School of Health Sciences, Massey University, Wellington 6021, New Zealand.
Ngāti Porou, Ngāpuhi, Te Whānau a Apanui, Ngāti Hine, Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand.
Int J Environ Res Public Health. 2021 Sep 24;18(19):10050. doi: 10.3390/ijerph181910050.
In Aotearoa, New Zealand, the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30-69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles, and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women, and 17, during the discussion, were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource-intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were five positive results (6%), including one participant with HPV18 who was found to have a cervical Adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of cervical Adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy-relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening.
在新西兰的奥克兰，大多数宫颈癌病例发生在从未接受过筛查或未接受过充分筛查的女性中。毛利族、太平洋岛民和亚裔女性的宫颈癌筛查率最低。人乳头瘤病毒（HPV）自我采样（HPV-SS）已被证明可提高宫颈癌筛查的参与率。需要采取全系统的方法，以最有效的方式提供 HPV-SS，以缩小奥克兰不同女性群体在宫颈癌筛查机会和结果方面的可避免差距。这项 HPV 自我采样的单臂可行性和可接受性研究邀请了从未接受过筛查（≥5 年未接受筛查）且年龄在 30-69 岁之间的奥克兰全科医生的女性参加。通过国家宫颈癌计划（NCSP）登记册和实践数据之间的数据匹配，确定了符合条件的女性。另外还与符合条件的毛利族、亚裔和太平洋岛民妇女举行了焦点小组会议，共同设计新的患者信息材料。向女性提供 HPV 知识和测试后经验的问卷。我们的随访方案包括共同决策原则，我们承诺对检测出 HPV 呈阳性的女性进行≥90%的随访。数据匹配确定了参与实践的 366 名符合条件的从未接受过筛查且年龄在 30-69 岁之间的毛利族、太平洋岛民和亚裔女性。我们只能联系到 114 名女性，在讨论过程中发现有 17 名女性不符合条件。确定和联系需要进行宫颈癌筛查的女性需要大量资源，尽管多次尝试，但仍有很高的无法联系到的比例。我们发现自我采样的最佳吸收率是在焦点小组。在总共 84 次 HPV-SS 测试中，有 5 次阳性结果（6%），其中包括一名 HPV18 阳性的参与者，经阴道镜检查发现患有宫颈腺癌。在我们的可行性研究中，自我采样是可以接受的，并且可以有效地检测 HPV，并预防奥克兰未接受充分筛查的毛利族、太平洋岛民和亚裔女性的宫颈癌。这是奥克兰首次报告 HPV-18 阳性自我样本导致的宫颈腺癌（1B 级）。我们采用健康素养和种族特异性的方法共同设计了新的患者信息材料。这项工作为 NCSP 提供了与实施有效的 HPV 自我采样计划以改善国家宫颈癌筛查公平性相关的政策信息。
