Health Care Personnel’s Perspectives on Human Papillomavirus (HPV) Self-Sampling for Cervical Cancer Screening:    A Pre-Implementation, Qualitative Study

Abstract

Background: Persistent infection with high-risk human papillomavirus (hrHPV) types are well-documented causes of cervical cancer. Since the implementation of cervical cancer screening methods (e.g., Pap tests), cervical cancer rates have declined. However, Pap tests are still unacceptable to many women and require complex infrastructure and training. Self-sampling techniques for collecting HPV specimens (or “HPV self-sampling”) have been proposed as a possible alternative to overcome these barriers. The objective of this study was to understand various health care personnel’s perspectives on the potential implementation of an HPV self-sampling practice in US primary care settings. Methods: Between May – July 2021, a study invitation was emailed to various health care professional networks across the Midwest, including a snowball sampling of these networks. Eligible participants were invited to a 45-60 minute Zoom-recorded interview session and asked to complete a pre-interview survey. The survey collected sociodemographics on age, occupation, level of educational attainment, race/ethnicity, gender, and an awareness of HPV self-sampling. The semi-structured interview was guided by the Consolidated Framework for Implementation Research and asked participants about their views on HPV self-sampling and its potential implementation. All interviews were audio-recorded, transcribed, and analyzed using NVivo 12. Results: Key informant interviews were conducted with thirty health care professionals - 13 health care providers, 6 clinic staff, and 11 health care leaders - from various health care systems. Most participants had not heard of HPV self-sampling but reported a general enthusiasm for wanting to implement it as an alternative cervical cancer screening tool. Possible barriers to implementation were knowledge of clinical evidence and ease of integration into existing clinic workflows. Potential facilitators included previous adoption of similar self-sampling tools (e.g., stool-based testing kits) and key decision-makers.Conclusion: Although support for HPV self-sampling is growing, its intervention’s characteristics (e.g., advantages, adaptability) and the evidence of its clinical efficacy and feasibility needs to be better disseminated across US primary care settings and its potential adopters. Future research is also needed to support the integration of HPV self-sampling within various delivery modalities (mail-based vs. clinic-based).