title: The effect of self-sampled HPV testing on participation to cervical cancer screening in Italy: a randomised controlled trial (ISRCTN96071600).
abstract: BACKGROUND
  In Italy, cervical cancer screening programmes actively invite women aged 25-64 years. Programmes are hindered by low participation.
  
  
  METHODS
  A sample of non-responder women aged 35-64 years, belonging to three different programmes (in Rome, Florence and Teramo), was randomly split into four arms: two control groups received standard recall letters to perform either Pap-test (first group) or human papillomavirus (HPV) test (second group) at the clinic. A third arm was sent letters offering a self-sampler for HPV testing, to be requested by phone, whereas a fourth group was directly sent the self-samplers home.
  
  
  RESULTS
  Compliance with standard recall was 13.9% (N619). Offering HPV test at the clinic had a nonsignificant effect on compliance (N616, relative risk (RR)=1.08; 95% CI=0.82-1.41). Self-sampler at request had the poorest performance, 8.7% (N622, RR=0.62; 95% CI=0.45-0.86), whereas direct mailing of the self-sampler registered the highest compliance: 19.6% (N616, RR=1.41; 95% CI=1.10-1.82). This effect on compliance was observed only in urban areas, Florence and Rome (N438, RR=1.69; 95% CI=1.24-2.30), but not in Abruzzo (N178, RR=0.95; 95% CI=0.61-1.50), a prevalently rural area.
  
  
  CONCLUSIONS
  Mailing self-samplers to non-responders may increase compliance as compared with delivering standard recall letters. Nevertheless, effectiveness is context specific and the strategy costs should be carefully considered.
authors.affiliation: Agency for Public Health, Lazio Region, Via di S Costanza 53, Rome 00198, Italy. giorgirossi@asplazio.it
authors.forename: P
authors.initials: P
authors.lastname: Giorgi Rossi
authors.forename: L M
authors.initials: LM
authors.lastname: Marsili
authors.forename: L
authors.initials: L
authors.lastname: Camilloni
authors.forename: A
authors.initials: A
authors.lastname: Iossa
authors.forename: A
authors.initials: A
authors.lastname: Lattanzi
authors.forename: C
authors.initials: C
authors.lastname: Sani
authors.forename: C
authors.initials: C
authors.lastname: Di Pierro
authors.forename: G
authors.initials: G
authors.lastname: Grazzini
authors.forename: C
authors.initials: C
authors.lastname: Angeloni
authors.forename: P
authors.initials: P
authors.lastname: Capparucci
authors.forename: A
authors.initials: A
authors.lastname: Pellegrini
authors.forename: M L
authors.initials: ML
authors.lastname: Schiboni
authors.forename: A
authors.initials: A
authors.lastname: Sperati
authors.forename: M
authors.initials: M
authors.lastname: Confortini
authors.forename: C
authors.initials: C
authors.lastname: Bellanova
authors.forename: A
authors.initials: A
authors.lastname: D'Addetta
authors.forename: E
authors.initials: E
authors.lastname: Mania
authors.forename: C B
authors.initials: CB
authors.lastname: Visioli
authors.forename: E
authors.initials: E
authors.lastname: Sereno
authors.forename: F
authors.initials: F
authors.lastname: Carozzi
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007558:Italy; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears