Hpv, how to improve adherence to screening? With the do-it-yourself test

Adherence to HPV (human papillomavirus) screening programs can significantly increase if women receive a do-it-yourself test kit at home. This is what emerges from the results of a study conducted in the United States and published in JAMA Internal Medicine , which involved almost 2,500 women who had missed some screenings or who had never been tested. And where adherence increased from 17.4 to 41.1%.

HPV and prevention

99% of cervical cancer cases are linked to HPV infection. Hence the importance of vaccination and adherence to screening programs, which together prevent most cases, as emphasized by the WHO (World Health Organization).

The available vaccines, in fact, are particularly effective against the strains of the virus that most often lead to the development of cervical cancer, but also cancer of the anus, penis, vagina, and oral cavity. In Italy, vaccination is offered free of charge to boys and girls who have turned 11. Many regions have active programs offering free vaccinations for various categories of people (immunosuppressed, women who have had precancerous lesions, people with HIV, and men who have sex with men).

On the other hand, screening (with HPV tests and Pap tests) allows for early detection of the infection and any lesions before they evolve into an invasive form of cancer.

Self-collection tests

According to the results of the study published in JAMA Internal Medicine , offering the option of self-collection, as an alternative to having to go to a health facility to undergo the test, could prove to be a winning strategy to encourage adherence to screening programs.

The authors of the study randomly divided the participants into three groups: the women included in the first group received only a phone call inviting them to go to a clinic to take the test; the participants included in the second and third groups received the same phone call, at the end of which, however, the operator informed them of the possibility of taking the test at home.

Within a week of the call, the appropriate kits were mailed to the women included in these two groups, along with a prepaid envelope to mail the sample back. Participants in the third group then received an additional reminder phone call if they had not mailed the sample back within three weeks. Screening adherence was 17.4% in the first group, 41.1% in the second group, and 46.6% in the third group.

Do-it-yourself test approved in the United States

Precisely on this front, in May of this year the US Food and Drug Administration (FDA) approved the first “do-it-yourself” test. According to the results of a study involving approximately 600 participants, conducted by the company that produces the kit in question, the test performed with self-collection would have an accuracy comparable to that of samples taken by medical personnel. In particular, during the study the percentage of self-collected samples correctly identified as positive for HPV was evaluated, taking as a reference the corresponding samples taken by a clinician and tested positive for the infection. This parameter would have reached 95%.

How does it work in Italy?

Currently, in Italy, self-collection kits are sold in pharmacies, but only some Local Health Authorities (AS) have officially integrated them into their screening programs. The Local Health Authority (ASL) of Bologna is said to have led the way, followed by that of Ferrara, which in March of this year announced the start of a collaboration with pharmacies and other organizations for this very purpose. “This is an important innovation at a national and regional level that places us second in Italy after the experience launched in Bologna,” explained Nicoletta Natalini, general director of the Ferrara Health Authorities. As usual, women between the ages of 30 and 64 will receive a letter inviting them to take the test, which will offer them the option of taking the test at a health facility, or picking up the special self-collection kit at pharmacies participating in the project.