Acceptability and feasibility of a community based participatory research project comparing cytology and urine HPV DNA testing for cervical cancer screening in Yap, Federated States of Micronesia

Abstract

Non-invasive, self-collected sampling methods for HPV DNA detection in women, which are reliable, efficient, and acceptable have the potential to address barriers to cervical cancer screening in underserved communities, including low-middle income countries (LMIC) such as the island nation of the Federated States of Micronesia (FSM). Urine-based HPV testing has not been rigorously evaluated in clinical trials. A pilot community-based participatory randomized control research project evaluated use of urine HPV testing as a more culturally- and human resource appropriate method of cervical cancer screening in Yap State, FSM. Women participated in a cervical screening intervention using pap vs. urine test (N = 217). This manuscript described attitudes about screening feasibility and preferences. Stakeholders and women participants were interviewed (N = 23), and a survey also evaluated women’s screening preferences (N = 217). Qualitative content thematic analysis with multiple coders identified themes from interviews on acceptability and feasibility of screening tests. Women research participants were comfortable with the urine test (95%), despite limitations in some to provide samples. While 82.0% indicated that they felt comfortable with Pap smear, they also preferred a clinician (42%) to do the Pap smear, explaining that they preferred having a trained worker instead of themselves to do tests. Women want to be screened but accessibility remains a challenge. Education and training of professionals and community members alike will improve clinical skills, research capacity, knowledge of screening tests and behaviors including prioritizing HPV screening and testing.

A biomarker feasibility study in the South East Asia Community Observatory health and demographic surveillance system

“…Compared with the growing focus on feasibility studies for randomised clinical trials ( 13 – 24 ), literature on operational outcomes of observational feasibility studies remains scarce, and restricted to a limited number of measures, such as the overall proportion of invited individuals ultimately participating ( 7 – 10 ). Few studies have directly assessed measures of sample collection feasibility, with none identified here that specifically examined blood sample collection ( 7 , 25 ). Here, we identified useful indicators relating to various aspects of study operation including sample collection, using these in the context of our study to obtain a clearer understanding of the feasibility of scale-up.…”

Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review

“…Community-based organizations.-The involvement of community leaders through community-based organizations was discussed in 80% of the articles. [62][63][64][65][66][67]69,70,[98][99][100][101][102][103][104][105][106][107][108][109][110][111][112]116,117,[120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136] The involvement of community-based organizations was cited as a way to leverage, build, and sustain leadership within the Pacific Islander community. 81 Community-based organizations (e.g., federally qualified community health centers and grassroots non-profit community-based organizations) were described as playing a direct role in the research design, study conduct, and dissemination of the results back to the community.…”

“…Community advisory board.-More than half (54%) of the reviewed articles mentioned partnering with a community advisory board. 62,[64][65][66][67]69,70,[72][73][74][75][76][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112]116,117,[120][121][122][123]…”

Comparison of the performance of paired urine and cervical samples for cervical cancer screening in screening population

“…Vaginal self‐sampling is feasible and acceptable as an alternative to improve attendance in cervical cancer screening . In comparison, urine collection is noninvasive, more convenient, easy to do, and less clinician‐dependent . Several studies implied its potential usage in the surveillance of the impact of the HPV prophylactic vaccine in adolescents, research on HPV and related diseases in men, and cervical cancer screening in pregnant women .…”

“…[5][6][7][8] In comparison, urine collection is noninvasive, more convenient, easy to do, and less clinician-dependent. 3,9,10 Several studies implied its potential usage in the surveillance of the impact of the HPV prophylactic vaccine in adolescents, research on HPV and related diseases in men, and cervical cancer screening in pregnant women. [11][12][13][14][15][16] Additionally, urine-based testing has been shown to be flexible and promising in cervical cancer screening in referral population, [17][18][19][20] but the findings have not been demonstrated in screening practice.…”