Amanda Le

Implementing self-collection for primary human papillomavirus testing: Perspectives on implications for federally qualified health center patient populations

Background: Primary testing for high-risk human papillomavirus (HPV) via self-collection can increase cervical cancer screening rates. In the United States, federally qualified health center (FQHC) patients often have low incomes, lack health insurance, are medically underserved, and are screened less than the national average. Implementation of HPV self-collection can increase cervical cancer screenings among FQHCs. Objectives: To assess the potential impact of implementing HPV self-collection with FQHC patients by considering perspectives of frontline clinical and administrative staff and leadership to identify patient-focused implementation considerations. Design: This qualitative study utilized focus groups and key informant interviews, and transcripts were analyzed using a coding-based thematic analysis. Emergent themes regarding self-collection implementation perspectives were mapped onto Consolidated Framework for Implementation Research constructs to identify potential facilitators and barriers to implementation for FQHC patient populations. Methods: Participants from six FQHCs in North Carolina were identified. Forty-five clinical and administrative staff participated in focus groups. One chief executive officer, senior level administrator, chief medical officer, and clinical data manager from each FQHC ( N  = 24) were interviewed one-on-one. Coding-based thematic analysis was applied to focus group and interview transcripts to uncover emerging themes. Results: Interviewees indicated that HPV self-collection can be advantageous to patients who do not routinely visit the clinic due to socioeconomic and cultural barriers. Programs must consider these barriers and patient literacy to ensure proper self-collection utilization. For example, FQHC patients may benefit from illustrated instructions for proper self-collection procedures. Conclusion: Tailoring an HPV self-collection implementation to FQHC patient populations may be an important strategy for increasing screening.

Self-Collection for HPV Testing: Potential Issues Related to Performance Measures and Quality Improvement Among Federally Qualified Health Centers

Context: Most incident cases of cervical cancer in the United States are attributable to inadequate screening. Federally qualified health centers (FQHCs) serve a large proportion of women who are low-income, have no insurance, and are underserved—risk factors for insufficient cervical cancer screening. FQHCs must maintain quality measures to preserve their accreditation, address financial reimbursements, and provide quality care. Implementation of human papillomavirus (HPV) self-collection can improve cervical cancer screening coverage within FQHCs. Objectives: To understand perspectives from clinical personnel on current cervical cancer screening rates at FQHCs in North Carolina and the impact of implementing HPV self-collection among underscreened patients on screening rates and performance measures. Design: The study used focus groups and key informant interviews. Coding-based thematic analysis was applied to both focus group and interview transcripts. Emergent themes regarding perspectives on self-collection implementation were mapped onto Consolidated Framework for Implementation Research (CFIR) constructs to identify future barriers and facilitators to implementation. Setting: Two FQHCs in North Carolina and a cloud-based videoconferencing platform. Participants: Six FQHCs in North Carolina; 45 clinical and administrative staff from the 6 FQHCs; 1 chief executive officer (n = 6), 1 senior-level administrator (n = 6), 1 chief medical officer (n = 6), and 1 clinical data manager (n = 6) from each FQHC. Main Outcome Measure: Achievement of clinical perspectives. Results: Societal-, practice-, and patient-level factors currently contribute to subpar cervical cancer screening rates. HPV self-collection was expected to improve screening uptake among underscreened women at FQHCs, and thus quality and performance measures, by offering an alternative screening approach for in-clinic or at-home use. Implementation barriers include financial uncertainties and HPV self-collection not yet a Food and Drug Administration–approved test. Conclusion: HPV self-collection has potential to improve cervical cancer screening quality and performance measures of FQHCs. For a successful implementation, multilevel factors that are currently affecting low screening uptake need to be addressed. Furthermore, the financial implications of implementation and approval of HPV self-collection as a test for cervical cancer screening quality measures need to be resolved.