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Self-sampled specimens demonstrate comparable accuracy and consistency to clinician-sampled specimens for HPV detection among men who have sex with men in China
  1. Yuxin Ni1,
  2. Ying Lu1,
  3. Xi He2,
  4. Yumei Li3,
  5. Yongqing Li2,
  6. Shiyu Guo4,
  7. Jason J. Ong5,6,7,
  8. Chen Xu1,
  9. Xiaman Wang3,
  10. Xumeng Yan1,
  11. Yusha Tao1,
  12. Na Liu3,
  13. Weiming Tang1,8
  1. 1University of North Carolina Project-China, Guangzhou, Guangdong, China
  2. 2Zhuhai Xutong Voluntary Services Center, Zhuhai, China
  3. 3BGI Genomics, Shenzhen, China
  4. 4BGI Clinical Laboratories (Shenzhen), Shenzhen, China
  5. 5Central Clinical School, Monash University, Melbourne, Victoria, Australia
  6. 6Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
  7. 7Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  8. 8Guangdong No.2 People's Hospital, Guangzhou, People's Republic of China
  1. Correspondence to Dr Weiming Tang, University of North Carolina Project-China, Guangzhou, Guangdong, China; weiming_tang{at}


Objectives Despite a high risk of human papillomavirus (HPV) infection among men who have sex with men (MSM), few have ever tested. This study aimed to evaluate the feasibility and accuracy of HPV self-sampling among Chinese MSM, with the purpose of measuring the feasibility of self-sampling as an alternative in HPV testing scenarios.

Methods Eligible participants were those who were assigned male at birth, aged 18 or above, had sex with men in the past year and had never gotten HPV vaccine. Participants followed the instructions to self-sample and were also clinician-sampled from the same anatomical sites (oral fluid, penis and rectum) in both approaches. All specimens were processed using multiplex PCR assay. The reference standard of an individual with a true positive for HPV is determined via PCR test, regardless of sampling methods. Sensitivity and specificity were calculated for each approach independently and kappa test was used to assess the consistency between the two approaches.

Results Overall, 211 MSM were recruited at the local clinic from April to October 2020 in Zhuhai, China. The mean age was 31 years old. Only 3% of the participants sought help from healthcare providers during self-sampling. The prevalence of HPV was 49% (103 of 211). Clinician sampling detected 91 of 103 MSM infected with HPV, with a sensitivity of 88.3% (95% CI 80.2 to 93.6) and a specificity of 100.0% (95% CI 95.7 to 100.0). Self-sampling detected 81 of 103 MSM infected with HPV, with a sensitivity of 78.6% (95% CI 69.2 to 85.9) and a specificity of 100.0% (95% CI 95.7 to 100.0). The level of agreement was moderate between clinician sampling and self-sampling (k=0.67).

Conclusions Self-sampled HPV testing demonstrated comparable accuracy and consistency to clinician sampling among MSM in China. It holds the potential to complement sexual health services especially among key populations.

  • Diagnostic Screening Programs
  • Homosexuality, Male

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Federico Garcia

  • YN and YL contributed equally.

  • NL and WT contributed equally.

  • Contributors YN, YiL and SG drafted the manuscript. YN, YiL, XH, YuL, NL and WT contributed to study design. YN, YiL, XH, YuL, YoL, SG, CX, XW, NL and WT contributed to the development and implementation of study procedures. YN, YiL, XH, YoL, JJO, XY, YT and WT participated in the statistical analysis and interpretation of the findings. WT is responsible for the overall content as the guarantor. All authors critically reviewed and edited the manuscript.

  • Funding This work was supported by the National Key Research and Development Program of China (2017YFE0103800).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.