Mackay Olivia, Lifford Kate Joanna, Kalra Anahat, Williams Denitza
School of Medicine, Cardiff University, Cardiff, UK.
Division of Population Medicine, Cardiff University, Cardiff, UK.
J Med Screen. 2025 Mar;32(1):2-18. doi: 10.1177/09691413241274312. Epub 2024 Aug 30.
To review the existing evidence to identify the optimum methods for implementing human papillomavirus self-sampling to increase screening uptake for underserved groups.
Specific groups are less likely to participate in cervical screening. These include individuals from low socioeconomic status groups, ethnic minority groups, younger age groups (25-29), older age groups (≥50), with a physical disability, with a learning disability and with an LGBTQ+ identity. The advent of human papillomavirus self-sampling for cervical screening presents an opportunity to promote equitable access to screening. Implementation for human papillomavirus self-sampling can vary, for example, opt-out or opt-in approaches. However, it is unclear which of these is the best method of offering human papillomavirus self-sampling to underserved groups.
Six databases were searched through May 2023. Studies comparing cervico-vaginal human papillomavirus self-sampling provision using different implementation strategies with the standard screening pathway in underserved groups were identified. A narrative synthesis was conducted.
In total, 4574 studies were identified; 25 studies were included, of which 22 were from high-income countries. Greater uptake was found for offering human papillomavirus self-sampling compared to standard clinician-based sampling. Directly mailing human papillomavirus self-sampling kits to participants resulted in higher uptake of screening than using an 'opt-in' approach or standard recall in low socioeconomic status and ethnic minority groups, and older women. Strategies that used community health workers or educational materials increased uptake in ethnic minority and low socioeconomic status groups.
Directly mailing human papillomavirus self-sampling kits to low socioeconomic status groups, ethnic minority groups and older women has the potential to increase uptake of human papillomavirus self-sampling. Using community health workers to offer human papillomavirus self-sampling should be considered for ethnic minority and low socioeconomic status groups. Further research exploring the preferences of younger women is needed.
回顾现有证据，以确定实施人乳头瘤病毒自我采样的最佳方法，从而提高服务不足群体的筛查参与率。
特定群体参与宫颈筛查的可能性较小。这些群体包括社会经济地位较低的群体、少数族裔群体、较年轻年龄组（25 - 29岁）、较年长年龄组（≥50岁）、身体残疾者、有学习障碍者以及具有LGBTQ +身份者。用于宫颈筛查的人乳头瘤病毒自我采样的出现为促进公平获得筛查提供了机会。人乳头瘤病毒自我采样的实施方式可能有所不同，例如，退出式或加入式方法。然而，尚不清楚这些方法中哪种是向服务不足群体提供人乳头瘤病毒自我采样的最佳方法。
检索了截至2023年5月的六个数据库。确定了在服务不足群体中比较使用不同实施策略的宫颈阴道人乳头瘤病毒自我采样与标准筛查途径的研究。进行了叙述性综合分析。
总共识别出4574项研究；纳入了25项研究，其中22项来自高收入国家。与基于临床医生的标准采样相比，提供人乳头瘤病毒自我采样的参与率更高。直接向参与者邮寄人乳头瘤病毒自我采样试剂盒，在社会经济地位较低和少数族裔群体以及老年女性中，筛查参与率高于使用“加入式”方法或标准召回方式。使用社区卫生工作者或教育材料的策略提高了少数族裔和社会经济地位较低群体的参与率。
直接向社会经济地位较低群体、少数族裔群体和老年女性邮寄人乳头瘤病毒自我采样试剂盒有可能提高人乳头瘤病毒自我采样的参与率。对于少数族裔和社会经济地位较低群体，应考虑使用社区卫生工作者来提供人乳头瘤病毒自我采样。需要进一步研究探索年轻女性的偏好。
