title: Randomized Intervention of Self-Collected Sampling for Human Papillomavirus Testing in Under-Screened Rural Women: Uptake of Screening and Acceptability.
abstract: BACKGROUND
  Our aim was to determine if cervical cancer screening uptake would increase among under-screened women living in rural Ontario, Canada, if at-home self-collected sampling for human papillomavirus (HPV) testing was offered as a primary cervical cancer screening modality, compared to invited papanicolaou (Pap) testing or routine opportunistic screening.
  
  
  METHODS
  Women 30-70 years of age who were overdue for cervical cancer screening were randomized to receive (1) an at-home self-collected HPV kit, (2) a reminder invitation for Pap testing, or (3) standard of care opportunistic screening. The first two arms were also asked demographic and screening history questions. Women randomized to arm 1 were asked about acceptability.
  
  
  RESULTS
  In total, 818 eligible women were identified in a small rural community in Southwestern Ontario: 335 received a self-collected HPV testing kit, 331 received a reminder letter, and 152 received standard of care. In the HPV self-collection arm, 21% (70/335) returned the sample and questionnaire and 11% (37/335) opted to undergo Pap testing. In total, 32% from the HPV self-collection arm, 15% (51/331) from the Pap invitation arm, and 8.5% (13/152) with standard of care were screened. Women receiving the self-collected HPV kit were 3.7 (95% confidence interval 2.2-6.4) times more likely to undergo screening compared to the standard of care arm. In the HPV self-sampling arm, 80% (56/70) said they would be very likely to choose self-collected sampling in the future.
  
  
  CONCLUSIONS
  Providing self-collected sampling for HPV testing was more effective than sending reminder letters to increase screening coverage in under-screened women.
authors.affiliation: 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada .
authors.forename: C Sarai
authors.initials: CS
authors.lastname: Racey
authors.affiliation: 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada .
authors.forename: Dionne C
authors.initials: DC
authors.lastname: Gesink
authors.affiliation: 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada .|2 Department of Community and Family Medicine, Li Ka Shing Knowledge Institute , St. Michael's Hospital, Toronto, Canada .
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.affiliation: 3 Mount Forest Family Health Team , Mount Forest, Canada .
authors.forename: Suzanne
authors.initials: S
authors.lastname: Trivers
authors.affiliation: 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada .|4 Health Canada , Ottawa, Canada .
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
authors.affiliation: 5 DynaCare , Brampton, Canada .
authors.forename: Anu
authors.initials: A
authors.lastname: Rebbapragada
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D065006:Papanicolaou Test / Q000379:methods*; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012424:Rural Population; D012648:Self Care / Q000379:methods*; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000821:virology*; D014626:Vaginal Smears / Q000379:methods*