Patient- and Practice-Centered Assessment of Self-Collection

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Failures to screen women for cervical cancer are well documented. The current U.S. screening program fails to reach small pockets of populations living mainly in low-resource, medically underserved regions as part of a complex of diseases linked to poverty and/or racial disparities. These populations have cen/ical cancer rates that are similar to middle-income countries and contribute approximately 60% of the cervical cancer cases that occur annually in the U.S. it is reasonable to suggest that the current cervical cancer prevention program has reached its limits and innovative strategies are needed to overcome these barriers and further reduce the burden in underserved populations. HPV DNA testing offers a promising strategy to enhance cervical screening coverage and address both patient and primary care provider challenges along the care process. HPV DNA testing is highly sensitive (90-95%) for identifying women with cervical precancer and cancer when using a clinician-collected specimen, and 20-50% more sensitive than routine cytology programs. Thus, self-collection combined with HPV DNA testing can potentially be used to extend access to women who are not reached by current Pap-based programs. However, there are only limited, small studies of self-collection in the U.S. and more work is needed to determine whether self-collection is acceptable to diverse patient populations as well as potential barriers toward integration of this approach into primary care settings. This mixed method study is designed to: 1. fully describe the current cervical cancer screening and treatment care continuum, and to assess the translational potential of a promising new approach¿self-collection¿by conducting a three-phase sequential mixed-method translational study (Phase la): 2. involve American Indian and Hispanic women in the co-development of a culturally-appropriate approach to self-collection (Phase lb): 3. integrate practice assessment and patient findings (Aims 1 and 2) in an intervention to assess the feasibility and comparability of self-collection methods for HPV testing and routine cervical cytology with HPV co-testing in four purposefully selected primary care clinical settings: (Phase 2)