A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV

Abstract

Objective Women living with HIV experience higher risk of cervical cancer, but screening rates in the U.S. are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervico-vaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV. Methods This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women over age 18, with HIV infection, attending an HIV Clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer. Results A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences comparing HPV positive with HPV negative women, nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer. Conclusions The intervention did not improve cytology test attendance, though education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average 3.6 years prior to the baseline appointment. Self-sampling for HPV testing was feasible.

Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis

“…After two independent reviewers screened in duplicate and gained consensus, 149 articles were pulled for full-text review. Of these, 33 studies (reported in 34 articles) were included in the review 21–54…”

Mailed Human Papillomavirus Self-Collection With Papanicolaou Test Referral for Infrequently Screened Women in the United States

“…Several well-conducted US studies have implemented HPV self-testing through community health workers and other direct-interaction approaches. 23–27,41 Direct one-to-one engagement has many strengths, but requires considerable personnel time and effort. Our approach has the potential to require fewer resources per woman screened.…”

“…US studies have found that women from diverse populations respond positively to HPV self-testing, although most studies delivered self-collection kits and provided instructions in-person to women at clinics, 23 community centers, 24,25 or their homes for immediate return to health workers. 26,27 To our knowledge, only 2 US studies have used mailed kits for at-home HPV self-testing.…”

Human Papillomavirus DNA Self-Testing to Promote Cervical Cancer Screening Practices Among WLHIV: Revisiting the Evidence

“…al. aimed to increase the cervical cancer screening practice of cervical cytology testing among WLHIV through administration of Human Papillomavirus (HPV) DNA self-tests [1]. Based on the health belief model (HBM), they hypothesized that self-testing would increase self-perception of cervical cancer risk leading to increased cytology test completion.…”