Human papillomavirus self-sampling for screening nonattenders: Opt-in pilot implementation with electronic communication platforms

Abstract

In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self‐sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full‐implementation. Moreover, an innovative approach using self‐sampling brushes with unique radio frequency identification chips allowed for unprecedented levels patient identification safety. Nonattenders from the capital region of Denmark were identified via the organized national invitation module. Screening history was obtained via the nationwide pathology registry. Twenty‐four thousand women were invited, and as an alternative to the regular communication platforms (letter and phone), women could request a home test via a mobile‐friendly webpage. Instruction material and video‐animation in several languages were made available online. Chi‐square test was used to test differences. Out of all invited, 31.7% requested a home test, and 20% returned it to the laboratory. In addition, 10% were screened at the physician after receiving the invitation. Stratified by screening history, long‐term unscreened women were less likely to participate than intermittently screened women (28% vs. 16%, p < 0.001). Of all contacts received, 64% (63–65) came via letter, and 31% (95CI: 30–32%) via webpage/mobile‐app. Self‐sampling was well‐accepted among nonattenders. Adopting modern technology‐based platforms into the current organized screening program would serve as a convenient communication method between health authority and citizens, allowing easy access for the citizen and reducing the work load in administrating self‐sampling approaches.

Increasing participation in cervical screening by targeting long‐term nonattenders: Randomized health services study

“…7 Invitations to call a "nurse navigator" or offering a possibility to order HPV self-sampling kits online may be other options. [8][9][10] Such alternative strategies could lead to greater participation in long-term nonattenders, without substantial increases in health care resource use due to the limited size of this group. HPV testing on self-samples has similar accuracy for the detection of cervical precancer as HPV testing on clinician samples if a clinically validated PCR-based HPV assay is used.…”

Human Papillomavirus Research: Where Should We Place Our Bets?

“…Self-sampling based on the dissemination of postal testing kits, which contain swabs for the self-collection of exfoliated vaginal samples, has been introduced in certain settings, including at the programme level [18, 19]. Self-sampling has largely been directed to women who default from regular screening invitations [20, 21].…”

Cervical screening in Denmark – a success followed by stagnation

“…In the Capital Region, a random sample of non-attenders was invited for self-sampling for HPV-testing in 2014/15 [31]. Divided into 24 batches over a period of approximately 1 year, 23,632 women were scheduled for invitation.…”