Testing for human papillomavirus (HPV) through a mail-based self-test holds promise as a means to reach underscreened women, according to results of a study conducted among women in Appalachian Ohio and published in Sexually Transmitted Diseases. Response rates were high, as were levels of satisfaction for women who used the self-test.

This pilot study involved sending HPV self-tests to 103 women in Appalachian Ohio, aged 30 to 65 years, who had not received a Pap test within the past 3 years. The participants were randomly assigned 1:1 to either the intervention (detailed information and instructions written by the Health Outcomes through Motivation and Education [HOME] Project) or the control (generic information and instructions written by the manufacturer).

Of the overall sample, 78% (n=80) sent back their self-test for HPV; a return rate which was similar for both the intervention and control participants. Reasons for not returning the self-test included forgetting (27%), concern about pain associated with the test, not enough time, concern that they might incorrectly use it, and concern over receiving a positive result (13% each).

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Respondents reported high satisfaction and a positive experience with the self-test, with more than 90% reporting the test was easy to use, convenient and they would be willing to use an HPV self-test again and to recommend it to other women. Oncogenic HPV was detected in 26% of returned samples. During the study, only women who had returned their self-test received Pap tests. This rate was similar for the intervention (14%) and control (8%) groups, with an odds ratio (OR) of 1.91 (95% CI, 0.52-6.97). Women whose self-test detected a high-risk HPV type were more likely to receive a Pap test than those whose self-test did not detect a high-risk HPV type (33% vs 7%; OR=6.88; 95% CI, 1.76-26.82).   

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The researchers noted that a modest response rate and small sample size limited the scope of the analyses.

The study researchers concluded that “[mail]-based HPV self-testing is a potentially promising strategy for reaching underscreened women from Appalachian Ohio, about a quarter of whom are infected with a high-risk HPV type. Most women returned an HPV self-test as part of our mail-based program and subsequently reported very positive feedback about the self-testing process. Future efforts are needed to better understand how to optimize the success of mail-based HPV self-testing programs, including how to increase women’s attendance at follow-up visits after returning an HPV self-test.”


Reiter PL, Shoben AB, McDonough D, et al. Results of a pilot study of a mail-based HPV self-testing program for underscreened women from Appalachian Ohio [published online November 19, 2018]. Sex Transm Dis. doi: 10.1097/OLQ.0000000000000944