Perceptions of Mailed HPV Self-testing Among Women at Higher Risk for Cervical Cancer

Abstract

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.

Perspectives from health-care providers and women about completing human papillomavirus (HPV) self-testing at home

“…The findings from the current study are similar to prior studies conducted among women living in other countries (Racey, Withrow, and Gesink 2013; Verdoodt et al 2015), and in recent research studies completed in the U.S. (Crosby et al 2015; Galbraith et al 2014; Montealegre et al 2015; Nelson et al 2015; Scarinci et al 2013). Most studies conducted in the U.S. have found that women were receptive to having an HPV self-test mailed to their home and to completing the test; these studies reported many of the same concerns, especially about correctly completing the test (Galbraith et al 2014; Nelson et al 2015).…”

“…Most studies conducted in the U.S. have found that women were receptive to having an HPV self-test mailed to their home and to completing the test; these studies reported many of the same concerns, especially about correctly completing the test (Galbraith et al 2014; Nelson et al 2015). These findings were similar among immigrant women (Barbee et al 2010; Sewali et al 2015), among lesbian and bisexual women (Reiter and McRee 2015), and underserved women (Crosby et al 2015; Galbraith et al 2014; Montealegre et al 2015). …”

Perceived cervical cancer risk among women treated for high-grade cervical intraepithelial neoplasia: The importance of specific knowledge

“…It has been noted that in most countries with cervical cancer screening programs, the majority of cervical cancers occur in women who have not been regularly screened [ 34 ]. Low income and low levels of education have frequently been associated with non-participation in cervical cancer screening [ 35 – 37 ], although the evidence is not entirely consistent [ 38 ]. Among women aged 20 to 64 in 2014 in Sweden, median annual gross income is approximately 280 000 Swedish kronor (~ $32 700 USD), with over 90% of these women earning less than 450 000 (~ $52 500 USD) [ 39 ].…”

Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs

“…German women aged 20–30 years, who participated in a study to self-sample by cervicovaginal lavage rated the user-friendliness of the self-sampling method as easy ( 79 ). In a telephone survey of 199 low-income women in North Carolina who had not had a Pap test in 4 years, HPV self-tests delivered by mail were perceived to be trustworthy ( 80 ). However, in a recent study among 1,769 women presenting to two University of Washington clinics for routine cervical cancer screening, about 40% of participants were concerned that self-sampling might be inferior to clinician-collected samples, although both patients as well as physicians were supportive of the concept of self-sampling for HPV testing ( 81 ).…”