Perceptions related to HPV self-testing: Disparities by race and income among under-screened women

Purpose. The ability of human papillomavirus (HPV) self-testing to expand access to cervical cancer screening rests on the test's acceptability to higher-risk women. We sought to assess perceptions related to HPV self-testing in a sample of low-income, under-screened women. Methods. We conducted a telephone survey of at-risk women in North Carolina (n=213) who received HPV self-test kits by mail. Eligibility criteria included not having had a Pap test in over 3 years and reporting at least 1 of 4 indicators of economic hardship, such as being uninsured or Medicaid-eligible. Results. Most respondents were non-Hispanic black (54%) or white (33%), and a majority (86%) reported an annual household income of $20,000 or less. Overall trust in HPV self-testing was high, and most women (98%) agreed the test was safe. A few women (6%) preferred self-testing to Pap testing, but most (75%) had no preference. Trust in or preference for the self-test did not vary by race or income. However, compared to white women, black women had lower HPV-related knowledge (OR=0.47, 95% CI, 2.24-0.91) and perceived lower cervical cancer risk (OR=0.42, 95% CI, 0.22-0.81). On these measures, we found a similar pattern of disparities for women with very low (<$0,000) versus higher incomes. Conclusions. Our findings suggest that, across racial and economic subgroups, HPV self-testing is highly acceptable to low-income, under-screened women. To be successful, programs for HPV self-testing must seek to overcome disparities in knowledge and perceptions related to the test.