Objective
Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention.
Materials and Methods
We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured.
Results
Over half (55%) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74%) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98%) agreeing the mailed test was safe. A few women (6%) preferred HPV self-testing to Pap testing for protecting health, but most (75%) had no preference. Trust in or preference for mailed self-testing did not vary by race or income. However, compared to white women, black women had lower HPV-related knowledge (OR=0.46, 95% CI, 0.23–0.92) and perceived lower cervical cancer risk in the absence of screening (OR=0.44, 95% CI, 0.22–0.86). We found similar patterns of disparities for women with very low (<$10,000) versus relatively higher incomes.
Conclusions
Our findings suggest that, across racial and economic subgroups, under-screened women generally trust HPV self-tests delivered by mail. To succeed, programs for HPV self-testing must overcome disparities in knowledge and perceptions related to cervical cancer screening.