BACKGROUND AND PURPOSE:

• Des Marais et al. (Obstetrics & Gynecology, 2018) assessed the validity and acceptability of at-home self-collection kit to test for human papillomavirus (HPV) and STDs in women at higher risk as a result of underscreening for cervical cancer

METHODS:

• Observational study
  • 2^nd phase of My Body, My Test study
• Participants
  • 30–64 years of age | No history of Pap testing in the past 4 years | Household income below 250% of the poverty level | Not pregnant | No previous hysterectomy | Uninsured, underinsured, or on Medicaid
• Participants provided cervicovaginal samples by one of 3 routes
  • Self-home (sample returned by mail)
  • Self-clinic (sample handed to nurse at visit)
  • Clinician
• Samples were tested for
  • High-risk HPV (14 high-risk HPV genotypes, with positive results reflexed for types 16 and for 18/45)
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Trichomonas vaginalis
  • Mycoplasma genitalium
• Cervical samples were also tested by liquid-based cytology
• Primary outcome: Clinical performance of high-risk HPV testing on self-collected cervicovaginal samples vs clinician-collected samples for ≥CIN2
• Other outcomes
  • Chlamydia trachomatis | Neisseria gonorrhoeae | Trichomonas vaginalis | Mycoplasma genitalium

RESULTS:

• 193 women had conclusive high-risk HPV results for all three samples and cytology results
  • Median age: 45 years
  • Median time from last Pap: 5 years
• Prevalence of high-risk HPV was similar between different screens
  • Self-home: 12.4%
  • Clinician: 11.4% (P=.79)
  • Self-clinic:15.5% (P=.21)
• Positivity for high-risk HPV in all sample types increased with increasing grades of cervical abnormality (P<.001)
• Self-home samples detected high-risk HPV in all
  • High-grade squamous intraepithelial lesions (HSIL)
  • CIN ≥2
• Detection was comparable across sample types for
  • T vaginalis (range 10.2–10.8%)
  • M genitalium (3.3–5.5%)
  • C trachomatis (1.1–2.1%)
  • N gonorrhoeae (0–0.5%)
• Acceptability
  • Most participants reported no difficulty understanding self-collection instructions (93.6%) and were willing to use self-collection in the future (96.3%)

CONCLUSION:

• Self-home collection for HPV and STD screening was demonstrated to be a valid alternative among infrequently screened women
• The authors state

“…future implementation research is needed on program efficacy and cost-effectiveness, including a comprehensive assessment of continuity from screening to treatment”

Learn More – Primary Sources:

Home Self-Collection by Mail to Test for Human Papillomavirus and Sexually Transmitted Infection

Related ObG Topics:

Guidance Update: Professional Organizations Align on Cervical Cancer Screening

Cervical Cytology and HPV Screening in the HIV Positive Woman

Cervical Cancer Screening Guidelines: The Role of Pap and HPV