Overview

Embracing new technology and knowledge, VCS set about to provide evidence for new approaches to cervical screening. The iPap trial was Australia’s first evaluation of self-sampling in cervical screening for under and never screened women. Partners:
  • Melbourne School of Population and Global Health (University of Melbourne)
  • Cancer Council Victoria
  • Department of Oncology and Dysplasia (The Royal Women’s Hospital Vic)
  • Department of Obstetrics and Gynaecology (University of Melbourne)
  • Michael Murphy Research
  • Funded by NHMRC

Challenge

The trial aimed to:
  • determine whether home based HPV self-sampling increased participation in cervical screening when compared with a traditional reminder letter for a Pap test.
  • estimate the proportion of women who following a positive test had further investigations
  • document women’s experience and explore reasons for not participating

Solution

We conducted a randomized controlled trial to determine whether HPV self-sampling increases participation in cervical screening for never and under-screened (not screened in past 5 years) women when compared with sending a traditional reminder letter for a Pap test.  The trial included matching of electoral roll with Registry data to identify never and under-screened women, focus group testing of communication materials, monitoring of women with positive tests and surveys to determine the acceptability to women and reasons for not participating. Women were randomly allocated to self-sampling and Pap test reminder groups. Women in the self-sampling group were sent a kit through the mail asking them to complete the test and return via reply paid mail.  Women in the reminder letter group were encouraged to visit their healthcare provider for a Pap test. The results showed a response rate for the self-sampling kits mailed to the home to be 20.3% versus 6% for never screened and 11.5% versus 6.4% for under-screened compared to a reminder letter, demonstrating that self-sampling can be acceptable in the Australian setting and that most women who test positive will attend for further investigation. VCS presented the results at a self-sampling policy workshop organised by the Department of Health, providing input into the formation of policy for the renewed 2017 Cervical Screening Program.      Data from the study has been published in the International Journal of Cancer 2016 Jul 15;139(2):281-90 – “Home-based HPV self-sampling improves participation by never-screened and under-screened women: Results from a large randomized trial (iPap) in Australia”.