Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand

Background: Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Mā...

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Autores principales:	Naomi Brewer, Karen Bartholomew, Jane Grant, Anna Maxwell, Georgina McPherson, Helen Wihongi, Collette Bromhead, Nina Scott, Sue Crengle, Sunia Foliaki, Chris Cunningham, Jeroen Douwes, John D. Potter
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Cervical screening Self-sampling HPV DNA testing Indigenous minorities Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/e501bb1ce69b4bbc85f6dfd2a173243f
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spelling	oai:doaj.org-article:e501bb1ce69b4bbc85f6dfd2a173243f2021-12-02T05:04:03ZAcceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand2666-606510.1016/j.lanwpc.2021.100265https://doaj.org/article/e501bb1ce69b4bbc85f6dfd2a173243f2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666606521001747https://doaj.org/toc/2666-6065Background: Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Māori women, as well as Pacific and Asian women. Methods: We invited never- and markedly under-screened (≥5 years overdue) 30-69-year-old Māori, Pacific, and Asian women to participate in an open-label, three-arm, community-based, randomised controlled trial, with a nested sub-study. We aimed to assess whether two specific invitation methods for self-sampling improved screening participation over usual care among the least medically served populations. Women were individually randomised 3:3:1 to: clinic-based self-sampling (CLINIC – invited to take a self-sample at their usual general practice); home-based self-sampling (HOME – mailed a kit and invited to take a self-sample at home); and usual care (USUAL – invited to attend a clinic for collection of a standard cytology sample). Neither participants nor research staff could be blinded to the intervention. In a subset of general practices, women who did not participate within three months of invitation were opportunistically invited to take a self-sample, either next time they attended a clinic or by mail. Findings: We randomised 3,553 women: 1,574 to CLINIC, 1,467 to HOME, and 512 to USUAL. Participation was highest in HOME (14.6% among Māori, 8.8% among Pacific, and 18.5% among Asian) with CLINIC (7.0%, 5.3% and 6.9%, respectively) and USUAL (2.0%, 1.7% and 4.5%, respectively) being lower. In fully adjusted models, participation was statistically significantly more likely in HOME than USUAL: Māori OR=9.7, (95%CI 3.0-31.5); Pacific OR=6.0 (1.8-19.5); and Asian OR=5.1 (2.4-10.9). There were no adverse outcomes reported. After three months, 2,780 non-responding women were invited to participate in a non-randomised, opportunistic, follow-on substudy. After 6 months,192 (6.9%) additional women had taken a self-sample. Interpretation: Using recruitment methods that mimic usual practice, we provide critical evidence that self-sampling increases screening among the groups of women (never and under-screened) who experience the most barriers in Aotearoa New Zealand, although the absolute level of participation through this population approach was modest. Follow-up for most women was routine but a small proportion required intensive support. Trial registration: ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531 Funding: Health Research Council of New Zealand (HRC 16/405) Protocol: http://publichealth.massey.ac.nz/assets/Uploads/Study-protocol-V2.1Self-sampling-for-HPV-screening-a-community-trial.pdfNaomi BrewerKaren BartholomewJane GrantAnna MaxwellGeorgina McPhersonHelen WihongiCollette BromheadNina ScottSue CrengleSunia FoliakiChris CunninghamJeroen DouwesJohn D. PotterElsevierarticleCervical screeningSelf-samplingHPV DNA testingIndigenousminoritiesPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Western Pacific, Vol 16, Iss , Pp 100265- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cervical screening Self-sampling HPV DNA testing Indigenous minorities Public aspects of medicine RA1-1270
spellingShingle	Cervical screening Self-sampling HPV DNA testing Indigenous minorities Public aspects of medicine RA1-1270 Naomi Brewer Karen Bartholomew Jane Grant Anna Maxwell Georgina McPherson Helen Wihongi Collette Bromhead Nina Scott Sue Crengle Sunia Foliaki Chris Cunningham Jeroen Douwes John D. Potter Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand
description	Background: Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Māori women, as well as Pacific and Asian women. Methods: We invited never- and markedly under-screened (≥5 years overdue) 30-69-year-old Māori, Pacific, and Asian women to participate in an open-label, three-arm, community-based, randomised controlled trial, with a nested sub-study. We aimed to assess whether two specific invitation methods for self-sampling improved screening participation over usual care among the least medically served populations. Women were individually randomised 3:3:1 to: clinic-based self-sampling (CLINIC – invited to take a self-sample at their usual general practice); home-based self-sampling (HOME – mailed a kit and invited to take a self-sample at home); and usual care (USUAL – invited to attend a clinic for collection of a standard cytology sample). Neither participants nor research staff could be blinded to the intervention. In a subset of general practices, women who did not participate within three months of invitation were opportunistically invited to take a self-sample, either next time they attended a clinic or by mail. Findings: We randomised 3,553 women: 1,574 to CLINIC, 1,467 to HOME, and 512 to USUAL. Participation was highest in HOME (14.6% among Māori, 8.8% among Pacific, and 18.5% among Asian) with CLINIC (7.0%, 5.3% and 6.9%, respectively) and USUAL (2.0%, 1.7% and 4.5%, respectively) being lower. In fully adjusted models, participation was statistically significantly more likely in HOME than USUAL: Māori OR=9.7, (95%CI 3.0-31.5); Pacific OR=6.0 (1.8-19.5); and Asian OR=5.1 (2.4-10.9). There were no adverse outcomes reported. After three months, 2,780 non-responding women were invited to participate in a non-randomised, opportunistic, follow-on substudy. After 6 months,192 (6.9%) additional women had taken a self-sample. Interpretation: Using recruitment methods that mimic usual practice, we provide critical evidence that self-sampling increases screening among the groups of women (never and under-screened) who experience the most barriers in Aotearoa New Zealand, although the absolute level of participation through this population approach was modest. Follow-up for most women was routine but a small proportion required intensive support. Trial registration: ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531 Funding: Health Research Council of New Zealand (HRC 16/405) Protocol: http://publichealth.massey.ac.nz/assets/Uploads/Study-protocol-V2.1Self-sampling-for-HPV-screening-a-community-trial.pdf
format	article
author	Naomi Brewer Karen Bartholomew Jane Grant Anna Maxwell Georgina McPherson Helen Wihongi Collette Bromhead Nina Scott Sue Crengle Sunia Foliaki Chris Cunningham Jeroen Douwes John D. Potter
author_facet	Naomi Brewer Karen Bartholomew Jane Grant Anna Maxwell Georgina McPherson Helen Wihongi Collette Bromhead Nina Scott Sue Crengle Sunia Foliaki Chris Cunningham Jeroen Douwes John D. Potter
author_sort	Naomi Brewer
title	Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand
title_short	Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand
title_full	Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand
title_fullStr	Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand
title_full_unstemmed	Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand
title_sort	acceptability of human papillomavirus (hpv) self-sampling among never- and under-screened indigenous and other minority women: a randomised three-arm community trial in aotearoa new zealand
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/e501bb1ce69b4bbc85f6dfd2a173243f
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Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand

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