The Effect of Mailing HPV Self-sampling Kits to Women Underscreened for Cervical Cancer on Uptake of Preventive Health Services

Abstract

Background Previous studies reported that adults who attended an in-clinic health screening are more likely to attend other preventive services, yet the effect of home-based screening on adherence to other preventive services is unknown. This study examined the effect of receiving or using a high-risk (hr) human papillomavirus (HPV) kit among women who were underscreened for cervical cancer on uptake of breast cancer screening (mammography), colorectal cancer (CRC) screening, influenza vaccination, depression screening, and hemoglobin A1c (HbA1c) testing for monitoring diabetes. Methods This study was a secondary analysis of electronic medical record data from the Home-based Options to Make cervical cancer screening Easy (HOME) trial, a pragmatic randomized controlled trial to examine the effect of mailing hrHPV self-sampling kits among women underscreened for cervical cancer. A total of 16,590 women were randomized to either a mailed hrHPV self-sampling kit intervention or usual care reminders to attend Papanicolaou (Pap) screening. Uptake of each preventive service 12-months post-randomization was assessed between the control and intervention arms using univariate logistic regression models to estimate odds ratios (ORs). Among women randomized to the intervention arm, uptake of each preventive service was also compared across categories of women’s cervical cancer screening behavior (returned a kit, received a Pap, or did nothing) using logistic regression models adjusted for demographic, health, or healthcare utilization covariates that changed OR estimates by 10% or more. Results Preventive services uptake varied by service and ranged from 20.9% for depression screening to 79.9% for HbA1c testing among women who were randomized to the control group, with no significant differences between the intervention vs. control groups for any of the five preventive services. Preventive services uptake was similar in women who returned a kit vs. women who received a Pap test, but higher than in women who did nothing. Among women randomized to receive a mailed kit, the analyses except for HbA1c testing showed a significant difference between women who completed a kit and women who did nothing. Comparisons between kit returners and those who remained underscreened were 55.2% versus 26.6% for mammography (unadjusted OR = 3.39 [95% CI, 2.46 – 4.68]), 58.1% vs 15.1% for CRC screening (OR adjusted for time since last Pap = 7.22 [95% CI, 5.33 – 9.77]), 43.6% vs 29.1% for influenza vaccination (unadjusted OR = 1.91 [95% CI, 1.66 – 2.20]), 24.2% vs 19.1% for depression screening (OR adjusted for time since last Pap = 1.24 [95% CI, 1.05 – 1.46]), and 82.5% vs 74.4% for HbA1c testing (unadjusted OR = 1.62 [95% CI, 0.79 – 3.32]). Conclusions Mailing hrHPV self-sampling kits to women who were underscreened for cervical cancer did not result in a decrease or increase in other preventive health services uptake. In the intervention arm, preventive services uptake was higher in women who received cervical cancer screening by either completing a home-screening kit or attending Pap screening compared with women who did neither. Mailing the kits may have motivated women to engage in preventive care, however, a majority of women remained underscreened for cervical cancer and also had low uptake of other preventive services. Future home screening interventions need to target how to engage hard-to-reach populations in preventive care in general.