self-collection for hpv testing to improve cervical cancer prevention (ship) trial (lmi-001-a-s01)

Conditions: Cervical Carcinoma; Human Papillomavirus Infection

Summary: this clinical trial evaluates the use of self-collected vaginal samples for human papillomavirus (hpv) testing in patients referred for a colposcopy and/or cervical excisional procedures to improve cervical cancer prevention. hpv is a common virus which usually causes infections that last only a few months, but sometimes can last longer. it is known to cause a variety of cancers including cancer of the cervix. even though there are ways to detect cervical cancer early, many individuals do not undergo screening that involves pelvic exams. over half of all new cervical cancer cases are among those who have either never been screened or who are not screened enough. without appropriate screening and care, preventable pre-cancers may turn into cancer. a new way to detect cervical cancer is to have individuals collect their own vaginal sample for hpv testing to know their risk for cervical cancer. this may give individuals more flexibility and comfort having the ability to collect samples themselves, compared to a doctor performing a speculum examination and collecting the samples in a clinic. this study compares clinical accuracy of hpv testing on self-collected vaginal samples versus cervical samples collected by clinician. the self-collection for hpv testing to improve cervical cancer prevention (ship) trial is part of the national cancer institute (nci)'s cervical cancer 'last mile' initiative, a public private partnership that seeks to increase access to cervical cancer screening. the ship trial focuses on developing clinical evidence to inform the us food and drug administration (fda)'s regulatory reviews of self-collection approaches as alternative sample collection approaches for cervical cancer screening. several industry partner-specific self-collection device and assay combinations will be non-competitively and independently evaluated with a similar study design framework to inform pre-approval and/or post-approval regulatory requirements.

primary objective: i. to evaluate clinical accuracy (including clinical sensitivity, clinical specificity, false positive rate, and false negative rate) for the detection of cervical precancer/cancer and agreement/concordance (including positive percent agreement and negative percent agreement) on self-collected (sc) versus clinician collected (cc) samples for the following hpv genotype detections and groupings by becton, dickinson and company (bd) onclarity (trademark) hpv assay: any high risk (hr) hpv genotype, hpv16, hpv18, hpv31, hpv45, hpv51, hpv52, hpv33/58, hpv35/39/68, hpv56/59/66. exploratory objective: i. to evaluate human factors affecting usability, acceptability, and preferences for self-collection. objective for pilot phase: i. the emphasis in the pilot phase of the study will be on streamlining and refining study procedures and clinical and operational workflows. outline: patients undergo self-collection of two vaginal samples and then undergo clinician-collection of a cervical test sample. patients then undergo standard of care colposcopy with biopsy/endocervical curettage and/or cervical excisional procedures as clinically indicated. after completion of study intervention (one time), laboratory results available within 90 days are collected for study analysis purposes.

Eligibility criteria:
inclusion criteria: * willingness and ability to provide a documented informed consent * is 25 years or older * has an intact cervix * has had a referral for colposcopy and/or cervical excisional procedure in which routine cervical cancer screening has included hpv testing (hpv primary screening, co-testing, or atypical squamous cells of undetermined significance \[asc-us\] cytology triage) or abnormal cytology performed within the past 12 months preceding the referral visit * willing and able to undergo colposcopy, and if clinically indicated for soc purposes, a biopsy, endocervical curettage, and/or a cervical excisional procedure, as applicable exclusion criteria: * is pregnant when presenting for the referral visit or gave birth within the past 3 months * has a known history of excisional or ablative therapy to the cervix (e.g., loop electrosurgical excision procedure \[leep\], cone biopsy, cervical laser surgery, cryotherapy, thermal ablation) in the last 12 months prior to the referral visit * has had a complete or partial hysterectomy, either supracervical or involving removal of the cervix, via self-report or confirmation via medical records * known medical conditions that, in the opinion of the investigator, preclude study participation * previous participation in the ship trial. participation is defined as completing the self-collection * is experiencing unusual bleeding or pelvic pain