Uptake and acceptability of human papillomavirus self-sampling in rural and remote aboriginal communities: evaluation of a nurse-led community engagement model

Anne Vail,Nichole Callan,Jo Marjoram,David Hawkes,Tegan Dutton,Jannine Bailey,Laurinne Montgomery,Shellie Burgess,Sunil Jacob,Marion Saville

doi:10.1186/s12913-020-05214-5

Abstract

BackgroundAboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants.MethodsAboriginal women aged 25–69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model.ResultsIn total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n = 46) were never-screened and one-third (n = 69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women tested positive for a high risk type other than HPV 16/18 (HPV other), of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (> 92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them.ConclusionsA community-based service model that respects Aboriginal Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services.

Highlights

Aboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection
Never-screened or under-screened women are at higher risk of cervical cancer than those who regularly participate in screening programs [5,6,7].This recent change to Human Papilloma Virus (HPV) testing and the ability to self-sample provides a unique opportunity to engage these women
Community consultation Marathon Health Primary Health Care Nurses (PHCNs) consulted extensively with local organisations and community members across rural and remote New South Wales, Australia to establish the new service model for HPV self-sampling amongst Aboriginal women, including clinical governance processes

Summary

Introduction

Aboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. To be eligible for selfsampling, a woman must be aged 30 years or over and be overdue for screening by at least two years [1] This change was based on extensive evidence demonstrating that HPV testing is a more sensitive screening test, providing better protection against cervical cancer through detection of HPV before cell changes occur in the cervix [2,3,4]. Never-screened or under-screened women are at higher risk of cervical cancer than those who regularly participate in screening programs [5,6,7].This recent change to HPV testing and the ability to self-sample provides a unique opportunity to engage these women

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Conclusion