Implementation of self-collected cervical screening in an under-screened, culturally and linguistically diverse antenatal population: a quality improvement study.

Abstract

Eliminating cervical cancer requires high screening participation levels. Pregnancy is an opportunity to reach under-screened women, but clinician-collected speculum examination is a barrier to uptake. Patient self-collected cervical screening tests (SC-CST) using a vaginal swab for detection of human papillomavirus (HPV) may offer a solution. The objective of this study was to evaluate the outcomes and implementation of a comprehensive programme embedding SC-CST into antenatal care.This is a prospective quality improvement study in a tertiary hospital servicing a population with one of the lowest cervical screening rates nationally. Pregnant women attending public maternity care and eligible for screening under national guidelines were included. Screening histories were obtained from the national registry to identify screen-overdue or never-screened women for SC-CST offer. Staff education and patient information encouraged participation. Test packs facilitated specimen collection. Referral pathways were created for abnormal results. Main outcome measures include reach, effectiveness, implementation and maintenance of quality improvement.From 19 February 2024 to 31 July 2025, 48.0% (2492/5190) of eligible pregnant women required a CST, 69.7% were offered SC-CST and 93.7% accepted. Cervical screening rates increased 22-fold from 3.0% prior to the programme to 65.3%. Parous women were offered SC-CST at lower rates than nulliparous women (66.5% vs 74.1%; p=0.024). Women residing in the lowest socioeconomic quintile had lower acceptance rates (91.9% vs 94.8%; p=0.024). Being overseas-born and need for interpreter were not barriers to SC-CST offer or acceptance rates. Results were high risk HPV-negative in 88.1%, HPV 16/18 positive in 1.9%, HPV non-16/18 positive in 9.1% and invalid in 0.9%. Colposcopy was performed for 41 women, with 7 cases of biopsy-confirmed high-grade squamous intraepithelial lesion requiring treatment.Introduction of SC-CST into antenatal care is an effective strategy to improve cervical screening rates and was highly acceptable to pregnant women. Programme sustainability requires additional resources, staff engagement, and timely follow-up.