Clinician and patient experiences with opportunistic offer of HPV self-testing in Aotearoa New Zealand primary care clinics: interview and survey findings

Background

To support the introduction of human papillomavirus (HPV) self-testing in the New Zealand National Cervical Screening Programme, we conducted an implementation study aimed to explore the acceptability and feasibility of opportunistically offering HPV self-testing in general practice from both clinician and participant perspectives with a home testing option and centralised follow-up.

Methods

Primary care clinicians trained to offer the HPV self-test were invited to semi-structured interviews exploring their perception of receptivity to the opportunistic offer and challenges and enablers to implementation. Reflexive thematic analysis was undertaken on transcripts. Participants (aged 30–69 years) were sent a link to an online survey after HPV result notification. Survey results were analysed using descriptive statistics with an inductive approach to analysis of free text responses. Participant recruitment and data collection occurred between November 2021 and January 2024.

Results

Of the 40 clinicians trained to offer HPV self-testing, 12 primary care clinicians from six ethnically diverse primary care sites in Auckland completed an interview. ‘Positive reception’ was the strongest theme with clinicians reporting that overwhelmingly, participants were receptive to the HPV self-test offer. The four enabler themes were: ‘supportive practice systems’, ‘importance of the discussion’, ‘options for testing' and ‘specialised support and consistency’. Key challenge themes in implementing opportunistic self-testing were ‘competing demands’ and ‘communicating what it’s all about’.

Of the 3,524 self-tested participants, 394 responded to the survey. Most (93%) found the amount of information they received about HPV self-testing ‘about right’ and 86% were comfortable in their decision to self-test. Considering their next cervical screening, more respondents preferred home-based self-testing options than self-testing at a clinic (46% versus 37%).

Conclusion

Offering the HPV self-test opportunistically to people due for screening when they visited their primary care provider for any reason was generally well received and feasible for clinic staff. The option to take kits home for sampling was an enabler of participation. Supportive systems and resources for clinicians will be important if opportunistic HPV self-testing is offered more widely in primary care, including further consideration of a central specialist team to follow-up and support home testing and participants with HPV detected results.

Trial registration

This study did not reach the ICJME or WHO criteria for clinical trial registration.