Mira L. Katz

A Mail-Based HPV Self-Collection Program to Increase Cervical Cancer Screening in Appalachia: Results of a Group Randomized Trial

Abstract Background: Despite the promise of mail-based human papillomavirus (HPV) self-collection programs for increasing cervical cancer screening, few have been evaluated in the United States. We report the results of a mail-based HPV self-collection program for underscreened women living in Appalachia. Methods: We conducted a group randomized trial from 2021 to 2022 in the Appalachian regions of Kentucky, Ohio, Virginia, and West Virgnia. Participants were women of ages 30 to 64 years who were underscreened for cervical cancer and from a participating health system. Participants in the intervention group (n = 464) were mailed an HPV self-collection kit followed by telephone-based patient navigation (if needed), and participants in the usual care group (n = 338) were mailed a reminder letter to get a clinic-based cervical cancer screening test. Generalized linear mixed models compared cervical cancer screening between the study groups. Results: Overall, 14.9% of participants in the intervention group and 5.0% of participants in the usual care group were screened for cervical cancer. The mail-based HPV self-collection intervention increased cervical cancer screening compared with the usual care group (OR, 3.30; 95% confidence interval, 1.90–5.72; P = 0.005). One or more high-risk HPV types were detected in 10.5% of the returned HPV self-collection kits. Among the participants in the intervention group whom patient navigators attempted to contact, 44.2% were successfully reached. Conclusions: HPV self-collection increased cervical cancer screening, and future efforts are needed to determine how to optimize such programs, including the delivery of patient navigation services. Impact: Mail-based HPV self-collection programs are a viable strategy for increasing cervical cancer screening among underscreened women living in Appalachia.

A Randomized Control Trial of Two Interventions Compared with Usual Care for Increasing Cervical Cancer Screening among Women Living in the Rural Midwest

Abstract Background: Lower cervical cancer screening rates are associated with higher cervical cancer mortality among women living in rural compared with urban areas (defined by rural–urban community codes). The study purpose was to examine the effectiveness of a mailed digital video disc (DVD) versus DVD plus patient navigation (PN) versus usual care (UC) on increasing the percentage of rural women up to date (UTD) with cervical cancer screening guidelines. Methods: Rural women (ages 50–74 years) who were not UTD for cervical cancer screening (n = 553) were consented and randomized 2:2:1 (DVD, DVD + PN, and UC, respectively). Baseline and 12-month surveys included sociodemographic characteristics, history of previous cervical cancer screening, and cervical cancer screening knowledge and beliefs. Screening status was assessed by medical record review at baseline and 12 months after randomization. Results: The mean age of participants was 59.8 years. After controlling for covariates, women randomized to the DVD + PN group had greater odds [OR = 5.01; 95% confidence interval (CI), 2.38–11.50] of being UTD with cervical cancer screening compared with UC at 12 months after randomization. Other significant covariates in the model included having a college versus high school or lower education (OR = 2.36; 95% CI, 1.08–5.63), private (OR = 4.16; 95% CI, 1.28–19.1) or no insurance (OR = 8.74; 95% CI, 1.77–51.9) versus public insurance, normal (OR = 3.25; 95% CI, 1.46–7.24) or overweight (OR = 2.15; 95% CI, 1.05–4.42) versus obese body mass index, and positive screening intention in the next six months (OR = 2.59; 95% CI, 1.48–4.52). Conclusions: A DVD + PN intervention increased the percentage of rural women UTD with cervical cancer screening compared with UC or DVD only. Impact: Women who have a high school or lower education, were on public insurance, obese, and not planning to be screened need increased attention to become UTD with cervical cancer screening.