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Sherman SM, Brewer N, Bartholomew K, Bromhead C, Crengle S, Cunningham C, Douwes J, Foliaki S, Grant J, Maxwell A, McPherson G, Scott N, Wihongi H, Potter JD. Human papillomavirus self-testing among unscreened and under-screened Māori, Pasifika and Asian women in Aotearoa New Zealand: A preference survey among responders and interviews with clinical-trial nonresponders. Health Expect 2022; 25:2914-2923. [PMID: 36161964 DOI: 10.1111/hex.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Māori, Pasifika and Asian women are less likely to attend cervical screening and Māori and Pasifika women are more likely to be diagnosed with later-stage cervical cancer than other women in Aotearoa New Zealand. This study-with under-screened women taking part in a randomized-controlled trial comparing self-testing and standard screening-explored the acceptability of a human papillomavirus (HPV) self-test kit and the preferred method for receiving it. METHODS Māori, Pasifika and Asian women (N= 376) completed a cross-sectional postal questionnaire. Twenty-six women who had not accepted the trial invitation were interviewed to understand their reasons for nonparticipation. RESULTS Most women found the self-test kit easy and convenient to use and reported that they did not find it painful, uncomfortable or embarrassing. This was reflected in the preference for a self-test over a future smear test on the same grounds. Most women preferred to receive the kit by mail and take the test themselves, rather than having it done by a doctor or nurse. There was a range of preferences relating to how to return the kit. Phone calls with nonresponders revealed that, although most had received the test kit, the reasons for not choosing to be involved included not wanting to, being too busy or forgetting. CONCLUSION HPV self-testing was acceptable for Māori, Pasifika and Asian women in Aotearoa New Zealand. HPV self-testing has considerable potential to reduce the inequities in the current screening programme and should be made available with appropriate delivery options as soon as possible. PATIENT OR PUBLIC CONTRIBUTION This study explored the acceptability of HPV self-testing and their preferences for engaging with it among Māori, Pasifika and Asian women. Thus, women from these underserved communities were the participants and focus of this study.
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Affiliation(s)
| | - Naomi Brewer
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, Aotearoa, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | | | - Nina Scott
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Hei Āhuru Mōwai
| | - Helen Wihongi
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | - John D Potter
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
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Brewer N, Bartholomew K, Grant J, Maxwell A, McPherson G, Wihongi H, Bromhead C, Scott N, Crengle S, Foliaki S, Cunningham C, Douwes J, Potter JD. Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 16:100265. [PMID: 34590066 PMCID: PMC8427317 DOI: 10.1016/j.lanwpc.2021.100265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 08/08/2021] [Indexed: 12/02/2022]
Abstract
Background Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Māori women, as well as Pacific and Asian women. Methods We invited never- and markedly under-screened (≥5 years overdue) 30-69-year-old Māori, Pacific, and Asian women to participate in an open-label, three-arm, community-based, randomised controlled trial, with a nested sub-study. We aimed to assess whether two specific invitation methods for self-sampling improved screening participation over usual care among the least medically served populations. Women were individually randomised 3:3:1 to: clinic-based self-sampling (CLINIC – invited to take a self-sample at their usual general practice); home-based self-sampling (HOME – mailed a kit and invited to take a self-sample at home); and usual care (USUAL – invited to attend a clinic for collection of a standard cytology sample). Neither participants nor research staff could be blinded to the intervention. In a subset of general practices, women who did not participate within three months of invitation were opportunistically invited to take a self-sample, either next time they attended a clinic or by mail. Findings We randomised 3,553 women: 1,574 to CLINIC, 1,467 to HOME, and 512 to USUAL. Participation was highest in HOME (14.6% among Māori, 8.8% among Pacific, and 18.5% among Asian) with CLINIC (7.0%, 5.3% and 6.9%, respectively) and USUAL (2.0%, 1.7% and 4.5%, respectively) being lower. In fully adjusted models, participation was statistically significantly more likely in HOME than USUAL: Māori OR=9.7, (95%CI 3.0-31.5); Pacific OR=6.0 (1.8-19.5); and Asian OR=5.1 (2.4-10.9). There were no adverse outcomes reported. After three months, 2,780 non-responding women were invited to participate in a non-randomised, opportunistic, follow-on substudy. After 6 months,192 (6.9%) additional women had taken a self-sample. Interpretation Using recruitment methods that mimic usual practice, we provide critical evidence that self-sampling increases screening among the groups of women (never and under-screened) who experience the most barriers in Aotearoa New Zealand, although the absolute level of participation through this population approach was modest. Follow-up for most women was routine but a small proportion required intensive support. Trial registration ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531 Funding Health Research Council of New Zealand (HRC 16/405) Protocol http://publichealth.massey.ac.nz/assets/Uploads/Study-protocol-V2.1Self-sampling-for-HPV-screening-a-community-trial.pdf
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Affiliation(s)
- Naomi Brewer
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | | | - Helen Wihongi
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Nina Scott
- University of Auckland, Waikato District Health Board, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - John D Potter
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Bromhead C, Wihongi H, Sherman SM, Crengle S, Grant J, Martin G, Maxwell A, McPherson G, Puloka ‘A, Reid S, Scott N, Bartholomew K. Human Papillomavirus (HPV) Self-Sampling among Never-and Under-Screened Indigenous Māori, Pacific and Asian Women in Aotearoa New Zealand: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910050. [PMID: 34639352 PMCID: PMC8507781 DOI: 10.3390/ijerph181910050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
In Aotearoa, New Zealand, the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30–69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles, and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women, and 17, during the discussion, were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource-intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were five positive results (6%), including one participant with HPV18 who was found to have a cervical Adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of cervical Adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy-relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening.
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Affiliation(s)
- Collette Bromhead
- School of Health Sciences, Massey University, Wellington 6021, New Zealand;
| | - Helen Wihongi
- Ngāti Porou, Ngāpuhi, Te Whānau a Apanui, Ngāti Hine, Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand;
| | | | - Sue Crengle
- Waitaha, Kāti Mamoe and Kāi Tahu, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand;
| | - Jane Grant
- Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand; (J.G.); (A.M.)
| | - Georgina Martin
- Te Rarawa, Te Aupōuri, Ngāpuhi, Wai Research, Te Whānau O Waipareira. Level 1, 6-8 Pioneer Street, Henderson, Waitakere City, Auckland 0605, New Zealand;
| | - Anna Maxwell
- Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand; (J.G.); (A.M.)
| | - Georgina McPherson
- Makea Ngāti Kao, Ngāti Tane, Waitematā District Health Board, Auckland 0740, New Zealand;
| | - ‘Aivi Puloka
- The Fono Health & Social Services, Henderson, Auckland 0612, New Zealand;
| | - Susan Reid
- Te Rarawa, Health Literacy New Zealand Limited, Auckland 1347, New Zealand;
| | - Nina Scott
- Ngāpuhi, Ngāti Whātua, Waikato, Waikato District Health Board, Hamilton 3240, New Zealand;
| | - Karen Bartholomew
- Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand; (J.G.); (A.M.)
- Correspondence:
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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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Brewer N, Bartholomew K, Maxwell A, Grant J, McPherson G, Wihongi H, Bromhead C, Scott N, Crengle S, Cunningham C, Douwes J, Potter JD. Correction to: Comparison of two invitation-based methods for human papillomavirus (HPV) self-sampling with usual care among un- and under-screened Māori, Pacific and Asian women: study protocol for a randomised controlled community trial to examine the effect of self-sampling on participation in cervical-cancer screening. BMC Cancer 2020; 20:163. [PMID: 32106841 PMCID: PMC7047358 DOI: 10.1186/s12885-020-6671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Naomi Brewer
- Centre for Public Health Research, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand.
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | | | - Helen Wihongi
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Nina Scott
- University of Auckland, Waikato District Health Board, Hamilton, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Chris Cunningham
- Research Centre for Māori Health and Development, Massey University, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - John D Potter
- Centre for Public Health Research, Massey University, Wellington, New Zealand
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