Implementation of Human Papillomavirus Self-Collection and Barriers to Follow-Up Among Unhoused Individuals in Texas: The EMPOWER Study.

OBJECTIVE Although cervical cancer rates are low in the United States, certain populations experience disproportionate incidence and mortality attributable to inadequate access to screening, diagnosis, or treatment. High-risk human papillomavirus (HPV) self-collection is an effective strategy to increase uptake of cervical cancer screening; however, its effectiveness among unhoused individuals is unknown. The objective of this study was to assess the feasibility of HPV self-collection among unhoused individuals and to identify barriers to follow-up diagnosis and treatment. METHODS This is a single-arm feasibility trial. Unhoused individuals aged 25 years or older were prospectively enrolled in Austin, Texas, at community resource centers. They were offered brief education about cervical cancer and the opportunity to screen with high-risk HPV self-collection. Samples were sent to a commercial laboratory for testing. Result notification occurred in person or by telephone. Participants with high-risk HPV-positive results were navigated to follow-up with colposcopy. All participants answered an exit survey. RESULTS From May to October 2024, 89 participants were enrolled, of whom 87 collected samples. There were six invalid samples (6.9%), two of which were recollected. Of the 83 valid samples, 21 (25.3%) were positive for high-risk HPV and 62 (74.7%) were negative for high-risk HPV. Only 46 of 87 participants who collected samples (52.9%) received their results despite multiple attempts to contact them. Of the 21 participants with high-risk HPV-positive results, four (19.0%) have undergone colposcopy. There were numerous barriers to follow-up care. CONCLUSION Our results suggest that it is feasible to implement high-risk HPV self-collection among unhoused individuals; however, there are significant barriers to follow-up for those who test positive. Although high-risk HPV self-collection may improve cervical cancer screening rates among underscreened populations, follow-up diagnosis and treatment of precancerous lesions are necessary to prevent cervical cancer. Future research is needed to identify strategies to decrease loss to follow-up rates. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT06109870.