At-home cervical cancer screening & strategies to enhance engagement with the care pathway for under-screened populations

Cervical cancer is caused by persistent infection with human papillomavirus (HPV). It can be prevented with early detection through regular screening. Irregular or non-attendance to screening is one of the key barriers to further reducing cervical cancer rates in BC. HPV DNA testing is an evidence-based, highly sensitive, and effective way to screen for cervical cancer, where women can collect the sample for testing at home (HPV self-collection).

This project will look to HPV DNA testing as the best way to implement at-home cervical cancer screening for under-screened populations in BC.

Two implementation approaches will be used:

1. CervixCheck, an online service for at-home cervical cancer screening for women who do not regularly attend screening, piloted in selected family medical clinics in Surrey, BC and in northern BC in partnership with Métis Nation BC.
2. At-home screening piloted in First Nations community health centres in partnership with Carrier Sekani Family Services in rural northern BC.

By offering women an alternative to clinician collected samples for screening, this work can address many of the personal, geographic, historical and system-level barriers women face. However, as with other screening programs, HPV screening identifies women most at risk for progressing to cervical cancer, and is not a diagnostic tool in itself. Therefore, it is necessary to examine implementation and evaluate engagement in the full pathway of screening, diagnosis, treatment, and follow-up.

Through an implementation science approach, this project aims to:

1. Determine strategies to optimally engage under-screened women through the full pathway of screening, diagnosis, treatment and follow-up, primarily with colposcopy.
2. Assess the needs, gaps, and facilitators at the user, clinical, and health system levels to inform adaptability for other settings and contexts in the province.

Quantitative and qualitative methods will be applied, using the Quality Implementation Framework to inform evaluation design.

The outcomes for this project will be adoption, penetration, fidelity, and safety. Planning and development is already underway for the pilot implementation of CervixCheck. A critical aspect of this approach will be to assemble a team of stakeholders at the community level in pilot sites including patient advocates and physician and nursing leads, as well as at the health system level at the BC Cancer Cervical Cancer Screening Program and the BC Colposcopy Program.