HPV Self-Collection Experience in US Hispanic/Latinx Women Using a Device Designed for at-Home Collection
Lisa Memmel, LaShonda Crane, Youri Hwang, Clair Kaplan, Christine Conageski, Sangini S. Sheth, Kimberly Harshberger, Sigrid Williams, Elizabeth Sutton, Colleen McNicholas, Ann Collins, R. Lamar Parker, Jenell Coleman, Lindsay Kuroki, Emeline Aviki, Ronald Orso, Ashley Jennings, Meghna Mukherjee, Megan Burke Fitzpatrick, Karl Hibler, Catherine BehrensBackground
Cervical cancer is a preventable disease, and reaching populations who are under-screened and/or at highest risk is essential to the goal of disease elimination. Hispanic women in the US have a disproportionately higher incidence rate than non-Hispanic women.
Objective
Post hoc analysis of the SELF-CERV study of the unique experience and preferences among Hispanic compared to non-Hispanic participants with the goal of facilitating and improving screening and follow-up in more vulnerable populations.
Methods
Women 25 to 65 years who were enrolled performed self-collection (SC) of vaginal samples for high-risk human papillomavirus (hrHPV) testing using a unique device in a simulated at-home environment. For method comparison, a clinician-collected (CC) sample was obtained. Participants also completed usability and screening preference surveys.
Results
A total of 609 participants were consented and 603 used the SC device. Of the 603 SC users, 115 (19.1%) identified themselves as Hispanic/Latinx. Compared to non-Hispanic women, Hispanic women, had significantly lower annual income (p < .001), a lower percentage of private insurance with more uninsured (p < .001) and lower levels of education (p < .001). There was no significant difference between Hispanic and non-Hispanic women in understanding the purpose of cervical cancer screening. No difference was noted in delaying screening, although English Not Primary speaking Hispanic women were somewhat more likely to delay (p = 0.22). Financial barriers were observed to be more of an impediment to Hispanic women compared to non-Hispanic women (p = 0.016). Negative experiences with in-clinic speculum exams were similar; however, Hispanic women (78%) expressed a significantly higher endorsement of SC than non-Hispanic women (62%), (p = 0.001). Both populations reported that they would be more likely to stay up to date with cervical cancer screening with the at-home SC device, but non-Hispanic women to a significantly lesser degree (p = 0.002). In terms of assessing utility of telemedicine in screening, both populations reported similar engagement in healthcare activities, willingness to try new technology and current use of smartphones. Hispanic and non-Hispanic women were both nearly equally divided as to their preference for in-clinic visits vs telehealth.
Conclusions
Facilitating screening uptake is especially critical for Hispanic women, who bear a disproportionate burden of cervical cancer diagnoses and mortality while facing more obstacles to screening than non-Hispanic women. A clinically validated and accessible at-home SC alternative holds potential for meaningful impact and improved health outcomes within this community.