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Cervical Cancer Screening With Human Papillomavirus Self-Collection Testing in an Opioid Treatment Program
Elizabeth M Swisher1, Mallory Davis2,3, Mayumi Rubin-Saika1
1Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Washington, Seattle.
Importance:
Individuals with opioid use disorder and substance use disorder have lower cervical cancer screening rates than the general population. Human papillomavirus (HPV) self-collection testing provides opportunities to expand screening access to previously unreached patient populations.
Objectives:
To assess the feasibility and uptake of incorporating HPV self-collection testing for cervical cancer screening into routine care for patients with opioid use disorder and substance use disorder, and to track the rates of high-risk HPV and guideline concordant follow-up care in this population.
Design, Setting, And Participants:
This prospective cohort study was conducted from June 24, 2024, through December 31, 2025, at We Care Daily Clinics, a federally certified opioid treatment program (OTP) and American Indian Health Facility in Auburn, Washington. Eligible patients were 25 years or older, had a cervix, and were either overdue for cervical cancer screening or unsure of their last screening.
Intervention:
Screening using self-collection kits was offered during the patient's annual wellness visit, and self-collection occurred privately in the clinic restroom. Samples were analyzed for 14 high-risk HPV types at a laboratory. Screened patients with HPV-positive results received education and recommendations for guideline-concordant care. OTP staff facilitated patient referrals to local clinicians for gynecologic services, and follow-up was tracked.
Main Outcomes And Measures:
The primary outcomes were the rates of HPV self-collection testing uptake, HPV positivity, and successful linkage to follow-up care.
Results:
A total of 194 patients (median [range] age, 41 [25-65] years) were evaluated. Of 174 patients (89.7%) eligible for cervical cancer screening, 158 (90.8%) completed HPV self-collection testing. There were 0 unsatisfactory test results, and 128 patients (81.0%) had HPV-negative results, 7 (4.4%) had HPV-16- or HPV-18-positive results, and 23 (14.6%) had positive results for other high-risk HPV types (non-HPV-16 or HPV-18 types only). Of the 30 patients with HPV-positive test results, 2 (6.7%) were lost to follow-up and 12 (40.0%) completed follow-up to date, which often required multiple coordination attempts by clinicians. The remaining 16 of 30 patients (53.3%) are currently actively engaged in various stages of referral and scheduling.
Conclusions And Relevance:
In this cohort study, incorporation of cervical cancer screening into an OTP using HPV self-collection testing was feasible with high patient eligibility and uptake.
