Evidence-Based Approach to Empower Asian American Women in Cervical Cancer Screening

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PROJECT SUMMARY The introduction of the Pap test has led to significant reductions in cervical cancer incidence and mortality in the US. However, screening rates are suboptimal in many Asian American subgroups, and remain persistently lower than rates in non-Hispanic White, non-Hispanic Black, and Hispanic women. Studies report that Korean and Vietnamese American women, in particular, have among the lowest rates of screening compared to other ethnic/racial groups. Multiple factors may contribute to non-screening among Asian American women. Embarrassment, cost, lack of insurance or regular healthcare provider, lack of time, and language difficulties are key barriers to screening in this population. Emerging technologies supporting self-sampling for human papillomavirus (HPV) testing may offer a valuable, evidence-based strategy for empowering Asian American women who have been resistant -- or unable -- to obtain clinic-based cervical cancer screening. National guidelines now include primary HPV screening every 5 years as an appropriate cervical cancer screening strategy. Because HPV self-sampling in non-clinical settings has comparable accuracy to HPV-testing on clinician-obtained samples, self-collection may represent an important strategy for increasing screening rates among underscreened populations. In the United States, the provision of self-sampling kits improved screening rates among women with limited resources and was highly acceptable. Notably, women reported experiencing less embarrassment with self-sampling, and some studies found it improved subsequent participation in clinic- based screening. Although prior studies have demonstrated that HPV self-sampling can be feasibly offered in low-resource community settings, not one study has focused on underserved Asian American women, despite the fact that this population has among the lowest cervical cancer screening rates. Therefore, the goal of the proposed project is to examine HPV self-sampling in a community-based study of 800 Asian American women. Using a matched-pair design, 12 community sites (n=400 women) will receive our previously tested community education program on cervical cancer screening plus navigation, along with HPV self-sampling kits; and 12 community sites (n=400) will receive our previously tested community education program plus navigation to clinic-based screening. The aims of the proposed project are to: (1) Compare rates of providing a self-collected sample vs. obtaining clinic-based screening among 800 Asian American women; (2) Examine mediators of participation; and (3) Assess the relative cost-effectiveness of HPV self-sampling vs. clinic-based screening. Demographics, social/cultural environment, and physical environment factors will be assessed at baseline, post- intervention, and 6-month follow-up. Participation in self-sampling or clinic-based screening will be assessed at 6- month follow-up. The proposed project will be the first large-scale study to evaluate HPV self-sampling among underserved Asian American women. Study findings will inform future evidence-based programs designed to enhance screening participation among Asian American women nationally.