Objective

Cytology in combination with high-risk human papilloma virus (HPV) testing is an effective method for cervical cancer screening, but it is resource intensive, creating barriers for vulnerable populations often not screened. The Food and Drug Administration approved HPV testing as an alternative to cytology as a primary screening method for precancerous cervical lesions and cervical cancer. Self-collected, instead of clinician-collected, vaginal HPV swabs are a feasible, cost-effective tool that may facilitate screening for populations often missed because of unstable housing, substance use, incarceration, or resource limitations.

The purpose of this study was to determine the acceptability and accuracy of self-collected vaginal swabs for detecting high-risk HPV among women in temporary residential programs.

Study Design

This cross-sectional study evaluated the accuracy and acceptability of self-collected vaginal swabs to detect high-risk HPV compared with physician-collected cervical swabs and cervical ThinPrep Papanicolaou tests (Hologic, Inc., Marlborough, MA) among women from 3 temporary residential programs. The programs include an emergency shelter for 26 families and 2 22-bed recovery programs at a Boston community health center.

Women were recruited at an educational program on cervical cancer screening from August 2013 to March 2014 and were eligible if they were at least 21 years of age and able to provide informed consent in English.

Each participant received verbal instructions, a pictorial diagram, and private space to collect a vaginal swab. A physician then performed a speculum examination, cervical swabs, and a cervical ThinPrep Papanicolaou test. Swabs were analyzed using the polymerase chain reaction–based Hybrid Capture 2 system (Qiagen, Gaithersburg, MD). Participants were asked to complete a survey to assess perception of the self-swab process.

We estimated 44 women were needed to achieve 80% power to detect a sensitivity of 92% for self-collected compared with physician-collected swabs at a significance level of P = .05. Our institutional review board approved the study; participants provided written informed consent.

Study Design

This cross-sectional study evaluated the accuracy and acceptability of self-collected vaginal swabs to detect high-risk HPV compared with physician-collected cervical swabs and cervical ThinPrep Papanicolaou tests (Hologic, Inc., Marlborough, MA) among women from 3 temporary residential programs. The programs include an emergency shelter for 26 families and 2 22-bed recovery programs at a Boston community health center.

Women were recruited at an educational program on cervical cancer screening from August 2013 to March 2014 and were eligible if they were at least 21 years of age and able to provide informed consent in English.

Each participant received verbal instructions, a pictorial diagram, and private space to collect a vaginal swab. A physician then performed a speculum examination, cervical swabs, and a cervical ThinPrep Papanicolaou test. Swabs were analyzed using the polymerase chain reaction–based Hybrid Capture 2 system (Qiagen, Gaithersburg, MD). Participants were asked to complete a survey to assess perception of the self-swab process.

We estimated 44 women were needed to achieve 80% power to detect a sensitivity of 92% for self-collected compared with physician-collected swabs at a significance level of P = .05. Our institutional review board approved the study; participants provided written informed consent.