Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Mailed at-home human papillomavirus (HPV) self-testing and telehealth management in Aotearoa New Zealand: An implementation study  (126240)

Karen Bartholomew 1 , Lily Yang 1 , Cleo Neville 1 , Anna Maxwell 1 , Phyu Sin Aye 1 2 , Jane Grant 1 , Collette Bromhead 3 , Georgina McPherson 4 , Kate Moodabe 5 , Richard Massey 6 , Sue Crengle 7 , Susan Sherman 8 , Nina Scott 1 , Pania Coote 9 , Wendy Burgess 1 , Deralie Flower 1 , Jyoti Kathuria 10 , Erin Stirling 1
  1. Te Whatu Ora Health New Zealand, Auckland, New Zealand
  2. University of Auckland, Auckland, New Zealand
  3. Massey University, Auckland, New Zealand
  4. Te Whatu Ora Health New Zealand, Waitemata, New Zealand
  5. Total Healthcare, Auckland, New Zealand
  6. Pathology Associates New Zealand, Auckland, New Zealand
  7. University of Otago, Dunedin, New Zealand
  8. University of Sheffield, Sheffield, United Kingdom
  9. AwhiMai Consultancy, Bluff, New Zealand
  10. Te Whatu Ora Health New Zealand, Counties Manukau, New Zealand

Objective/purpose

In 2023, Aotearoa New Zealand introduced human papillomavirus (HPV) self-testing to improve screening access and reduce inequities. To contribute policy-relevant information supporting this change, this study aimed to assess the potential of mailed at-home self-testing, supported by a central telehealth team, focusing on priority populations.

Sample and setting

We invited participants aged 30-69 years, who were eligible for self-testing and enrolled with the selected primary health organisation between 03/04/2023 and 11/10/2023.

Procedures

Eligible participants were invited via text message and kits were mailed. Follow-up was conducted via telehealth by a centralised nurse-led coordination team. Māori and Pacific people who did not respond were re-invited. An incentive to return a sample was tested in eligible Māori and Pacific in a nested, randomised, controlled trial (RCT).

Results

Of 25,315 people invited, 24% consented to receive a test kit. Almost half (48%) of participants returned a sample; total uptake was 12% (n=2,925). Uptake was significantly lower in all priority groups (p<0.001): Māori (12.7%) and Pacific (8.4%) vs. European/Other (19.0%); overdue for screening by ≥2 years (10.5%) vs. overdue by <6 months (19.4%); those living in high (9.6%) vs. low (13.5%) socioeconomic deprivation levels. In the RCT, no significant difference in sample return was seen between the incentive (7.9%; n=49 of 617) and control (8.5%; n=52 of 609) groups. HPV was detected in 7.7% of 3,018 valid results. Follow-up test rates were high (97% cytology, 90% colposcopy). Almost all survey respondents preferred a mailed at-home self-test for their next screen (92%; n=193 of 210).

Conclusion and clinical implications

Mailed at-home HPV self-testing, supported by telehealth, can engage priority groups in cervical screening and is strongly preferred by participants. It warrants consideration in a broader screening programme to improve access, alongside further strategies to improve sample return rates for priority groups.