Rural community health center partnerships to develop and implement process for HPV self-collection and follow-up among women overdue for cervical cancer screening

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ABSTRACT In 2021, Huntsman Cancer Institute (HCI) formalized our long-standing service to the entire 5-state Mountain West (MW). Three of the five states: Idaho, Nevada, and Utah, all ranked among the top five fastest growing states in the 2020 U.S. Census. At the same time, the area we serve is notable for its vast frontier areas. Of the 169 counties in the Mountain West, 104 are frontier (< 7 people per square mile), covering 74% of the landmass and an additional 54 classify as rural (< 100 people per square mile). Combined, the frontier and rural counties account for 97% of the landmass. Over 10% of the Mountain West population lives in frontier counties and over 40% lives in frontier and rural counties combined. These populations experience disparities due primarily to distance to care. HCI is committed to overcome distance as a disparity by ensuring frontier and rural patients have equal access to excellent care and prevention services, regardless of location. Cervical cancer incidence rates are higher in rural Utah (compared to urban Utah) and 5-year relative survival rates are lower among rural cervical cancer patients than among urban patients. Furthermore, Utah ranks as one of the lowest states in the nation for cervical cancer screening with rural communities demonstrating the lowest rates. This study pilot tests a mail-delivered HPV self-collection program for rural Utah women (N=900). This study aims to develop a rural community health center delivered home-based human papillomavirus (HPV) self- collection outreach program for women overdue for cervical cancer screening and a follow-up program for women with HPV screen-positive results. Specifically, we will launch an HPV self-collection program to women overdue for cervical cancer screening, revise related illustrated video- and print-delivered instructions in English and Spanish on how to complete the test, and develop an effective follow-up approach for HPV screen-positive patients. Through surveys, we will assess barriers for why patients do not return the HPV self- collection kits and why HPV screen-positive women do not receive follow-up care. We will also assess the organizational, provider, and clinic staff level factors at rural community health centers that facilitate the implementation, assessment and follow-up for the pilot HPV self-collection program. These clinic-level assessments will be completed through work-flow analyses, surveys, and semi-structured interviews. Findings from this study will be used to develop a mail-delivered HPV self-collection protocol for rural community health centers that can be adapted and replicated in other rural community health center settings.