Acceptability and Feasibility of Home-Based Human Papillomavirus Self-Testing as Primary Screening for Cervical Cancer Detection in the State of Alabama.

Abstract

Alabama has the highest cervical cancer mortality and sixth highest incidence rates nationwide. We assessed the acceptability and feasibility of at-home HPV self-testing for cervical cancer screening in Alabama. Eligible women (ages 30-64y, no Pap last 3.5y, not being pregnant, no hysterectomy history, and satisfying either rural residency or being African American) were recruited by community health workers (CHW), foodbanks, churches, and trusted relationships in targeted communities. Participants received a mailed package including an Evalyn® HPV self-test kit (for analysis against high-risk (HR) HPV-16, -18, and -other HR-groups); and a questionnaire seeking information on health literacy, healthcare experience and attitudes about the HPV self-testing. CHWs recruited 86% of participants. Thirty-five (60%) out of 58 consented-to-participate women returned the completed questionnaires and test kits. Half reported having public insurance, a quarter were uninsured. Half had > 5 sex partners. About 40-77% had incorrect answers to HPV knowledge questions. Ten participants (29%) reported having little trust in doctors. Over 90% of the self-collected samples were analyzable. Three samples were positive with HR-16 and -18 (received referral information for follow-up) but either negative or invalid with other HR-groups, and 29 tests were negative for all HR-groups. Almost all participants (94%) were comfortable with receiving test-kits via mail, and most (83%) preferred home- to clinic-based screening. Overall, HPV self-testing was acceptable among women recruited in community setting. Health literacy, medical trust, and the CHW role can be emphasized in future work to promote HPV self-testing to eliminate cervical cancer.