Mailed HPV self-sampling with Pap smear referral among high-risk women: The My Body, My Test Study

Background: The United States has over 4,000 cervical cancer deaths annually, of which an estimated 50% are attributable to insufficient screening. Home-based screening for high-risk HPV infection is a promising but untested approach to increase screening in hard-to-reach populations.

Objective: Test the feasibility and acceptability of a mailed self-collection HPV test among women not recently screened for cervical cancer.

Methods: Eligible criteria were no Pap test in ≥4 years, ages 30-65, not pregnant, no prior hysterectomy, and income ≤250% of poverty. Recruitment occurred in North Carolina through flyers, agency outreach, and referrals from 211 social assistance helplines. We asked participants to self-collect cervico-vaginal samples at home, return specimens by mail, receive HPV results by telephone, visit a clinic for Pap screening, and complete two surveys. Samples were collected using a Rovers brush, preserved in Scope mouthwash, and tested for high-risk HPV infection using Hybrid-Capture II.

Results: Of 945 women screened via study hotline, 500(53%) were eligible, of whom 339 returned samples (68% participation). Of 294 participants who completed post-test surveys, many were Black(61%), uninsured(64%), or very low income(84%). Respondents reported high satisfaction with the self-collection experience, citing convenience, privacy, and ease of use. Of returned samples, 95% were adequate, of which 16% were HPV positive. We will present findings from ongoing Pap smear follow-up and survey analysis.

Conclusions: Outreach among hard-to-reach, under-screened women indicates that home self-sampling is feasible and well-accepted. This study is the first we know of on mailed HPV screening among high-risk women in the United States.