Evelyn Jane MacDonald1, Stacie Geller2, Nokuthaba Sibanda1, Kendall Stevenson1, Lorna Denmead1, Anna Adcock1, Fiona Cram3, Merilyn Hibma4, Peter Sykes5, Bev Lawton1. 1. Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand. 2. Center for Research on Women and Gender, National Center of Excellence in Women's Health, Department of Obstetrics and Gynecology, College of Medicine, University of Illinois, Chicago, USA. 3. Katoa Ltd, Auckland, New Zealand. 4. Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 5. Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand.
Abstract
BACKGROUND:Indigenous women in the high-income countries of Canada, Australia, New Zealand and USA, have a higher incidence and mortality from cervical cancer than non-Indigenous women. Increasing cervical screening coverage could ultimately decrease cervical cancer disparities. AIMS: To increase cervical screening for under-screened/never-screened Māori women. MATERIALS AND METHODS: This study was a cluster randomised controlled trial. Inclusion criteria were women aged 25-69, last screened ≥4 years ago, in Northland, New Zealand. The intervention arm was the offer of a human papilloma virus (HPV) self-test and the control arm was the usual offer of standard care - a cervical smear. The primary outcome was rate of cervical screening in the intervention group compared to control in Māori, the Indigenous peoples of New Zealand. Six primary care clinics were randomly allocated to intervention or control. RESULTS: Of 500 eligible Māori women in the intervention arm, 295 (59.0%) were screened. Of 431 eligible Māori women in the control arm, 94 (21.8%) were screened. Adjusting for age, time since last screen, deprivation index, Māori women in the intervention arm were 2.8 times more likely to be screened than women in the control arm (95% CI: 2.4-3.1, P-value <0.0001). CONCLUSIONS: Offer of HPV self-testing could potentially halve the number of under-screened/never-screened Māori women and decrease cervical morbidity and mortality. These results may be generalisable to benefit Indigenous peoples facing similar barriers in other high-income countries.
RCT Entities:
BACKGROUND: Indigenous women in the high-income countries of Canada, Australia, New Zealand and USA, have a higher incidence and mortality from cervical cancer than non-Indigenous women. Increasing cervical screening coverage could ultimately decrease cervical cancer disparities. AIMS: To increase cervical screening for under-screened/never-screened Māori women. MATERIALS AND METHODS: This study was a cluster randomised controlled trial. Inclusion criteria were women aged 25-69, last screened ≥4 years ago, in Northland, New Zealand. The intervention arm was the offer of a human papilloma virus (HPV) self-test and the control arm was the usual offer of standard care - a cervical smear. The primary outcome was rate of cervical screening in the intervention group compared to control in Māori, the Indigenous peoples of New Zealand. Six primary care clinics were randomly allocated to intervention or control. RESULTS: Of 500 eligible Māori women in the intervention arm, 295 (59.0%) were screened. Of 431 eligible Māori women in the control arm, 94 (21.8%) were screened. Adjusting for age, time since last screen, deprivation index, Māori women in the intervention arm were 2.8 times more likely to be screened than women in the control arm (95% CI: 2.4-3.1, P-value <0.0001). CONCLUSIONS: Offer of HPV self-testing could potentially halve the number of under-screened/never-screened Māori women and decrease cervical morbidity and mortality. These results may be generalisable to benefit Indigenous peoples facing similar barriers in other high-income countries.
Authors: Naomi Brewer; Karen Bartholomew; Jane Grant; Anna Maxwell; Georgina McPherson; Helen Wihongi; Collette Bromhead; Nina Scott; Sue Crengle; Sunia Foliaki; Chris Cunningham; Jeroen Douwes; John D Potter Journal: Lancet Reg Health West Pac Date: 2021-09-07