Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil

Abstract

Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the 2 among 483 unscreened/underscreened women in Brazil. Three public Basic Health Units (BHU) were each randomly assigned to three arms: (i) Pap testing at the BHU (N = 160), (ii) "Self&HPV" (self-collection for HPV testing) (N = 161), and (iii) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N = 162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHW) at participants' home. With the first invitation, 60.0% in the Pap arm, 95.1% [154 of 161 (95.7%) who selected Self&HPV and 0 of 1 (0.0%) who selected Pap] in the Choice arm, and 100% in the Self&HPV arm completed screening. By the second invitation to choose a method of screening in the Choice arm, 100% completed screening. After three invitations, 75.0% of women in the Pap arm completed screening. Adherence to screening differed by study arm (P < 0.001). In conclusion, Self&HPV testing is a promising strategy for unscreened/underscreened women who are recalcitrant or unable to undergo clinic-based cervical screening to complement the screening modality used in the general population. In Brazil, where Pap testing is recommended for routine cervical screening, training CHWs in behavior change strategies and offering Self&HPV or Choice could greatly improve screening population coverage by reaching the unscreened/underscreened populations.

Trial registration: ClinicalTrials.gov NCT03713697.

Conflict of interest statement

Disclosures/Conflicts of Interests:

Dr. Castle has received HPV tests and assays for research at a reduced or no cost from Roche, Cepheid, Becton Dickinson, and Arbor Vita Corporation. The other authors do not have competing interests.

©2019 American Association for Cancer Research.

Figures

Figure 1.

Consort diagrams for the three cervical screening arms of the trial, Pap, Choice (of Pap or self-collection & high-risk human papillomavirus [HPV] testing [Self&HPV]), or Self&HPV.

Figure 2.

High-risk human papillomavirus (HPV) prevalence, with 95% confidence intervals shown as bars, stratified by age group and for all women who underwent self-collection and high-risk HPV testing (Self&HPV) in the Choice or Self&HPV Arm.