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

Abstract

Background Testing for high-risk human papillomavirus (HPV) infection using mailed, self-collected samples is a promising approach to increase screening in women who do not attend clinic screening at recommended intervals. Methods To assess this intervention among high-risk women in the United States, 429 women without a Papanicolaou (Pap) test in 4 or more years (overdue by US guidelines) were recruited from the general population. Participants aged 30 to 65 years were mailed a kit to self-collect a cervicovaginal sample at home, return the sample by mail, and receive HPV results by telephone, with referral to follow-up cytological Pap testing at a local clinic. Cervicovaginal self-samples were collected with a Viba brush, stored in Scope mouthwash, and tested by Hybrid Capture 2. Data were collected in 2010 to 2011 and analyzed in 2017. Results Two-thirds (64%) of participants returned a self-collected sample, of whom 15% tested HPV DNA positive. Human papillomavirus self-test–positive women reported higher rates of follow-up Pap tests (82%) than did those with self-test negative results (51%). No demographic differences were found in self-test return rate or HPV positivity. High acceptability was reported in participant surveys: most women (81%) had “mostly positive” overall thoughts about the self-test, and most reported being comfortable receiving the kit in the mail (99%), returning their self-collected sample by mail (82%), and receiving their test results by telephone (97%). Conclusions Conducting HPV self-testing through population-based recruitment, mailed kit delivery and return by mail, and results delivery by telephone has the potential to reach a broad segment of US underscreened women.

Results of a Pilot Study of a Mail-Based Human Papillomavirus Self-Testing Program for Underscreened Women From Appalachian Ohio

“…Our results are similar to the few recent mail-based HPV self-testing programs in the US, which had self-test return rates of at least 64% and HPV prevalence estimates up to 18%. 17,18 It is worth noting that the return rates in US studies, including our study, are noticeably higher than those from large international mail-based programs (pooled return rate of 24%). 7 A potential reason for this is that the US studies required women to provide consent as part of the study process, and this may have resulted in these studies enrolling women who were highly interested in using an HPV self-test.…”

“…These findings add to the growing literature of women reporting extremely positive feedback after using an HPV self-test. 17,26,27 The positive feedback in our study is likely due in part to the HPV self-test device that was used. Prior to our pilot study, we conducted formative research with women from Appalachian Ohio to examine their acceptability of different HPV self-test devices.…”

“…15,16 A few recent studies have begun implementing mail-based HPV self-testing programs in the US. 17,18 In these studies, at least 64% of women used and returned an HPV self-test that was mailed to them.…”

Acceptability of self‐taken vaginal HPV sample for cervical screening among an under‐screened Indigenous population

“…The post/mail was the lead preference for receiving and returning HPV self‐test kits, although some women and HCPs expressed reservations about its reliability/efficacy. Internationally, mail‐out self‐test screening studies using different settings and designs have shown a wide range of return rates (8–93%) . Fourth, there was a strong preference for HPV self‐testing to happen at home with no support necessary.…”

The incremental role of trait emotional intelligence on perceived cervical screening barriers

“…Since its introduction, it has been effective in decreasing rates of cervical cancer (Kowalski & Brown, 1994;SEER, 2011). Despite the reported health benefits, the availability of free or low-cost Pap screening and the overwhelming success of screening initiatives, some women diagnosed with cervical cancer have never had a Pap test or were infrequently screened (Centers for Disease Control and Prevention, 2013;Sabatino et al, 2015;Smith et al, 2017).…”