A systematic review to identify the optimum implementation for HPV self-sampling in underserved communities

Problem

Cervical cancer is the second most diagnosed cancer in individuals with a cervix under 45 years of age in the UK. Cervical screening using Human Papillomavirus (HPV) testing is routinely offered to individuals with a cervix between the ages of 25 and 64 years via the NHS cancer screening programmes. Cervical screening samples are largely collected in primary care settings. Over the last 10 years there has been a steady decline in participation in the cervical screening programme, and it is known that specific groups are even less likely to participate. These include those from low socioeconomic groups, ethnic minority groups, younger age groups, older age groups, those with a physical disability, those with a learning disability and those with an LGBTQ+ group identity.

HPV self-sampling has been identified as a method to increase participation in non-attenders. There are different methods of implementing HPV self-sampling, for example an opt-out, mail-to-all or opt-in approach. However, it is less clear which of these is the best method of offering HPV self-sampling to underserved groups. Indeed, this may vary for the different underserved groups. The aim of this study was to review the existing evidence to identify the optimum method for implementing HPV self-sampling to increase uptake for each of these underserved groups.

Approach

The systematic review is in progress and has been registered to Prospero (CRD42023390276). We searched six databases (Medline, Embase, Scopus, PsycInfo, Web of Science and CINAHL) through January 2023. Studies comparing the efficacy of strategies offering HPV self-sampling with other implementation strategies or the standard screening pathway in an underserved group were identified. Risk of bias was assessed using Cochrane risk of bias 2 tool for RCTs and the “Risk of Bias in Non-randomised studies – of interventions” (ROBINS-I) was used for observational studies. A narrative approach will be used for data synthesis.

Findings

The review is scheduled for completion in May 2023. 1,582 studies were screened at title-abstract level, 95 of these were then screened at full-text. Twenty-one relevant studies have been included to date. Twelve of these are RCTs and 9 are observational studies. Most of the studies are from high-income countries. We will report on the different implementation strategies and their effect on uptake of screening. Preliminary analysis suggests providing the option of HPV self-sampling can increase uptake across all groups. We will also report on studies that examined the acceptability of HPV self-sampling.

Consequences

Results and implications will be discussed at the conference. Several countries have introduced HPV self-sampling as a component of their national cervical screening programmes, and the UK plans to follow suit. The findings from our review will provide evidence on the best way to offer HPV self-sampling for underserved groups to increase participation.