Self-Collected Swabs for Primary Human Papilloma Virus (HPV) Screening

Study Overview
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Brief Summary
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In this study, the investigators will assess whether implementing a self-swab protocol for primary Human Papilloma Virus (HPV) testing is an effective method to increase cervical cancer screening in a sample of unscreened women in Hawaii. The findings of this study may support adoption of HPV self swab protocols both at Kalihi Palama Health Center (KPHC) and other Federally Qualified Health Centers (FQHC) in Hawaii.

Detailed Description
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Cervical cancer is the fourth most common cancer worldwide. In the United States, the majority of cervical cancer diagnoses are made in individuals who have not been adequately screened. Cervical cancer prevention relies on adequate screening using one of three methods: pap smear cytology, Human Papilloma Virus (HPV) testing alone, or a combination of these two tests. These screening tests are performed by clinicians comfortable performing a pelvic exam, most commonly a women's health provider. Currently, less than 60% of individuals with an indication for cervical cancer screening in the Kalihi Palama Health Center (KPHC) are up-to-date on their cervical cancer screening test. Even patients who regularly see their primary care provider (PCP) can face major barriers to attending an appointment with a women's health provider. These barriers include practical issues such as inability to take time off, cost concerns, and lack of transportation. Emotional barriers include embarrassment, lack of privacy, and discomfort associated with the test. Self-collected swabs for HPV testing is a proven strategy for populations with low screening rates. Prior studies have demonstrated increased screening rates for transgender men, African American women in the Mississippi Delta, and Women From Appalachian Ohio. Studies also reported patient evaluations of the self-sampling to be comfortable, convenient, and user-friendly; and one study found a majority preference of self-sampling over practitioner-sampling for the next screening. Self-collected samples have also demonstrated good concordance with practitioner-collected cervical samples, as seen in multiple studies. The multiple benefits of self-swabbing without compromising screening accuracy enables the HPV self swab protocol to be an effective alternative for under screened populations. In fact, multiple countries have adopted national guidelines for self-sampled HPV screening for either under screened populations or as primary screening for all women, and more countries are piloting self-sampling to date. In this study, the investigators will assess whether implementing a self-swab protocol for primary HPV testing is an effective method to increase cervical cancer screening in a sample of unscreened women in Hawaii. The findings of this study may support adoption of HSS protocols both at (KPHC) and other Federally Qualified Health Centers (FQHC) in Hawaii.

Official Title
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Self-Collected Swabs for Primary Primary Human Papilloma Virus (HPV) Screening

Conditions
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HPV

Intervention / Treatment
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* Diagnostic Test: Self-swab for genital HPV


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of 25 years or older Have a cervix Have an indication for cervical cancer screening per Accreditation Council for Continuing Medical Education (ASCCP) guidelines Have been previously referred to women's health in the past 5 years or subjects have declined a women's health referral. Subjects must not have been seen in women's health clinic since referral was placed Exclusion Criteria: Subjects unable to consent in one of the following languages: English, Chuukese, or Marshallese Subjects with known history of cervical cancer Subjects that are currently pregnant or within 3 months of giving birth

Ages Eligible for Study
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Minimum Age: 25 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Human Papilloma Virus (HPV) Self swab<br>Enrolled participants will be instructed to perform a self swab for genital Human Papilloma Virus (HPV) infection. Additionally, a short survey will be administered to collect demographic information, evaluate knowledge of HPV/cervical cancer, and assess acceptability of HPV self swab. | Diagnostic Test: Self-swab for genital HPV<br>* Participants will insert a swab in the vagina to collect a sample for HPV testing.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of swabs with result | Percentage of swabs with result | Within 1 week of swab collection | 
| Percentage of participants with abnormal result | Percentage of participants with abnormal result | Within 1 week of swab collection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self reported ease of collecting the swab | Self reported ease of collecting the swab | Immediately after swab is collected | 
| Willingness to collect this swab again in the future | Participants will be asked via written questionnaire: Would you be willing to self collect this swab again in the future? | Immediately after swab is collected | 
| Self reported level of worry concerning collecting self swab | Self reported level of worry concerning collecting self swab | Immediately after swab is collected | 
| Knowledge of HPV | Participants will be asked a true or false question concerning the prevalence of HPV in the United States on a written questionnaire. | Immediately after swab is collected | 
| Knowledge of cervical cancer | Participants will be asked a true or false question concerning the prevalence of cervical cancer in the United States on a written questionnaire. | Immediately after swab is collected | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hpv, self swab, cervical cancer