Perceptions of mailed HPV self-testing among women at higher risk for cervical cancer.

Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention. We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured. Over half (55 %) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74 %) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98 %) agreeing the mailed test was safe. A few women (6 %) preferred HPV self-testing to Pap testing for protecting health, but most (75 %) had no preference. Trust in or preference for mailed self-testing did not vary by race or income. However, compared to white women, black women had lower HPV-related knowledge (OR 0.46, 95 % CI 0.23-0.92) and perceived lower cervical cancer risk in the absence of screening (OR 0.44, 95 % CI 0.22-0.86). We found similar patterns of disparities for women with very low (<$10,000) versus relatively higher incomes. Our findings suggest that, across racial and economic subgroups, under-screened women generally trust HPV self-tests delivered by mail. To succeed, programs for HPV self-testing must overcome disparities in knowledge and perceptions related to cervical cancer screening.