Implementing primary care-based in-clinic HPV self-sampling to increase cervical cancer screening rates
Year: 2025
Type: conference-abstract
Abstract: Context HPV self-testing is FDA approved and can be offered by primary care clinics as a cervical cancer screening option. The Isbaar Project implemented HPV self-testing in 2023 in three primary care clinics, and conducted the first U.S. evaluation of in-clinic HPV self-sampling as a strategy for increasing screening and addressing screening disparities. Objective Assess the effect of implementing HPV self-sampling in primary care clinics on cervical cancer screening uptake, both overall and in Somali-American patients. Study Design and Analysis Hybrid Type 2 effectiveness-implementation study. Setting or Dataset U.S. Midwest urban primary care clinics. Population Studied Patients attending three primary care intervention clinics and 37 control clinics. Intervention/Instrument Intervention components included self-testing instructions; clinical staff training materials; and workflow guidance, referral processes, and results reporting/communication. Outcome Measures We used Kaplan-Meier methods to calculate 12-month screening completion and difference-in-difference Cox proportional hazards regression to compare screening changes 12-months pre-/post-implementation in intervention versus control clinics (overall and restricting to Somali-Americans), adjusting for age, screening history, and social vulnerability index (SVI). Results Intervention (N=5,661) versus control (N=61,577) patients were younger (mean 44.4 versus 47.1 years), more likely to have no prior screening documented (66.5% versus 62.8%), had higher SVI scores (44.1% versus 13.0% in highest quartile), and a higher proportion were Somali-American (34.4% versus 2.3%). Somali-Americans attending intervention versus control clinics also had higher SVI scores (53.5% versus 30.3% in highest quartile). 12-month screening increased overall from 22.0%-34.4% pre-/post-implementation in intervention versus 54.5%-57.2% in control clinics (difference-in-difference adjusted hazard ratio [aHR]:1.39, 95% CI:1.25-1.55), and 17.2%-31.5% pre-/post-implementation in intervention versus 63.6%-66.0% in control clinics in Somali-Americans (difference-in-difference aHR:1.80, 95% CI:1.40-2.32). Conclusions Offering in-clinic HPV self-sampling in primary care increased cervical screening overall and in Somali-Americans.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4415005653