Human papillomavirus vaccination, cervical cancer screening, and acceptability of self-sampling: a cross-sectional study in vulnerable women.

Abstract

The burden of cervical cancer is heterogeneously distributed across regions and population groups, which is likely to reflect inequalities in the access and use of human papillomavirus (HPV) vaccination and cervical cancer screening (CCS). Groups with worse vulnerability indicators are at higher risk. We aimed to describe the awareness, access, and use of HPV vaccination and CCS, as well as the acceptability of self-sampling, in vulnerable population groups. We evaluated 222 women recruited in institutions that support homeless people, drug users, sex workers, Roma communities, migrants, and older women (>50 years old) from low socioeconomic contexts. For data analysis, women pertaining to more than one group were analyzed in each of them, except for the older women group, that only included women not classified in any of the other groups. Most women never heard about the HPV vaccine (60%) and, among those aware, 80% were not vaccinated. The majority heard about CCS (96%) and had been screened at least once (91%), with Roma women presenting the lowest adherence (84%). Most women were screened opportunistically (68%) and were screened at no fixed intervals (34%) or more often than recommended (46%). Regarding self-sampling, 80% considered they would be able to perform it, and 65% of the unscreened women reported they would be more likely to undergo screening based on self-sampling. Most women were not vaccinated against HPV but underwent CCS. Self-sampling was widely perceived as an acceptable option for CCS that could increase adherence in vulnerable groups.