Cervical screening approach of self-collection, point-of-care HPV testing, and same-day colposcopy among Aboriginal and Torres Strait Islander women in remote Western Australia (the PREVENT Project): an implementation study

Abstract

Background

Aboriginal and Torres Strait Islander women can face substantial cancer screening barriers in remote areas. To support WHO cervical cancer elimination targets, we evaluated a novel screening approach integrating self-collection, point-of-care human papillomavirus (HPV) testing, and same-day specialist assessment for Aboriginal and Torres Strait Islander women in remote Western Australia.

Methods

We developed a screening approach using point-of-care HPV testing on self-collected samples with same-day results and immediate specialist assessment. This implementation study was delivered to six remote Kimberley Aboriginal communities and assessed clinical outcomes and participant satisfaction. The approach was implemented as part of routine outreach gynaecology care between Sept 1 and Dec 31, 2022, with follow-up for cervical test results continuing up to March 31, 2023. Women aged 25–74 years were eligible for this study if they identified as an Aboriginal and/or Torres Strait Islander, were asymptomatic, were due or overdue for cervical screening (or had not had a previous HPV screening test), and were residing in a remote community. The primary objective of this study was to assess whether a point-of-care testing and same-day follow-up approach increased participation in cervical screening among under-screened and never-screened Aboriginal and Torres Strait Islander women in remote Western Australia.

Findings

Of the 844 women identified as eligible, 303 (36%) were directly invited to participate. Within 4 months, 108 women participated in the intervention, a 36% response rate. Among participants, 22 (21%) of 108 tested positive for oncogenic HPV, with 21 (95%) of these completing the same-day colposcopic assessment. No high-grade cervical abnormalities were detected. Participants reported high satisfaction with self-collection rapid results and same-day specialist access, with 107 (99%) indicating a willingness to recommend the approach to others.

Interpretation

We showed the feasibility of integrating portable, same-day cervical screening and follow-up care into remote health-care settings, achieved through successful community engagement and advocacy. These findings offer valuable insights for policy makers and opportunities to increase women's participation in screening programmes, particularly in geographically remote areas.

Funding

Department of Health's Indigenous Australians' Health Programme Emerging Priorities Grant, Australian Gynaecological Cancer Foundation's Cindy Sullivan Fellowship, Mary Jane Foundation, and National Health and Medical Research Council.