title: Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis.
abstract: OBJECTIVE
  HPV testing has emerged as an effective cervical cancer screening test. The use of HPV self-testing has the potential to address many barriers to screening and reach at-risk women through engagement in screening. However, there is a need to examine the evidence for whether offering self-collected HPV testing in practice increases screening compliance. The objective of this review is to determine to what extent providing self-collected HPV testing increases screening participation in women who are never or underscreened for cervical cancer.
  
  
  METHODS
  A systematic literature review conducted in the databases Medline and Embase identified articles examining the use of HPV self-testing on cervical cancer screening participation. A meta-analysis using a random-effects model was used to calculate the relative compliance, with an intent-to-treat analysis of HPV self-testing compared to Pap testing, with 95% confidence intervals (CI). All statistical tests were two-sided.
  
  
  RESULTS
  Ten studies were reviewed, with 8 being European and 2 North American. Of the 10 studies, 9 employed a randomized design. In all studies, the relative compliance of HPV self-collected testing compared to Pap testing was significantly greater than 1.0 (p<0.01). The overall relative compliance was 2.14 (95% CI 1.30-3.52). There was large heterogeneity of screening compliance between studies for both HPV self-testing and Pap testing.
  
  
  CONCLUSIONS
  HPV self-collected testing significantly improved the participation of women who did not routinely attend cervical cancer screening programs. New approaches to HPV self-test delivery should be considered as HPV testing becomes more widely incorporated as a primary screening tool.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON. sarai.racey@gmail.com
authors.forename: C Sarai
authors.initials: CS
authors.lastname: Racey
authors.forename: Diana R
authors.initials: DR
authors.lastname: Withrow
authors.forename: Dionne
authors.initials: D
authors.lastname: Gesink
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010358:Patient Participation / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D013048:Specimen Handling / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: Human papillomavirus; cervical cancer screening; review; self collected specimens; under-screening