Department of Public Health Leadership, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill.
Prev Chronic Dis. 2023 Oct 19;20:E93. doi: 10.5888/pcd20.230056.
Primary testing for high-risk human papillomavirus (HPV) by self-collection could result in higher rates of cervical cancer screening. Federally qualified health centers (FQHCs) in the US serve a large proportion of women who have low income and no health insurance and are medically underserved - risk factors for being insufficiently screened for cervical cancer. Although the implementation of self-collection for HPV testing is not yet widespread, health care entities need to prepare for its eventual approval by the US Food and Drug Administration. We conducted focus groups and interviews among clinical and administrative staff and leadership to gather data on key logistical concerns that must be addressed before implementing self-collection for HPV testing in FQHCs.
We identified focus group and interview participants from 6 FQHCs in North Carolina. We conducted focus groups with clinical and administrative staff (N = 45) and semistructured interviews with chief executive officers, senior-level administrators, chief medical officers, and clinical data managers (N = 24). Transcripts were coded by using codebooks derived from research questions and notes taken during data collection. Themes emerged on implementation of self-collection for HPV testing. We applied the constructs from the Consolidated Framework for Implementation Research (CFIR) to themes to identify domains of potential barriers and facilitators to implementation.
Clinical personnel reported that offering self-collection for HPV testing is acceptable and feasible and can increase cervical cancer screening rates. Uncertainties emerged about accuracy of results, workflow disruptions, financial implications, and effects on clinic quality measures.
Implementing self-collection for HPV testing was considered feasible and acceptable by participants. However, important health service delivery considerations, including financial implications, must be addressed before integrating self-collection for HPV testing into the standard of care.
通过自我采集进行高危型人乳头瘤病毒（HPV）的初步检测，可能会提高宫颈癌筛查率。美国的联邦合格医疗中心（FQHC）为大量收入低、没有医疗保险和医疗服务不足的女性提供服务 - 这些都是宫颈癌筛查不足的风险因素。虽然自我采集 HPV 检测的实施尚未普及，但医疗保健实体需要为美国食品和药物管理局最终批准做好准备。我们对临床和行政人员以及领导层进行了焦点小组讨论和访谈，以收集在 FQHC 实施自我采集 HPV 检测之前必须解决的关键后勤问题的数据。
我们从北卡罗来纳州的 6 家 FQHC 中确定了焦点小组和访谈参与者。我们对临床和行政人员进行了焦点小组讨论（N = 45），对首席执行官、高级管理人员、首席医疗官和临床数据经理进行了半结构化访谈（N = 24）。使用源自研究问题和数据收集期间记录的笔记的代码簿对转录本进行编码。主题出现在 HPV 自我采集检测的实施上。我们应用实施研究综合框架（CFIR）的构建模块来确定实施的潜在障碍和促进因素领域。
临床人员报告称，提供 HPV 自我采集检测是可以接受且可行的，并且可以提高宫颈癌筛查率。对结果的准确性、工作流程中断、财务影响以及对诊所质量措施的影响存在不确定性。
参与者认为实施 HPV 自我采集检测是可行且可接受的。然而，在将 HPV 自我采集检测纳入常规护理之前，必须解决重要的医疗服务提供问题，包括财务影响。
