HPV Self-Sampling for Cervical Cancer Screening in Morocco: A Cross-Sectional Study

OBJECTIVE: Morocco is currently planning to introduce HPV testing as the primary screening method in routine cervical cancer screening. Accordingly, HPV self-sampling offers a potential solution to increase participation rates, particularly in underserved regions. Therefore, this study was designed to assess the feasibility and acceptability of HPV self-sampling using the GeneXpert assay as an alternative to clinician-administered screenings in Morocco. METHODS: A cross-sectional study was conducted among 997 women aged 30 or 40 years from four Moroccan provinces. Participants were offered the choice of clinician-collected sampling, supervised self-sampling, or unsupervised self-sampling. Socioeconomic and clinical data were collected using structured questionnaires, and HPV detection and genotyping were performed using the GeneXpert HPV assay. RESULTS: Overall, 13% of participants opted for self-sampling, including 4.8% who chose unsupervised, and 8.2% supervised self-sampling. Women living in urban areas, younger participants (30 years old), and those with higher education and income levels were more likely to select self-sampling. Satisfaction was high: 92.2% found the procedure easy to perform, all participants reported comfort using the cytobrush, and all indicated willingness to recommend the test to relatives or friends. Additionally, the diagnostic performance of high-risk HPV (hrHPV) testing was comparable between self-collected and clinician-collected samples, demonstrating no effect of sampling method on HPV detection. CONCLUSION: HPV self-sampling is feasible and highly acceptable among Moroccan women. However, the low uptake, particularly in rural settings, highlights the need for targeted education and awareness efforts. Integrating self-sampling into national screening programs may improve participation and contribute to reducing cervical cancer incidence in Morocco.