Prevalence of High-Risk Human Papillomavirus by RNA Assay in Home Self-Collected Samples Among Underscreened People in North Carolina

Abstract

Background: Low-income and uninsured people with a cervix (PWC) are at the highest risk of being underscreened for cervical cancer. We evaluated the prevalence of high-risk human papillomavirus (hrHPV) on home self-collected samples, as well as rates of in-clinic follow-up and risk factors associated with hrHPV positivity in this at-risk population.Methods: My Body My Test 3 was conducted between 2016 and 2019 in North Carolina among individuals aged 25 to 64 years, overdue for cervical cancer screening, and with incomes of <250% of the US Federal Poverty Level. Our analytic sample included participants randomized to the selfcollection arm who returned self-collected cervicovaginal brush samples for HPV testing (n = 329). Samples were tested for 14 hrHPV types by an HPV RNA assay and further genotyped for HPV-16 and HPV-18/45. We examined behavioral risk factors for hrHPV positivity using logistic regression and between-subject t tests.Results: High-risk HPV RNA prevalence was 16% (n = 52/329) in selfcollected samples. Of the hrHPV-positive participants, 24 (46%) presented for in-clinic cervical cancer screening, compared with 56 (20%) of hrHPVnegative participants. Those with ≥2 sexual partners in the past year were twice as likely to be hrHPV positive in adjusted analyses (adjusted odds ratio, 2.00 [95% confidence interval, 1.03-3.88]). High-risk HPV-positive and HPV-negative participants had similar attitudes toward screening, with the exception of hrHPV-positive participants who reported a lower perceived risk of cervical cancer than those who were hrHPV negative ( P < 0.05). Conclusion:The hrHPV RNA prevalence was similar to findings in other underscreened PWC in the United States. Efforts to reach underscreened PWC are critical for cervical cancer prevention. Future studies aimed at home self-collection should address methods of increasing clinic attendance and completion of treatment among those with HPV-positive results.

Effect of HPV self-collection kits on cervical cancer screening uptake among under-screened women from low-income US backgrounds (MBMT-3): a phase 3, open-label, randomised controlled trial

“…Eligible individuals were aged 25–64 years, were not pregnant, had an intact cervix (ie, no history of hysterectomy), had an income of 250% or less of the US Federal Poverty Level, were uninsured or enrolled in Medicaid or Medicare, and were living within the catchment area of a trial-associated clinic and eligible to receive screening from a trial-associated clinic. 13 , 17 The US Census Bureau sets annual household income thresholds, which vary by family size and composition, to define who is living in federal poverty. 18 Additionally, women were eligible only if they self-reported not having a Papanicolaou test for 4 years or more or not having a physician-collected HPV test in 6 years or more, which is considered overdue for screening according to US guidelines.…”

“…18 Additionally, women were eligible only if they self-reported not having a Papanicolaou test for 4 years or more or not having a physician-collected HPV test in 6 years or more, which is considered overdue for screening according to US guidelines. 2 , 13 , 17 If the participant was an established patient at one of the trial-affiliated clinics, the date of their last cervical cancer screening was confirmed by use of the participant’s medical records at the time of appointment scheduling. Trial eligibility was assessed by use of a telephone questionnaire administered by trial staff.…”

“…Recruitment occurred through printed advertisements, radio announcements, and online postings ( appendix pp 1–9). 13 , 17 Women were also recruited at community events and referred through community organisations and the United Way 2–1–1 social assistance helpline. 13 , 17 Recruitment materials referred to participants as “women”, but gender identity was not an exclusion criterion.…”

Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

“…A total of 759 women were eligible for baseline analyses as described elsewhere [33]. Of these 759 eligible participants, one participant did not self-identify any race or ethnicity, and 48 selfidentified as a race or ethnicity other than White, Black, or Hispanic/Latina.…”

“…Most surveyed women intended to get a Pap test in the next six months (70.6%). Our multivariable model (Table 3) indicated that older women were less likely to intend to screen compared to women ages 25 [25][26][27][28][29][30][31][32][33][34]. Black women were more likely to intend to screen compared to White women (OR: 1.48 (1.02, 2.06)).…”