Reasons for non-attendance to cervical cancer screening and acceptability of HPV self-sampling among Bruneian women: A cross-sectional study.

Objective: Uptake for cervical cancer screening remains well below the recommended rate of 80%. We conducted a pilot study to determine the reasons for non-attendance and explore their acceptance of human papillomavirus (HPV) self-sampling as an alternative to Pap test. Methods: A two-part cross-sectional study was conducted at a health centre in Brunei, from January to December 2019. Women who were eligible for a Pap test but who either never or did not have one within the past four years were conveniently recruited. Participants were first asked to complete a paper-based survey on their reasons for screening non-attendance, and then invited for HPV self-sampling. Results were analysed using descriptive and inferential statistics. Result: We enrolled 174 screening non-attendees, out of which 97 (55.7%) also participated in HPV self-sampling. The main reasons for not attending Pap test screening were fear of bad results (16.1%, n = 28); embarrassment (14.9%, n = 26) and lack of time due to home commitments (10.3%, n = 18). When compared to those who agreed to participate in HPV self-sampling, those who declined were significantly older (p = 0.002) and less likely to agree that they are susceptible to cervical cancer (p = 0.023). They preferred to receive Pap-test related information from healthcare workers (59.0%, n = 155), social messaging platforms (28.7%, n = 51) and social media (26.4%, n = 47). HPV self-sampling kits were positively-received, where > 90% agreed on its ease and convenience. Nine of 97 participants (9.3%) tested positive for hr-HPV, out of which eight were non-16/18 HPV genotypes. Conclusion: Our findings suggest that promoting knowledge on cervical cancer, the benefits of screening and clarifying any misconceptions of Pap test results would help increase screening uptake among Bruneian non-attendees. Response to HPV self-sampling was highly positive, implying its receptiveness in the local setting. Our high detection of non-16/18 HPV genotypes suggest high prevalence of other hr-HPV genotypes in Brunei. Larger studies can be conducted to further validate our findings.