Racial and Ethnic Differences in Acceptability of Urine and Cervico-Vaginal Sample Self-Collection for HPV-Based Cervical Cancer Screening

J Womens Health (Larchmt). 2020 Jul;29(7):971-979. doi: 10.1089/jwh.2019.8132. Epub 2020 Mar 26.

Abstract

Background: We compared women's acceptability of urine and cervico-vaginal sample self-collection for high-risk (oncogenic) human papillomavirus (hrHPV) testing and assessed whether acceptability varied across racial/ethnic groups. Methods: As part of a test accuracy study of urine-based hrHPV testing, we recruited a convenience sample of women 25-65 years of age at two colposcopy clinics in North Carolina between November 2016 and January 2019. After self-collection of urine and cervico-vaginal samples, women completed a questionnaire on the acceptability of the sample collection methods. We coded open-ended questions inductively. All results are presented stratified by racial/ethnic group. Results: We included 410 women (119 Hispanic, 115 non-Hispanic Black, 154 non-Hispanic White, and 22 women with other racial identities). Most women (79%, 95% confidence interval [CI] = 76%-83%) had positive feelings about urine-based hrHPV testing. Women generally preferred urine (78%, 95% CI = 74%-82%) over cervico-vaginal self-collection (18%, 95% CI = 14%-22%), but the degree differed by racial/ethnic group, increasing from 75% in non-Hispanic Black to 82% in Hispanic women (p = 0.011). Most women reported at least one positive aspect of urine (89%) and cervico-vaginal self-collection (85%) for hrHPV testing with the most common positive aspect being easy sample collection, although 16% of women were concerned about performing the cervico-vaginal self-collection correctly. Conclusions: Self-collection for hrHPV-based cervical cancer screening is highly acceptable to women across different racial/ethnic groups in the United States, and most women in our study would be more likely to attend future cervical cancer screening appointments if screening were urine based. Urine-based hrHPV testing is a promising approach to improve cervical cancer screening coverage.

Keywords: HPV testing; acceptability; cervical cancer screening; self-collection; urine.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Colposcopy
  • Early Detection of Cancer / methods
  • Female
  • Humans
  • Mass Screening / methods
  • Middle Aged
  • North Carolina
  • Papillomaviridae / genetics
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Infections / urine
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Preference / ethnology*
  • Predictive Value of Tests
  • Reproducibility of Results
  • Self-Examination / methods
  • Specimen Handling / methods*
  • Surveys and Questionnaires
  • Urinalysis / methods*
  • Uterine Cervical Dysplasia / diagnosis
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / prevention & control*
  • Vagina / pathology
  • Vagina / virology*
  • Vaginal Smears / methods*