Expanding Access to HPV Self-Collection to Promote Trauma-Informed, Equitable Cervical Cancer Screening
Abstract
Title: Expanding Access to HPV Self-Collection to Promote Trauma-Informed, Equitable Cervical Cancer Screening
Authors: Elizabeth Chen, Simran Gidwani, Jane Samaniego, Job Godino, Megha Shankar
Background: Cervical cancer persists as a significant health equity challenge in the United States, disproportionately affecting racial, ethnic, and gender minorities, as well as immigrants, refugees, and individuals with trauma histories who face persistent barriers to traditional Pap smear screening. The recent FDA approval of the HPV self-collection test presents a transformative opportunity to surmount these obstacles using trauma-informed, patient-centered approaches. Additionally, professional guidelines now include HPV self-collection as an acceptable form of cervical cancer screening test based on safety and efficacy data. However, successful implementation in clinical settings remains poorly understood, particularly in federally qualified health centers that serve historically marginalized and under-screened patient populations.
Description: This study aims to identify and address clinician barriers to implementing HPV self-collection for cervical cancer screening at a San Diego County federally qualified health center. In March 2026, primary care and OB/GYN clinicians at a federally qualified health center were administered a survey to identify barriers to implementation of HPV self-collection. Participant recruitment focused on clinicians with patient cervical cancer screening rates below 65% (n=100). Survey questions included demographics, current cervical cancer screening practices, and implementation factors around HPV self-collection. Survey data will be analyzed using descriptive statistics and subgroup comparisons, which will inform the development of a clinician educational intervention to promote HPV self-collection uptake, planned for May 2026.
Lessons learned or expected outcomes: Of the 100 clinicians surveyed, preliminary results from N = 20 survey respondents show a majority of participants utilizing standard Pap smear with HPV co-testing every 5 years, while expressing hesitancy to implement self-collection due to time constraints and anticipated patient physical discomfort. Early results also indicate low levels of familiarity with HPV self-collection, indicating a potential correlation with the frequency of cervical cancer screening. Therefore, we anticipate that cervical cancer screening rates will increase after interventions to educate and address barriers. In addition, we anticipate identifying systems-based barriers, including laboratory processing changes, insurance coverage, and medical assistant role in workflow.
Recommendations/Next Steps: Future steps include addressing myths and barriers to HPV self-collection through provider forums to properly educate and increase accessibility. Providers interested in implementing HPV self-collection will be given tip sheets that summarize cervical cancer screening options, EHR order set instructions, and patient self-collection instructions. These findings will inform clinician, system, and patient factors that can facilitate implementation and address gaps in HPV self-collection to advance equity in cervical cancer screening.
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