Acceptance of SELF-Collected HPV Testing and FOLLOW up for Cervical CANCER SCREENING IN RURAL Appalachia

OBJECTIVE: The purpose of the study was to determine the acceptance of Human Papillomavirus (HPV) self-swab sample collection and follow-up PAP testing of under screened women living in a rural Appalachia Kentucky where incidence and mortality rates from cervical cancer are higher than state and national rates. METHODS: During November 2011, women were recruited from the community and from the patient population of a free medical clinic. Women, ages 30-64, who had not been screened for cervical cancer in three or more years, had never had a positive HPV screen, were given verbal and written instructions for self-collecting a vaginal swab specimen. We used the Hybrid-2 Capture test which tests for the presence of oncogenic HPV. Women were informed of results and referred for PAP according to current screening guidelines. Investigators offered patient navigation assistance, including facilitation of transportation and support at follow-up appointments. Follow-up calls were made to determine if PAP tests were scheduled thereafter. RESULTS: All women who were invited to participate performed the self-collection (N=31, 100% response rate). Of the 31 women, five (16%) tested positive for one or more 15 oncogenic strains of HPV. Scheduling and adherence results to follow-up PAP appointments are pending. CONCLUSION: We found that under screened women in rural Appalachia were accepting of self-collecting vaginal specimens for HPV testing. Self-collection followed by patient navigation may serve as a model for reaching rarely and never screened rural women to avert cervical cancer.