Women's acceptability of and experience with primary human papillomavirus testing for cervix screening: HPV FOCAL trial cross-sectional online survey results.

Objective: To study participant's acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening.
Design: Cross-sectional online survey of clinical trial participants.
Setting: Primary care, population-based Cervix Screening Program, British Columbia, Canada.
Participants: A total of 5532 participants from the HPV FOCAL trial, in which women received HPV and cytology testing at study exit, were included in the analysis. Median age was 54 years. The median time of survey completion was 3 years after trial exit.
Outcome Measures: Acceptability of HPV testing for primary cervical cancer screening (primary); attitudes and patient perceptions towards HPV testing and receipt of HPV positive screen results (secondary).
Results: Most respondents (63%) were accepting of HPV testing, with the majority (69%) accepting screening to begin at age 30 years with HPV testing. Only half of participants (54%) were accepting of an extended screening interval of 4-5 years. In multivariable logistic regression, women who received an HPV positive screen test result during the trial (OR=1.41 95% CI 1.11 to 1.80) or were older (OR=1.01, 95% CI 1.00 to 1.02) were more likely to report HPV testing as acceptable.
Conclusions: In this evaluation of acceptability and attitudes regarding HPV testing for cervix screening, most are accepting of HPV testing for screening; however, findings indicate heterogeneity in concerns and experiences surrounding HPV testing and receipt of HPV positive results. These findings provide insights for the development of education, information and communication strategies during implementation of HPV-based cervical cancer screening.
Trial Registration Numbers: ISRCTN79347302 and NCT00461760.
Competing Interests: Competing interests: MK and AJC were principal investigators, and GSO, DvN and ELF were coinvestigators on industry-funded (Hologic Inc and Roche) investigator-led adjunct studies to the HPV FOCAL trial, designed to compare the performance of different HPV testing assays. No investigators personally benefitted financially. Funding for these adjunct studies was not applied to the operation of the HPV FOCAL results presented in this paper. ELF served as an occasional advisor for companies involved with HPV vaccines (Merck, GSK) and HPV diagnostics (Roche). He also holds a patent 'DNA methylation markers for early detection of cervical cancer', registered at the Office of Innovation and Partnerships, McGill University, Montreal, Quebec, Canada.
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