(P) Evaluating Implementation of HPV Self-Collection for Cervical Cancer Screening Among Low-Income, Under-Screened Women in the US

Publication Number: 1015

Background: Underscreened women account for the majority of cervical cancer cases in the US. Mailed, at-home HPV self-collection has the potential to reduce barriers and increase screening uptake among these infrequently screened women.

Objectives: We conducted a hybrid effectiveness-implementation study to identify factors that may affect the delivery of mailed, at-home HPV self-collection into real-world settings to increase cervical cancer screening.

Methods: Participants for the My Body My Test-3 randomized controlled trial were recruited from 22 counties in North Carolina, US. Participants were between 25-64 years, uninsured or enrolled in Medicaid/Medicare, reporting an income of ≤250% of US Federal Poverty Level, and overdue for screening per national guidelines (Pap >4 years/ high-risk HPV test >6 years ago). Participants were randomized to the intervention and control arms in a 2:1 ratio. Intervention arm participants received an HPV self-collection kit mailed to their homes, followed by testing cervico-vaginal samples for high-risk HPV RNA (Aptima, Hologic) and scheduling assistance to obtain screening. Control arm participants received scheduling assistance only. An implementation framework adapted from the Consolidated Framework for Implementation Research guided our implementation analysis. Using survey and process data from our study, we assessed participants' satisfaction with the self-collection device and results delivery, and facilitators and barriers to device usage. Quantitative data was analyzed using descriptive statistics, and qualitative data using content analysis.

Results: We randomized 665 participants, with 438 participants in the intervention arm and 227 in the control arm. Median participant age was 42 (range 25-61) years, and median time since last screening was 5 (range 4-25) years. Among 329 intervention participants who returned a kit with valid test results, 16% were HPV positive. Among intervention participants, 90% (95% CI: 0.87, 0.93) reported willingness to use the self-test in the future, and 68% (95% CI: 0.63, 0.73) reported a preference for the self-test over in-clinic screening. The most commonly reported reason for preferring the self-test was convenience/ease of use (94%, 95% CI: 0.90, 0.96). Performing the self-test correctly was a concern among a minority of participants (14%, 95% CI: 0.11, 0.18).

Conclusions: Mailed HPV self-collection was well-received among participants and may be preferable to in-clinic screening among low-income, underscreened women. Strategies such as providing educational material about HPV and cervical cancer in self-collection kits and during results delivery calls can support implementation and reduce barriers to HPV testing using self-collection.