Self-Sampling for Human Papillomavirus Testing: Acceptability in a U.S. Safety Net Health System

Area of Science:

• Public Health
• Gynecology
• Infectious Disease

Background:

• Cervical cancer screening access and utilization can be expanded through self-sampling strategies.
• Patient acceptability is crucial for the successful adoption of self-sampling methods.
• Underscreened populations in safety net health systems present a key target for improved screening interventions.

Purpose of the Study:

• To assess the acceptability and experiences of mailed self-sampling kits for human papillomavirus (HPV) testing.
• To identify barriers to traditional provider-performed cervical cancer screening.
• To evaluate patient experiences with HPV self-sampling kits compared to in-clinic screening.

Main Methods:

• A nested telephone survey was conducted with participants (n=272) from the Prospective Evaluation of Self-Testing to Increase Screening trial.
• Participants were patients aged 30-65 in a safety net health system who were not up-to-date on screening.
• Surveys collected data on barriers to provider-performed screening and experiences with mailed HPV self-sampling kits.

Main Results:

• Prevalent barriers to provider-performed screening included discomfort with pelvic exams (69.4%), male providers (65.4%), and embarrassment (57.0%).
• Among kit users (n=164), 84.8% reported positive experiences, with most finding self-sampling more convenient (89.0%), less embarrassing (99.4%), and less stressful (95.7%).
• Among nonusers (n=43), reasons for non-use included forgetting (76.7%), preference for provider screening (76.7%), and fear of cancer (67.4%).

Conclusions:

• Mailed HPV self-sampling kits were generally well-received by underscreened patients in a safety net setting.
• The increased comfort and reduced embarrassment/anxiety associated with self-sampling address key barriers to traditional screening.
• High acceptability indicates that HPV self-sampling could significantly increase cervical cancer screening rates upon regulatory approval and availability.