Researchers examined the effectiveness of opt-in and direct-mail strategies for offering self-sampling kits of human papillomavirus (HPV) to populations based on cervical cancer screening history.
Study
In the present study, researchers evaluated the efficacy of opt-in and direct-mail strategies for offering HPV self-sampling kits. The team used electronic health records from the Kaiser-Permanente Washington (KPWA) care system to identify individuals who were due (for screening in ≤ three months) or overdue (Papanicolaou testing > 3.25 years or co-testing > 5.25 years) or had an unknown screening history (no recorded history).
Inclusion criteria were age 30–64, female sex, intact cervix, KPWA insurance, having a primary care clinician, and being due or overdue for screening. The team stratified eligible subjects by screening history and randomized them into education, usual care, opt-in, or direct-mail groups. The usual care group did not receive study-related interventions or contact.
The education group received the usual care and educational materials to motivate them for screening. The direct-mail group received usual care and HPV self-sampling kits. The opt-in group received the same intervention as the direct-mail group, except that participants had to request a self-sampling kit. The kits contained dry testing swabs and patient specimen labels.
Samples were tested, and results were documented and reported per usual care. Test results that required follow-up were routed to the primary care clinician and a centralized licensed nurse. The nurse monitored adherence through follow-up visit completion (in-clinic colposcopy for individuals positive for HPV-16 or HPV-18 or reflex Papanicolaou testing for those positive for other high-risk HPVs).
The primary outcome of the study was screening completion within six months after randomization. Secondary outcomes included incremental cost-effectiveness ratios, screening initiation, time from randomization to screening completion, and completion of recommended follow-up after positive test results.
Results
The team randomized 31,355 individuals with an average age of 45.9 years. Most participants who were due (73.4%) or overdue (73.6%) for screening or had an unknown screening history (64.2%) were White. Baseline characteristics were similar across study groups. Most individuals completed the six-month follow-up.
Among participants due for screening, 61.7% in the direct-mail group and 51.1% in the opt-in group completed screening, compared to 47.6% in the education group. Further, among overdue participants, 35.7% in the direct-mail group completed screening compared to 18.8% in the education group. Among participants with an unknown screening history, 18% in the opt-in group completed screening compared to 15.9% in the education group.
The time to screening completion was shorter for opt-in and direct-mail groups than for the education group. It was also shorter for participants who returned HPV kits. About 9% of those who returned kits required follow-up (in-clinic reflex Papanicolaou testing or colposcopy). There were no unexpected adverse events. However, expected adverse events (vaginal pain and dysuria) were reported as mild discomfort.
Conclusion
In sum, directly mailing HPV self-sampling kits resulted in more than 14% higher screening among participants who were due or overdue for cervical cancer screening than education alone. By contrast, the opt-in strategy minimally increased screening. The direct-mail group also had a shorter time to screening completion.
Notably, the absolute difference in screening completion between direct-mail and education groups was nearly 17% among overdue individuals. Overall, the findings suggest prioritizing the direct-mail approach for those who are due or overdue for cervical cancer screening. For people with an unknown screening history, exploring alternative outreach strategies is required.
Source:
https://www.news-medical.net/news/20231128/HPV-self-sampling-kits-via-direct-mail-boost-cervical-cancer-screening-rates-study-finds.aspx