德克萨斯州无家可归者中人类乳头瘤病毒自我采样的实施情况及后续跟进障碍：赋权研究
Implementation of Human Papillomavirus Self-Collection and Barriers to Follow-Up Among Unhoused Individuals in Texas: The EMPOWER Study.
作者信息
Fallah Parisa N, Bowman Paige, Tran Christopher, Chen Virginia, Pippin Monica, Varon Melissa L, Baker Ellen, Milan Jessica, Parker Susan L, Lezama-Sierra Jennifer, Munsell Mark F, Desravines Nerlyne, Lavie Isaac, Batman Samantha, Montealegre Jane, Schmeler Kathleen M, Williams-Brown M Yvette, Salcedo Mila P
机构信息
University of Texas MD Anderson Cancer Center, Houston, and Dell Medical School at the University of Texas at Austin, Austin, Texas.
出版信息
Obstet Gynecol. 2025 Jul 17. doi: 10.1097/AOG.0000000000006003.
OBJECTIVE
Although cervical cancer rates are low in the United States, certain populations experience disproportionate incidence and mortality attributable to inadequate access to screening, diagnosis, or treatment. High-risk human papillomavirus (HPV) self-collection is an effective strategy to increase uptake of cervical cancer screening; however, its effectiveness among unhoused individuals is unknown. The objective of this study was to assess the feasibility of HPV self-collection among unhoused individuals and to identify barriers to follow-up diagnosis and treatment.
METHODS
This is a single-arm feasibility trial. Unhoused individuals aged 25 years or older were prospectively enrolled in Austin, Texas, at community resource centers. They were offered brief education about cervical cancer and the opportunity to screen with high-risk HPV self-collection. Samples were sent to a commercial laboratory for testing. Result notification occurred in person or by telephone. Participants with high-risk HPV-positive results were navigated to follow-up with colposcopy. All participants answered an exit survey.
RESULTS
From May to October 2024, 89 participants were enrolled, of whom 87 collected samples. There were six invalid samples (6.9%), two of which were recollected. Of the 83 valid samples, 21 (25.3%) were positive for high-risk HPV and 62 (74.7%) were negative for high-risk HPV. Only 46 of 87 participants who collected samples (52.9%) received their results despite multiple attempts to contact them. Of the 21 participants with high-risk HPV-positive results, four (19.0%) have undergone colposcopy. There were numerous barriers to follow-up care.
CONCLUSION
Our results suggest that it is feasible to implement high-risk HPV self-collection among unhoused individuals; however, there are significant barriers to follow-up for those who test positive. Although high-risk HPV self-collection may improve cervical cancer screening rates among underscreened populations, follow-up diagnosis and treatment of precancerous lesions are necessary to prevent cervical cancer. Future research is needed to identify strategies to decrease loss to follow-up rates.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT06109870.
目的
尽管美国宫颈癌发病率较低，但某些人群因筛查、诊断或治疗机会不足，其发病率和死亡率不成比例。高危人乳头瘤病毒（HPV）自我采样是提高宫颈癌筛查覆盖率的有效策略；然而，其在无家可归者中的有效性尚不清楚。本研究的目的是评估无家可归者进行HPV自我采样的可行性，并确定后续诊断和治疗的障碍。
方法
这是一项单臂可行性试验。25岁及以上的无家可归者在得克萨斯州奥斯汀的社区资源中心前瞻性入组。他们接受了关于宫颈癌的简短教育，并获得了通过高危HPV自我采样进行筛查的机会。样本被送往商业实验室进行检测。结果通过面对面或电话通知。高危HPV检测结果呈阳性的参与者被引导接受阴道镜检查随访。所有参与者都回答了一份退出调查问卷。
结果
2024年5月至10月，共入组89名参与者，其中87人采集了样本。有6份无效样本（6.9%），其中2份重新采集。在83份有效样本中，21份（25.3%）高危HPV检测呈阳性，62份（74.7%）高危HPV检测呈阴性。尽管多次尝试联系，但87名采集样本的参与者中只有46人（52.9%）收到了结果。在21名高危HPV检测结果呈阳性的参与者中，4人（19.0%）接受了阴道镜检查。后续护理存在诸多障碍。
结论
我们的结果表明，在无家可归者中实施高危HPV自我采样是可行的；然而，检测呈阳性者的后续随访存在重大障碍。尽管高危HPV自我采样可能提高筛查不足人群的宫颈癌筛查率，但对癌前病变进行后续诊断和治疗对于预防宫颈癌是必要的。未来需要开展研究以确定降低失访率的策略。
临床试验注册
ClinicalTrials.gov，NCT06109870。
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