P Lissouba","year":"2013","journal-title":"Sex Transm Infect"},{"key":"pone.0250426.ref013","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1309\/AJCP9P2KJSXEKCJB","article-title":"Development and Validation of a New HPV Genotyping Assay Based on Next-Generation Sequencing","volume":"141","author":"X Yi","year":"2014","journal-title":"American Journal of Clinical Pathology"},{"key":"pone.0250426.ref014","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1177\/096914130601300409","article-title":"Acceptability of unsupervised HPV self-sampling using written instructions","volume":"13","author":"J Waller","year":"2006","journal-title":"J Med 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Bell","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0250426.ref018","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1742-6413-3-4","article-title":"Randomized clinical evaluation of self-screening for anal cancer precursors in men who have sex with men","volume":"3","author":"TM Lampinen","year":"2006","journal-title":"Cytojournal"},{"key":"pone.0250426.ref019","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/00126334-200408010-00004","article-title":"Self-collected versus clinician-collected anal cytology specimens to diagnose anal intraepithelial neoplasia in HIV-positive men","volume":"36","author":"RD Cranston","year":"2004","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0250426.ref020","doi-asserted-by":"crossref","first-page":"300","DOI":"10.7326\/0003-4819-149-5-200809020-00004","article-title":"Comparison of Patient- and Clinician-Collected Anal Cytology Samples to Screen for Human Papillomavirus\u2013Associated Anal Intraepithelial Neoplasia in Men Who Have Sex with Men","volume":"149","author":"PV Chin-Hong","year":"2008","journal-title":"Annals of Internal Medicine"},{"key":"pone.0250426.ref021","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3747\/co.25.3845","article-title":"HPV self-sampling: A promising approach to reduce cervical cancer screening disparities in Canada","volume":"25","author":"M Vahabi","year":"2018","journal-title":"Curr Oncol"},{"key":"pone.0250426.ref022","doi-asserted-by":"crossref","first-page":"3851","DOI":"10.3390\/v4123851","article-title":"The Role of Human Papillomavirus in Human Immunodeficiency Virus Acquisition in Men who Have Sex with Men: A Review of the Literature","volume":"4","author":"B Brown","year":"2012","journal-title":"Viruses"},{"key":"pone.0250426.ref023","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1086\/425906","article-title":"Age-Specific Prevalence of Anal Human Papillomavirus Infection in HIV-Negative Sexually Active Men Who Have Sex with Men: The EXPLORE Study","volume":"190","author":"PV Chin-Hong","year":"2004","journal-title":"J Infect Dis"},{"key":"pone.0250426.ref024","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S1470-2045(12)70080-3","article-title":"Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis","volume":"13","author":"DA Machalek","year":"2012","journal-title":"Lancet Oncol"},{"key":"pone.0250426.ref025","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1093\/infdis\/jis458","article-title":"Prevalence of and Risk Factors for Anal Human Papillomavirus Infection Among Young Healthy Women in Costa Rica","volume":"206","author":"FA Castro","year":"2012","journal-title":"J Infect Dis"},{"key":"pone.0250426.ref026","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1002\/jmv.24825","article-title":"Genotypic diversity of anogenital human papillomavirus in women attending cervical cancer screening in Harare, Zimbabwe","author":"RS Dube Mandishora","year":"2017","journal-title":"J Med Virol"},{"key":"pone.0250426.ref027","first-page":"1","article-title":"Type-Specific Cervico-Vaginal Human Papillomavirus Infection Increases Risk of HIV Acquisition Independent of Other Sexually Transmitted Infections","volume":"5","author":"KK Smith-McCune","year":"2010","journal-title":"PLoS ONE"},{"key":"pone.0250426.ref028","first-page":"10","article-title":"Self-sampling for human papillomavirus testing among rural young women of KwaZulu-Natal, South Africa","author":"JN Mbatha","year":"2017","journal-title":"BMC Res Notes"},{"key":"pone.0250426.ref029","first-page":"364","article-title":"A Comparison of Dacron versus Flocked Nylon Swabs for Anal Cytology Specimen Collection","volume":"55","author":"JC Gage","year":"2011","journal-title":"ACY"},{"key":"pone.0250426.ref030","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.pvr.2018.04.006","article-title":"Intra-host sequence variability in human papillomavirus","volume":"5","author":"RS Dube Mandishora","year":"2018","journal-title":"Papillomavirus Res"},{"key":"pone.0250426.ref031","unstructured":"Zymo-research. ZR Genomic DNATM -Tissue MiniPrep\u2014Solid & FFPE Tissue DNA\u2014Genomic DNA\u2014DNA. Zymo-Research. 2015. http:\/\/www.zymoresearch.com\/dna\/genomic-dna\/solid-ffpe-tissue-dna\/zr-genomic-dna-tissue-miniprep. Accessed 18 Jan 2017."},{"key":"pone.0250426.ref032","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1128\/JCM.38.1.357-361.2000","article-title":"Improved Amplification of Genital Human Papillomaviruses","volume":"38","author":"PE Gravitt","year":"2000","journal-title":"J Clin Microbiol"},{"key":"pone.0250426.ref033","doi-asserted-by":"crossref","first-page":"5112","DOI":"10.1128\/AEM.01043-13","article-title":"Development of a Dual-Index Sequencing Strategy and Curation Pipeline for Analyzing Amplicon Sequence Data on the MiSeq Illumina Sequencing Platform","volume":"79","author":"JJ Kozich","year":"2013","journal-title":"Appl Environ Microbiol"},{"key":"pone.0250426.ref034","doi-asserted-by":"crossref","first-page":"D499","DOI":"10.1093\/nar\/gkw879","article-title":"The Papillomavirus Episteme: a major update to the papillomavirus sequence database","volume":"45","author":"K Van Doorslaer","year":"2017","journal-title":"Nucleic Acids Res"},{"key":"pone.0250426.ref035","first-page":"9","article-title":"Standardization of Sequencing Coverage Depth in NGS: Recommendation for Detection of Clonal and Subclonal Mutations in Cancer Diagnostics","author":"A Petrackova","year":"2019","journal-title":"Front Oncol"},{"key":"pone.0250426.ref036","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0169074","article-title":"HPV Genotyping of Modified General Primer-Amplicons Is More Analytically Sensitive and Specific by Sequencing than by Hybridization","volume":"12","author":"R Meisal","year":"2017","journal-title":"PLoS One"},{"key":"pone.0250426.ref037","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.pvr.2015.05.004","article-title":"Deep sequencing of HPV16 genomes: A new high-throughput tool for exploring the carcinogenicity and natural history of HPV16 infection","volume":"1","author":"M Cullen","year":"2015","journal-title":"Papillomavirus Research"},{"key":"pone.0250426.ref038","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"22","author":"ML McHugh","year":"2012","journal-title":"Biochem Med (Zagreb)"},{"key":"pone.0250426.ref039","first-page":"226","article-title":"Cohen\u2019s kappa or McNemar\u2019s test? A comparison of binary repeated measurements","volume":"171","author":"F Krummenauer","year":"1999","journal-title":"Rofo"},{"key":"pone.0250426.ref040","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1055\/s-2007-976535","article-title":"Analyse der Beurteiler\u00fcbereinstimmung f\u00fcr kategoriale Daten mittels Cohens Kappa und alternativer Ma\u00dfe","volume":"46","author":"M Wirtz","year":"2007","journal-title":"Rehabilitation (Stuttg)"},{"key":"pone.0250426.ref041","first-page":"118","article-title":"Feasibility and Acceptability of Anal Self-Sampling for Human Papillomavirus Screening in HIV-Infected Patients","volume":"59","author":"C Tamalet","year":"2016","journal-title":"INT"},{"key":"pone.0250426.ref042","first-page":"559","article-title":"HPV-6 Molecular Variants Association With the Development of Genital Warts in Men: The HIM Study","volume":"215","author":"E Flores-D\u00edaz","year":"2017","journal-title":"J Infect Dis"},{"key":"pone.0250426.ref043","first-page":"18","article-title":"Anal human papillomavirus infection in HIV-positive men and women at two opportunistic infections clinics in Harare, Zimbabwe","author":"S Chinyowa","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0250426.ref044","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1046\/j.1525-1438.2001.01009.x","article-title":"Distribution of HPV 53, HPV 73 and CP8304 in genital epithelial lesions with different grades of dysplasia","volume":"11","author":"T Meyer","year":"2001","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0250426.ref045","doi-asserted-by":"crossref","first-page":"k4823","DOI":"10.1136\/bmj.k4823","article-title":"Collaboration on Self-Sampling and HPV Testing. 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