Lessons learned from comparing self-collected vs. physician-collected vaginal swabs for diagnosing infections in resource-limited settings: a 24-year review

Authors

DOI:

https://doi.org/10.5327/DST-2177-8264-2024361410

Keywords:

Diagnostic, Reproductive health, Women’s health

Abstract

Introduction: Reproductive health is essential for women’s overall well-being, yet vaginal infections like Bacterial Vaginosis (BV), Candidiasis, and
Trichomoniasis are prevalent and can lead to severe complications if left untreated. In high-income countries, healthcare systems are generally equipped to handle these infections; however, in resource-limited settings, barriers such as geographic isolation, financial constraints, and social stigmas hinder access
to effective care. Self-collected vaginal swabs present a promising alternative to traditional physician-collected samples, offering potential benefits in these
underserved regions. Objective: This study aims to evaluate the feasibility, diagnostic accuracy, and community acceptance of self-collected vaginal swabs compared to physician-collected samples for diagnosing bacterial vaginosis, candidiasis, and trichomoniasis in resource-limited settings, and to explore strategies for the broader implementation of this approach to improve women’s reproductive health. Methods: This narrative review synthesizes literature on the effectiveness, feasibility, and community acceptance of self-collected vaginal swabs compared to physician-collected samples for diagnosing BV, Candidiasis, and Trichomoniasis. A systematic search was conducted across PubMed, Google Scholar, and institutional repositories for studies from January 2000 to May 2024. The review encompasses various sections, including background on the significance of timely diagnosis, initiatives empowering women through self-collection, challenges and successes of these initiatives, and strategies for quality assurance and policy advocacy. Results: Selfcollected vaginal swabs were found to be as accurate as physician-collected samples in diagnosing BV, Candidiasis, and Trichomoniasis. The method enhances accessibility and reduces stigma, showing potential for broader application in community health settings. Conclusion: Self-collected vaginal swabs represent a viable solution to reproductive health challenges in resource-limited settings. They offer comparable diagnostic accuracy, enhance accessibility, and can reduce cultural barriers to seeking care. Future efforts should focus on community education, technological innovations, and policy reforms to maximize the effectiveness and sustainability of this approach in improving global women’s health.

Downloads

Download data is not yet available.

References

World Health Organization. Reproductive health. Reproductive health

in the South-East Asia Region [Internet]. 2021 [cited on 2024 Jan 03].

Available from: https://www.who.int/southeastasia/health-topics/

reproductive-health#:~:text=Reproductive%20health%20implies%20

that%20people,how%20often%20to%20do%20so.

Mohankumar B, Shandil RK, Narayanan S, Krishnan UM. Vaginosis:

advances in new therapeutic development and microbiome restoration. Microb

Pathog. 2022;168:105606. https://doi.org/10.1016/j.micpath.2022.105606

Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369(9577):1961-71.

https://doi.org/10.1016/S0140-6736(07)60917-9

Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician.

;62(5):1095-104. PMID: 10997533.

Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S,

et al. High-quality health systems in the sustainable development goals

era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196-e1252.

https://doi.org/10.1016/S2214-109X(18)30386-3

Habib SS, Jamal WZ, Zaidi SMA, Siddiqui JU, Khan HM, Creswell J, et al.

Barriers to access of healthcare services for rural women-applying a gender

lens on TB in a rural district of Sindh, Pakistan. Int J Environ Res Public

Health. 2021;18(19):10102. https://doi.org/10.3390/ijerph181910102

Mohammadi F, Kohan S, Mostafavi F, Gholami A. The stigma of

reproductive health services utilization by unmarried women. Iran Red

Crescent Med J. 2016;18(3):e24231. https://doi.org/10.5812/ircmj.24231

Hariprasad R, John A, Abdulkader RS. Challenges in the implementation

of human papillomavirus self-sampling for cervical cancer screening in

India: a systematic review. JCO Glob Oncol. 2023;9:e2200401. https://

doi.org/10.1200/GO.22.00401

Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of

samples as an additional approach to deliver testing services for sexually

transmitted infections: a systematic review and meta-analysis. BMJ Glob

Health. 2019;4(2):e001349. https://doi.org/10.1136/bmjgh-2018-001349

Khan Z, Bhargava A, Mittal P, Bharti R, Puri P, Khunger N, et al.

Evaluation of reliability of self-collected vaginal swabs over physiciancollected

samples for diagnosis of bacterial vaginosis, candidiasis and

trichomoniasis, in a resource-limited setting: a cross-sectional study

in India. BMJ Open. 2019;9(8):e025013. https://doi.org/10.1136/

bmjopen-2018-025013

Jaya ZN, Mapanga W, Dlangalala T, Thembane N, Kgarosi K, Dzinamarira

T, et al. Accuracy of self-collected versus healthcare worker collected

specimens for diagnosing sexually transmitted infections in females: an

updated systematic review and meta-analysis. Sci Rep. 2024;14(1):10496.

https://doi.org/10.1038/s41598-024-61358-y

Lozar T, Nagvekar R, Rohrer C, Mandishora RSD, Ivanus U, Fitzpatrick

MB. Cervical cancer screening postpandemic: self-sampling opportunities

to accelerate the elimination of cervical cancer. Int J Womens Health.

;13:841-59. https://doi.org/10.2147/IJWH.S288376

Lwamba E, Shisler S, Ridlehoover W, Kupfer M, Tshabalala N, Nduku P,

et al. Strengthening women’s empowerment and gender equality in fragile

contexts towards peaceful and inclusive societies: a systematic review

and meta-analysis. Campbell Syst Rev. 2022;18(1):e1214. https://doi.

org/10.1002/cl2.1214

Kumar S, Preetha G. Health promotion: an effective tool for global health.

Indian J Community Med. 2012;37(1):5-12. https://doi.org/10.4103/0970-

94009

Matin BK, Williamson HJ, Karyani AK, Rezaei S, Soofi M, Soltani S.

Barriers in access to healthcare for women with disabilities: a systematic

review in qualitative studies. BMC Womens Health. 2021;21(1):44.

https://doi.org/10.1186/s12905-021-01189-5

Hussein J, Ferguson L. Eliminating stigma and discrimination in sexual

and reproductive health care: a public health imperative. Sex Reprod

Health Matters. 2019;27(3):1-5. https://doi.org/10.1080/26410397.2019.

Stangl AL, Earnshaw VA, Logie CH, van Brakel W, Simbayi LC, Barré

I, et al. The health stigma and discrimination framework: a global,

crosscutting framework to inform research, intervention development, and

policy on health-related stigmas. BMC Med. 2019;17(1):31. https://doi.

org/10.1186/s12916-019-1271-3

Nielsen M, D’Agostino D, Gregory P. Addressing rural health challenges

head on. Mo Med. 2017;114(5):363-6. PMID: 30228634.

Parsons LM, Somoskövi A, Gutierrez C, Lee E, Paramasivan CN, Abimiku

A, et al. Laboratory diagnosis of tuberculosis in resource-poor countries:

challenges and opportunities. Clin Microbiol Rev. 2011;24(2):314-50.

https://doi.org/10.1128/CMR.00059-10

World Health Organization. WHO guideline for screening and treatment

of cervical pre-cancer lesions for cervical cancer prevention: use of

dual-stain cytology to triage women after a positive test for human

papillomavirus (HPV). 2nd ed. Geneva: World Health Organization; 2024.

Semrau M, Gronholm PC, Eaton J, Maulik PK, Ayele B, Bakolis I, et al.

Reducing stigma and improving access to care for people with mental

health conditions in the community: protocol for a multi-site feasibility

intervention study (Indigo-Local). Res Sq [Preprint]. 2023:rs.3.rs-3237562.

https://doi.org/10.21203/rs.3.rs-3237562/v1

Nickel S, von dem Knesebeck O. Effectiveness of community-based

health promotion interventions in urban areas: a systematic review. J

Community Health.

Tolley A, Grewal K, Weiler A, Papameletiou AM, Hassan R, Basu S.

Factors influencing adherence to non-communicable disease medication

in India: secondary analysis of cross-sectional data from WHO –

SAGE2. Front Pharmacol. 2023;14:1183818. https://doi.org/10.3389/

fphar.2023.1183818

Ignoffo S, Gu S, Ellyin A, Benjamins MR. A review of community

health worker integration in health departments. J Community Health.

;49(2):366-76. https://doi.org/10.1007/s10900-023-01286-6

Yadav R, Zaman K, Mishra A, Reddy MM, Shankar P, Yadav P, et al.

Health seeking behaviour and healthcare utilization in a rural cohort of

North India. Healthcare (Basel). 2022;10(5):757. https://doi:.org/10.3390/

healthcare10050757

Frost D, Mahmud M, Kaiser MS, Musoke D, Henry P, Islam S. Innovative

approaches to strengthening health systems in low- and middle-income

countries: Current models, developments, and challenges. Health Policy

Technol. 2021;10(4):100567. https://doi.org/10.1016/j.hlpt.2021.100567

Iqbal A, Anil G, Bhandari P, Crockett ED, Hanson VM, Pendse BS,

et al. A digitally capable mobile health clinic to improve rural health

care in America: a pilot quality improvement study. Mayo Clin Proc

Innov Qual Outcomes. 2022;6(5):475-83. https://doi.org/10.1016/j.

mayocpiqo.2022.08.002

Ezike TC, Okpala US, Onoja UL, Nwike CP, Ezeako EC, Okpara OJ,

et al. Advances in drug delivery systems, challenges and future directions.

Heliyon. 2023;9(6):e17488. https://doi.org/10.1016/j.heliyon.2023.e17488

Zhang Y. Access to healthcare facilities and women’s healthcare

requirements in urban areas: a case study of Beijing. Int J Environ Res

Public Health. 2022;19(6):3709. https://doi.org/10.3390/ijerph19063709

Morales-Garzón S, Parker LA, Hernández-Aguado I, Tolosana MGM,

Pastor-Valero M, Chilet-Rosell E. Addressing health disparities through

community participation: a scoping review of co-creation in public

health. Healthcare (Basel). 2023;11(7):1034. https://doi.org/10.3390/

healthcare11071034

Gizaw Z, Astale T, Kassie GM. What improves access to primary

healthcare services in rural communities? A systematic review. BMC Prim

Care. 2022;23(1):313. https://doi.org/10.1186/s12875-022-01919-0

Grady PA, Gough LL. Self-management: a comprehensive approach to

management of chronic conditions. Am J Public Health. 2014;104(8):e25-

https://doi.org/10.2105/AJPH.2014.302041

Wakjira DB, Habedi D. Barriers to access and utilisation of sexual and

reproductive health services among adolescents in Ethiopia: a sequential

mixed-methods study. BMJ Open. 2022;12(11):e063294. https://doi.

org/10.1136/bmjopen-2022-063294

Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A,

Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health

workers and health equity in low- and middle-income countries: systematic

review and recommendations for policy and practice. Int J Equity Health.

;21(1):49. https://doi.org/10.1186/s12939-021-01615-y

Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C.

The effects of public health policies on health inequalities in high-income

countries: an umbrella review. BMC Public Health. 2018;18(1):869.

https://doi.org/10.1186/s12889-018-5677-1

Lassi ZS, Kumar R, Bhutta ZA. Community-based care to improve maternal,

newborn, and child health. In: Black RE, Laxminarayan R, Temmerman

M, Walker PN, Bustreo F, Jamison DT, et al., eds. Reproductive, maternal,

newborn, and child health: disease control priorities. 3rd ed. Washington:

The International Bank for Reconstruction and Development; 2016. https://

doi.org/10.1596/978-1-4648-0348-2_ch14

Ameyaw EK, Amoah PA, Ezezika O. Effectiveness of mHealth apps for

maternal health care delivery: systematic review of systematic reviews. J

Med Internet Res. 2024;26:e49510. https://doi.org/10.2196/49510

Anawade PA, Sharma D, Gahane S. A comprehensive review on

exploring the impact of telemedicine on healthcare accessibility. Cureus.

;16(3):e55996. https://doi.org/10.7759/cureus.55996

Ajuebor O, Boniol M, McIsaac M, Onyedike C, Akl EA. Increasing access

to health workers in rural and remote areas: what do stakeholders’ value

and find feasible and acceptable? Hum Resour Health. 2020;18(1):77.

https://doi.org/10.1186/s12960-020-00519-2

Stover J, Hardee K, Ganatra B, et al. Interventions to improve reproductive

health. In: Black RE, Laxminarayan R, Temmerman M, Walker PN,

Bustreo F, Jamison DT, et al., eds. Reproductive, maternal, newborn,

and child health: disease control priorities. 3rd ed. Washington: The

International Bank for Reconstruction and Development; 2016. https://

doi.org/10.1596/978-1-4648-0348-2_ch6

Ssetaala A, Ssempiira J, Wambuzi M, Nanyonjo G, Okech B, Chinyenze

K, et al. Improving access to maternal health services among rural hardto-

reach fishing communities in Uganda, the role of community health

workers. Womens Health (Lond). 2022;18:17455057221103993. https://

doi.org/10.1177/17455057221103993

Desai S, Misra M, Das A, Singh RJ, Sehgal M, Gram L, et al. Community

interventions with women’s groups to improve women’s and children’s

health in India: a mixed-methods systematic review of effects, enablers and

barriers. BMJ Glob Health. 2020;5(12):e003304. https://doi.org/10.1136/

bmjgh-2020-003304

Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M,

et al. Interventions to improve primary healthcare in rural settings: a

scoping review. PLoS One. 2024;19(7):e0305516. https://doi.org/10.1371/

journal.pone.0305516

Published

2024-09-16

How to Cite

1.
Lachyan D, Khunger D, Bharti D, Sharma D, Mehrotra D, Goyal D. Lessons learned from comparing self-collected vs. physician-collected vaginal swabs for diagnosing infections in resource-limited settings: a 24-year review. DST [Internet]. 2024 Sep. 16 [cited 2024 Oct. 5];36. Available from: https://bjstd.org/revista/article/view/1410

Issue

Section

Review Article