Opportunistic offer of human papillomavirus (HPV) self-testing in ethnically diverse primary care clinics in Aotearoa New Zealand: an implementation study

Background

Human papillomavirus (HPV) self-testing was introduced in Aotearoa New Zealand in September 2023, with the potential to improve screening access and reduce inequities for priority populations: Māori, Pacific, and those overdue for screening by ≥2 years (underscreened). To contribute towards informing this change, we tested the implementation of offering the self-test opportunistically in primary care (with a take-home option) with follow-up by a central nursing team.

Methods

Trained general practice clinicians offered HPV self-tests to eligible people aged 30-69 years who attended for any reason between November 2021 and September 2023. Six clinics were selected for high proportions of priority populations. The central team reminded participants to return samples (if tested at home), and notified and managed HPV results via telehealth.

Results

Of 9,292 potentially eligible people, 37.9% (n=3,524) were self-tested. A lower rate of self-testing was seen in all priority populations: 34.7% in Māori and 36.3% in Pacific vs. 40.4% in European/Other (p<0.01, p<0.05, respectively), and 32.2% in underscreened vs. 52.3% in those <6 months overdue (due) (p<0.001). In the 16.8% of participants who took self-test kits home (n=635), 61.1% (n=388) returned a sample. Priority populations were more likely to take a test kit home: 22.2% of Māori and 20.0% of Pacific vs. 12.1% of European/Other, and 21.5% of underscreened vs. 11.7% of due (all p<0.001). Although a similar return rate was seen in Māori (64.3%) vs. European/Other (70.3%), fewer Pacific (51.1% vs. 70.3% in European/Other; p<0.05) and underscreened (48.7% vs. 89.4% in due; p<0.001) returned their sample. HPV was detected in 9.5% of 3,524 returned results. Follow-up testing rates were high (96.4% for cytology; 92.8% for colposcopy).

Conclusions

Opportunistically offering HPV self-tests in primary care engaged priority populations in cervical screening. Intensive support is required to achieve high rates of sample return (if tested at home) and follow-up where HPV was detected. Opportunistic offer of HPV self-testing in primary care should be considered as an important component of a broader strategy to increase equitable participation in cervical screening, with more focus needed for Māori, Pacific and those who are underscreened.