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Assessing Acceptability of Self-Sampling Kits, Prevalence, and Risk Factors for Human Papillomavirus Infection in American Indian Women

Abstract

We evaluated the feasibility and acceptability of self-sampling for human papillomavirus (HPV) testing and calculated the prevalence of and risk factors for high-risk (hr) HPV infections in a community-based sample of American Indian women. To this end, we recruited 329 Hopi women aged 21–65 years to self-collect vaginal samples for hrHPV testing. Samples were tested by polymerase chain reaction for 14 hrHPV genotypes. We used Chi square tests to identify correlates of preference for clinician Pap testing versus HPV self-sampling, and age-adjusted Poisson regression to evaluate correlates of hrHPV prevalence. We found that satisfaction with HPV self-sampling was high, with 96 % of women reporting that the sample was easy to collect and 87 % reporting no discomfort. The majority (62 %) indicated that they preferred HPV self-sampling to receiving a Pap test from a clinician. Preference for Pap testing over HPV self-sampling was positively associated with adherence to Pap screening and employment outside the home. All samples evaluated were satisfactory for HPV testing, and 22 % were positive for hrHPV. HrHPV prevalence peaked in the late 20 s and declined with increasing age. HrHPV positivity was inversely associated with having children living the household. In conclusion, HPV self-sampling is feasible and acceptable to Hopi women, and could be effective in increasing rates of cervical cancer screening in Hopi communities. HrHPV prevalence was similar to estimates in the general United States population.

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Acknowledgments

This research was performed under the auspices of the Collaborative to Improve Native Cancer Outcomes, a P50 program project sponsored by the National Cancer Institute (Grant No. 1P50CA148110). The National Cancer Institute had no involvement in the study design; collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. We are grateful to the women who participated in this project, and to the Hopi Tribal Council and Lorencita Joshweseoma for their support. We thank our local project coordinators, Olivia Dennis and Lorene Vicente, for their coordination efforts, and our community advisors, Carrie Watahomagie, Lisa Lomavaya, and Marilyn Fredericks, for their input and advice. We also thank Odile Lallemand, John Lin, and Lisa Vu at the University of Washington for their assistance with project coordination, and we thank Raymond Harris at the University of Washington for editing the final manuscript.

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Correspondence to Rachel L. Winer.

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The Collaborative to Improve Native Cancer Outcomes includes D. Buchwald, D.R. Flum, E.M. Garroutte, A.A. Gonzales, J.A. Henderson, P. Nez Henderson, D.L. Patrick, S.P. Tu, and R.L. Winer.

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Winer, R.L., Gonzales, A.A., Noonan, C.J. et al. Assessing Acceptability of Self-Sampling Kits, Prevalence, and Risk Factors for Human Papillomavirus Infection in American Indian Women. J Community Health 41, 1049–1061 (2016). https://doi.org/10.1007/s10900-016-0189-3

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  • DOI: https://doi.org/10.1007/s10900-016-0189-3

Keywords

  • Human papillomavirus (HPV)
  • American Indian/Alaska Native (AI/AN)
  • Self-sampling
  • Prevalence
  • Acceptability