Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet few mail-based HPV self-testing programs have been implemented in the United States. We report the results of a pilot study of a mail-based program, the Health Outcomes through Motivation and Education Project.
In 2015 to 2016, we recruited 103 women from Appalachian Ohio who were aged 30 to 65 years and had not received a Papanicolaou (Pap) test in at least 3 years. Women were mailed an HPV self-test and randomized to receive either (a) self-test instructions developed by the device manufacturer and a standard information brochure about cervical cancer (control group) or (b) self-test instructions developed by the Health Outcomes through Motivation and Education Project and a photo story information brochure about cervical cancer (intervention group). Logistic regression compared study arms on HPV self-test return and receipt of a Pap test.
Overall, 80 (78%) women returned their HPV self-test. Return was similar among the intervention and control groups (78% vs. 77%; odds ratio, 1.09; 95% confidence interval, 0.43–2.76). Among returners, 26% had an oncogenic HPV type detected in their sample. Women who returned their self-test reported high levels of satisfaction and positive experiences with the self-testing process. Few women overall received a Pap test (11%), and Pap testing was similar among the intervention and control groups (14% vs. 8%; odds ratio, 1.91; 95% confidence interval, 0.52–6.97).
Mail-based HPV self-testing programs are a potentially promising strategy for reaching underscreened women in Appalachia. Efforts are needed to better understand how to optimize the success of such programs.
This study found that mail-based human papillomavirus self-testing programs are a potentially promising strategy for reaching underscreened women living in Appalachian Ohio.
From the *College of Public Health and
†Comprehensive Cancer Center, The Ohio State University, Columbus;
‡Valley View Health Centers, Waverly, OH;
§Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA;
¶Division of Global HIV and TB, Center for Global Health, and
∥Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; and
**College of Medicine, The Ohio State University, Columbus, OH
Acknowledgements: The authors thank Mariela Scarbrough and Troy Querec for their contributions to this study.
Conflict of Interest and Sources of Funding: The authors have no conflicts of interest to declare. This study was supported by a research grant from Pelotonia with additional support provided by the National Cancer Institute (P30CA016058; Behavioral Measurement Shared Resource at The Ohio State University Comprehensive Cancer Center).
Trials Registration: The trial is registered at ClinicalTrials.gov: identifier NCT02460237.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Correspondence: Paul L. Reiter, PhD, Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, 1841 Neil Ave, Room 359B, Columbus, OH 43210. E-mail: firstname.lastname@example.org.
Received for publication July 31, 2018, and accepted October 21, 2018.