Bromhead, C, Wihongi, H, Sherman, S, Crengle, S, Grant, J, Martin, G, Maxwell, A, McPherson, G, Puloka, A, Reid, S, Scott, N and Bartholomew, K (2021) Human papillomavirus (HPV) self-sampling among never- and under-screened indigenous Māori, Pacific and Asian women in Aotearoa New Zealand: A Feasibility Study. International Journal of Environmental Research and Public Health, 18 (19). ISSN 1660-4601

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In Aotearoa New Zealand the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical-cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30-69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women and 17 on discussion were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were 5 positive results (6%), including 1 participant with HPV18 who was found to have a cervical adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of a cervical adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening.

Item Type: Article
Additional Information: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (
Uncontrolled Keywords: indigenous health research, equity, cervical cancer screening, HPV, self-sampling, Kaupapa Maori Research
Subjects: H Social Sciences > HT Communities. Classes. Races
R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Natural Sciences > School of Psychology
Depositing User: Symplectic
Date Deposited: 23 Sep 2021 11:08
Last Modified: 10 Feb 2022 15:51

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