When rural women face barriers to receiving Pap smears and human papilloma virus (HPV) screening, can a program utilizing self-collected samples help? A group of University of Kentucky College of Public Health investigators collaborated with partners in Louisiana to study the of feasibility self-collected vaginal swab testing to screen poor, rural women of color for HPV and associated cancer risk. Results appear in the September 2017 issue of Preventive Medicine Reports.

[Photos: (left to right) Dr. Richard Crosby, Mr. Tom Collins, and Ms. Lindsay Stradtman]

Investigators set out to determine the post-procedure acceptability of self-collecting a vaginal swab for HPV testing among a highly impoverished and geographically isolated population of medically underserved Black women residing in the Mississippi Delta. Further, and to test correlates of reporting that self-collection is preferred over Pap testing. Finally, they aimed to determine the prevalence of any of 13 high-risk HPV types among this population and the correlates of testing positive.

Eighty-eight women were recruited from two churches located in different towns of the Mississippi Delta. After completing a survey, women were provided instructions for self-collecting a cervico-vaginal swab and completing a post-collection survey. Specimens were tested for 13 oncogenic HPV types. Due to the exploratory nature of the study, significance was defined by a 0.15 alpha-level.

Comfort levels with self-collection were high: 78.4 percent indicated a preference for self-collecting a specimen compared to Pap testing. Overall, 24 women (28.7 percent) tested positive for one or more of the 13 HPV types. Significant associations with testing positive were found for women having sex with females, those never having an abnormal Pap, younger women, those with greater fatalism scores, and those having less trust in doctors.

The investigators conclude that rural Black women from the deep-south are generally comfortable self-collecting cervico-vaginal swabs for HPV testing. Given that nearly 30 percent tested positive for oncogenic HPV, and that fatalism as well a lack of trust in doctors predicted prevalence, a reasonable screening alternative to Pap testing may be community-based testing for HPV using self-collected vaginal swabs.

The University of Kentucky authors are Dr. Richard Crosby, endowed professor and principal investigator, core research, Mr. Tom Collins, associate director, and Ms. Lindsay Stradtman. research analyst, all with the Rural Cancer Prevention Center.