Introduction:
Since 1 December 2017, the National Cervical Screening Program included self- collection of vaginal samples for HPV testing for never and under-screened people, aged >=30 years, with the aim to improve participation. From 1 July 2022, self-collection was expanded as a screening option for all eligible people aged 25 to 74 years.
Method:
We monitored quarterly self-collection uptake between 1 December 2017 and 30 June 2023, using data from the National Cancer Screening Register. Uptake was reported by 5-year age group, State & Territory, ARIA Index (remoteness) and SEIFA Quintiles (Quintile1 was most disadvantaged). HPV positivity and compliance to recommended follow-up was also assessed.
Results:
Prior to 1 July 2022, a small proportion (<1%) of all HPV screening tests were self-collected; however, the uptake of self-collect increased from 10% in Q3 2022 to 20% in Q2 2023. The increase post expansion was seen across all age groups, State & Territory, remoteness areas, and SEIFA quintiles with the highest uptake in the 70-74 years age group (25%), Northern Territory (38%), very remote areas (44%) and the most disadvantaged (22%). HPV positivity rates were significantly higher in self-collected samples compared to clinician collected samples (p<0.001). For both self and clinician-collected samples, HPV positivity was highest in people who were never and under-screened and lowest in those who screened on time. Six months colposcopy follow-up was significantly lower in HPV (16/18) positive people who had a self-collect versus those who had a practitioner-collected sample (80% vs 75%; p<0.001). Liquid based cytology within 6 months of self-collect HPV (not 16/18) positive result was around 63%.
Conclusion:
Expanding self-collection to include everyone eligible for screening has improved access and equity in the National Cervical Screening Program. Additional measures need to be put in place to improve compliance with follow-up testing after HPV detection.
Acknowledgements: Australian Government Department of Health and Aged Care