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.
This is a preview of subscription content,to check access.
Access this article
Similar content being viewed by others
Bosch, F. X., Broker, T. R., Forman, D., Moscicki, A. B., Gillison, M. L., Doorbar, J., et al. (2013). Comprehensive control of human papillomavirus infections and related diseases. Vaccine, 31(Suppl 7), H1–H31.
Benard, V. B., Thomas, C. C., King, J., Massetti, G. M., Doria-Rose, V. P., & Saraiya, M. (2014). Vital signs: Cervical cancer incidence, mortality, and screening—United States, 2007–2012. MMWR. Morbidity and Mortality Weekly Report, 63(44), 1004–1009.
Leyden, W. A., Manos, M. M., Geiger, A. M., Weinmann, S., Mouchawar, J., Bischoff, K., et al. (2005). Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. Journal of the National Cancer Institute, 97(9), 675–683.
Watson, M., Benard, V., Thomas, C., Brayboy, A., Paisano, R., & Becker, T. (2014). Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999–2009. American Journal of Public Health, 104(Suppl 3), S415–S422.
Coe, K., Martin, L., Nuvayestewa, L., Attakai, A., Papenfuss, M., De Zapien, J. G., et al. (2007). Predictors of Pap test use among women living on the Hopi reservation. Health Care for Women International, 28(9), 764–781.
Catarino, R, Jr, Vassilakos, P., Stadali-Ullrich, H., Royannez-Drevard, I., Guillot, C., & Petignat, P. (2015). Feasibility of at-home self-sampling for HPV testing as an appropriate screening strategy for nonparticipants in Switzerland: preliminary results of the DEPIST study. Journal of Lower Genital Tract Disease, 19(1), 27–34.
Waller, J., Bartoszek, M., Marlow, L., & Wardle, J. (2009). Barriers to cervical cancer screening attendance in England: A population-based survey. Journal of Medical Screening, 16(4), 199–204.
Sultana, F., Mullins, R., English, D. R., Simpson, J. A., Drennan, K. T., Heley, S., et al. (2015). Women’s experience with home-based self-sampling for human papillomavirus testing. BMC Cancer, 15, 849.
Saslow, D., Solomon, D., Lawson, H. W., Killackey, M., Kulasingam, S. L., Cain, J., et al. (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. American Journal of Clinical Pathology, 137(4), 516–542.
Petignat, P., Faltin, D. L., Bruchim, I., Tramer, M. R., Franco, E. L., & Coutlee, F. (2007). Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecologic Oncology, 105(2), 530–535.
Arbyn, M., & Castle, P. E. (2015). Offering self-sampling kits for HPV testing to reach women who do not attend in the regular cervical cancer screening program. Cancer Epidemiol Biomarkers Prev, 24(5), 769–772.
Arbyn, M., Verdoodt, F., Snijders, P. J., Verhoef, V. M., Suonio, E., Dillner, L., et al. (2014). Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: A meta-analysis. Lancet Oncology, 15(2), 172–183.
Schmeink, C. E., Bekkers, R. L., Massuger, L. F., & Melchers, W. J. (2011). The potential role of self-sampling for high-risk human papillomavirus detection in cervical cancer screening. Reviews in Medical Virology, 21(3), 139–153.
Racey, C. S., Withrow, D. R., & Gesink, D. (2013). Self-collected HPV testing improves participation in cervical cancer screening: A systematic review and meta-analysis. Canadian Journal of Public Health, 104(2), e159–e166.
Bell, M. C., Schmidt-Grimminger, D., Jacobsen, C., Chauhan, S. C., Maher, D. M., & Buchwald, D. S. (2011). Risk factors for HPV infection among American Indian and white women in the Northern Plains. Gynecologic Oncology, 121(3), 532–536.
Schmidt-Grimminger, D. C., Bell, M. C., Muller, C. J., Maher, D. M., Chauhan, S. C., & Buchwald, D. S. (2011). HPV infection among rural American Indian women and urban white women in South Dakota: An HPV prevalence study. BMC Infectious Diseases, 11, 252.
Alfonsi, G. A., Datta, S. D., Mickiewicz, T., Koutsky, L. A., Ghanem, K., Hagensee, M., et al. (2011). Prevalence of high-risk HPV types and abnormal cervical cytology in American Indian/Alaska Native women, 2003–2005. Public Health Reports, 126(3), 330–337.
Harper, D. M., Longacre, M. R., Noll, W. W., Belloni, D. R., & Cole, B. F. (2003). Factors affecting the detection rate of human papillomavirus. The Annals of Family Medicine, 1(4), 221–227.
Bouvard, V., Baan, R., Straif, K., Grosse, Y., Secretan, B., El Ghissassi, F., et al. (2009). A review of human carcinogens—Part B: Biological agents. Lancet Oncology, 10(4), 321–322.
Cherne, S., Popov, V., & Feng, Q. (2012). Protocol for the detection and genotyping of human papilloma viruses using a liquid bead microarray assay. Methods in Molecular Biology, 903, 205–223.
McNutt, L. A., Wu, C., Xue, X., & Hafner, J. P. (2003). Estimating the relative risk in cohort studies and clinical trials of common outcomes. American Journal of Epidemiology, 157(10), 940–943.
Huh, W. K., Ault, K. A., Chelmow, D., Davey, D. D., Goulart, R. A., Garcia, F. A., et al. (2015). Use of primary high-risk human papillomavirus testing for cervical cancer screening: Interim clinical guidance. Gynecologic Oncology, 136(2), 178–182.
National Center for Health Statistics. Health, United States (2013) Table 84. Use of Pap smears among women aged 18 and over, by selected characteristics: United States, selected years 1987–2010.
Bansil, P., Wittet, S., Lim, J. L., Winkler, J. L., Paul, P., & Jeronimo, J. (2014). Acceptability of self-collection sampling for HPV–DNA testing in low-resource settings: a mixed methods approach. BMC Public Health, 14, 596.
Barbee, L., Kobetz, E., Menard, J., Cook, N., Blanco, J., Barton, B., et al. (2010). Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action. Cancer Causes and Control, 21(3), 421–431.
Berner, A., Hassel, S. B., Tebeu, P. M., Untiet, S., Kengne-Fosso, G., Navarria, I., et al. (2013). Human papillomavirus self-sampling in Cameroon: Women’s uncertainties over the reliability of the method are barriers to acceptance. Journal of Lower Genital Tract Disease, 17(3), 235–241.
Dzuba, I. G., Diaz, E. Y., Allen, B., Leonard, Y. F., Lazcano Ponce, E. C., Shah, K. V., et al. (2002). The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening. Journal of Women’s Health & Gender-Based Medicine, 11(3), 265–275.
Guan, Y., Castle, P. E., Wang, S., Li, B., Feng, C., Ci, P., et al. (2012). A cross-sectional study on the acceptability of self-collection for HPV testing among women in rural China. Sexually Transmitted Infections, 88(7), 490–494.
Igidbashian, S., Boveri, S., Spolti, N., Radice, D., Sandri, M. T., & Sideri, M. (2011). Self-collected human papillomavirus testing acceptability: Comparison of two self-sampling modalities. Journal of Women’s Health (Larchmt), 20(3), 397–402.
Jones, H. E., Brudney, K., Sawo, D. J., Lantigua, R., & Westhoff, C. L. (2012). The acceptability of a self-lavaging device compared to pelvic examination for cervical cancer screening among low-income women. Journal of Women’s Health (Larchmt), 21(12), 1275–1281.
Litton, A. G., Castle, P. E., Partridge, E. E., & Scarinci, I. C. (2013). Cervical cancer screening preferences among African American women in the Mississippi Delta. Journal of Health Care for the Poor and Underserved, 24(1), 46–55.
Montealegre, J. R., Mullen, P. D., Jibaja-Weiss, M. L., Vargas Mendez, M. M., & Scheurer, M. E. (2014). Feasibility of cervical cancer screening utilizing self-sample human papillomavirus testing among Mexican immigrant women in Harris County, Texas: A pilot study. Journal of Immigrant and Minority Health, 17(3), 704–712.
Oranratanaphan, S., Termrungruanglert, W., & Khemapech, N. (2014). Acceptability of self-sampling HPV testing among Thai women for cervical cancer screening. Asian Pacific Journal of Cancer Prevention, 15(17), 7437–7441.
Quincy, B. L., Turbow, D. J., & Dabinett, L. N. (2012). Acceptability of self-collected human papillomavirus specimens as a primary screen for cervical cancer. Journal of Obstetrics and Gynaecology, 32(1), 87–91.
Rosenbaum, A. J., Gage, J. C., Alfaro, K. M., Ditzian, L. R., Maza, M., Scarinci, I. C., et al. (2014). Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador. International Journal of Gynaecology and Obstetrics, 126(2), 156–160.
Trope, L. A., Chumworathayi, B., & Blumenthal, P. D. (2013). Feasibility of community-based care HPV for cervical cancer prevention in rural Thailand. Journal of Lower Genital Tract Disease, 17(3), 315–319.
Virtanen, A., Nieminen, P., Niironen, M., Luostarinen, T., & Anttila, A. (2014). Self-sampling experiences among non-attendees to cervical screening. Gynecologic Oncology, 135(3), 487–494.
Waller, J., McCaffery, K., Forrest, S., Szarewski, A., Cadman, L., Austin, J., et al. (2006). Acceptability of unsupervised HPV self-sampling using written instructions. Journal of Medical Screening, 13(4), 208–213.
Anhang, R., Nelson, J. A., Telerant, R., Chiasson, M. A., & Wright, T. C, Jr. (2005). Acceptability of self-collection of specimens for HPV DNA testing in an urban population. Journal of Women’s Health (Larchmt), 14(8), 721–728.
Penaranda, E., Molokwu, J., Flores, S., Byrd, T., Brown, L., & Shokar, N. (2015). Women’s attitudes toward cervicovaginal self-sampling for high-risk HPV infection on the US-Mexico Border. Journal of Lower Genital Tract Disease, 19(4), 323–328.
Hariri, S., Unger, E. R., Sternberg, M., Dunne, E. F., Swan, D., Patel, S., et al. (2011). Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. Journal of Infectious Diseases, 204(4), 566–573.
Markowitz, L. E., Dunne, E. F., Saraiya, M., Chesson, H. W., Curtis, C. R., Gee, J., et al. (2014). Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports, 63(RR-05), 1–30.
Bell, M. C., Schmidt-Grimminger, D., Patrick, S., Ryschon, T., Linz, L., & Chauhan, S. C. (2007). There is a high prevalence of human papillomavirus infection in American Indian women of the Northern Plains. Gynecologic Oncology, 107(2), 236–241.
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.
Conflict of interest
The authors declare that they have no conflict of interest.
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.
About this article
Cite this article
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