Abstract
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. 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. 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. 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.
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Acknowledgments
We would like to thank Andrea Des Marais, Rachel Larsen, Kristen Ricchetti-Masterson, Kelly Murphy, Belinda Yen-Lieberman, and Jerome Belinson for supporting this study. This research was supported by Kate B. Reynolds Charitable Trust. Additional support for staff time came from the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center (R25 CA57726), the NCCU-LUCC Partnership in Cancer Research (5 U54 CA156733), and an unrestricted gift from GlaxoSmithKline.
Conflict of interest
J.S. has received grants from or served on paid advisory boards for Hologic-Genprobe, QIAGEN, and BD Corporation. NB has received grants from or served on paid advisory boards for GlaxoSmithKline and Merck Sharp & Dohme Corp. A.R. has received grants from Merck Sharp & Dohme Corp. K.G., M.G., and L.B. have no conflicts to report.
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Galbraith, K.V., Gilkey, M.B., Smith, J.S. et al. Perceptions of Mailed HPV Self-testing Among Women at Higher Risk for Cervical Cancer. J Community Health 39, 849–856 (2014). https://doi.org/10.1007/s10900-014-9931-x
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DOI: https://doi.org/10.1007/s10900-014-9931-x