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Table 1.  

CFIR constructa Theme Illustrative quotes on benefits of HPV self-collection
Individual characteristics Increase screening rates and care reach [S]elf-testing theoretically will increase the amount of people that you screen. . . . . So, if you allow people to self-swab . . . they are more likely to want to do it even if they do it onsite. They may go in the bathroom and swab and bring it out. (Focus group 1 [small, rural])
Acceptability

• I would like the idea only if the rollout of the test ensures that patients have the information to perform the self-collection, demonstration . . . [with] equity and health literacy around the entire process . . . especially for the populations of patients we serve. I believe in expanding access and meeting patients where they are, and if that does that and increases screening, that’s excellent, but if it’s just checking a box, no way. (Focus group 6 [medium, rural])
• [I]t can definitely increase access to care. . . . [S]pecimen swabs can be mailed to the patient’s home, they can do a self-collection . . . then mail those specimens back out to the laboratory facility, or the health center, who would then process them. (Focus group 3 [large, rural])

Feasibility [I]t’s a good idea comparing it to . . . our colorectal cancer screening. . . . [O]nce we started offering free testing, they didn’t have to come in for an appointment for it. They could . . . pick up the FIT [fecal immunochemical test] test and . . . bring it back . . . later, my numbers improved significantly. (Focus group 4 [medium, urban])
Intervention characteristics/implementation process Kit distribution in clinic The kit at the clinic when they come in … for any reason. They’re able to do it in the clinic. It’ll improve our numbers. (Focus group 4 [medium, urban])
Kit distribution via mail [We can] look through our registry and determine who would be eligible for that and mail those out or call them and let them know we’ve mailed it. (Focus group 5 [large, rural])
Kit distribution via community outreach events Send providers out to the community. . . . I think that the clinic would definitely allow time if that was something that we showed interest in. (Focus group 2 [small, urban])
Obtaining results for self-collected tests [B]ut if it’s a company that’s directly distributing the kits, they’re likely to be sending us reports rather than where we’re referring out. . . . So, it may actually be easier to track. (Focus group 1 [small, rural])
Inner setting Timesaver

• [I]t could be a . . . provider timesaver per visit. (Focus group 2 [small, urban])
• I think the value would lie in freeing up clinic appointments and time. . . .[I]f you have a negative HPV, that’s a time that we could move on not having to do the Pap. So, I think that’s the value . . . and knowing we’ve . . . screened. (Focus group 5 [large, rural])

Financial impact/billing [If] we wouldn’t be doing the billing for the tests . . . You would get more tests delivered to the patients. While they’re [patients] here, you just fill out the paperwork, have them sign, send it back with the billing information, and then they mail it back to the company. It would work better, especially if there’s no fee for storing it or having it in office. (Focus group 1 [small, rural])

Table 1. Benefits of Implementing Self-Collection for HPV Testing in Federally Qualified Health Centers: Results of Focus Groups (N = 6) Conducted Among Clinical Personnel (N = 45), North Carolina, January 2020–March 2021

Abbreviations: CFIR, Consolidated Framework for Implementation Research; HPV, human papillomavirus.
a The CFIR (14) considers implementation-related factors in 5 major domains: 1) inner setting (potential facilitators and barriers that would affect willingness to implement a proposed intervention), 2) individual characteristics (perceived benefits to and potential areas of pushback against adopting a proposed intervention and appropriateness for patients’ needs), 3) outer setting (external pressures, performance metrics, or other considerations that would encourage or disc!importantourage efforts to improve a proposed intervention among patients), 4) intervention characteristics (resources needed to implement a proposed intervention), and 5) implementation process (how staffing, scope of practice, and workflows may need to change to allow implementation).

Table 2.  

CFIR constructa Theme Illustrative quotes on concerns about HPV self-collection
Individual characteristics/inner setting Acceptability If they’re here, why not just do a Pap? I guess that’s . . . for us, we work in family medicine. So, it could be something that we give to them in addition. . . . But if they’re already gonna be on the OB [obstetrics] side, I don’t really see why they would need to do a self-collection for an OB appointment or even a gynecological appointment. (Focus group 2 [small, urban])
Accuracy and reliability

• [I]s the accuracy as far as detecting the HPV as well as actual cervical swabs? . . . Or if it doesn’t adequately screen them, then time has already been wasted. (Focus group 2 [small, urban])
• I would be more concerned about getting false negatives. (Focus group 1 [small, rural])
• I would be kind of concerned about that because you get one chance . . . to get a good vaginal exam and testing. . . . [D]o I want to risk them doing it themselves and not getting a good sample? And then I’m having to convince them to either do it themselves again or come in and have it done. (Focus group 1 [small, rural])
• [S]helf life would need to be decent if it costs a lot [and is] a simple tube and swab. (Focus group 1 [small, rural])

Reduction in direct patient–provider communication [If] we’re distributing these kits . . . they still need to come to their providers. I think if we’re just distributing things, it just is kind of a way to keep them from coming in for issues that may need to be addressed in other ways. (Focus group 2 [small, urban])
Financial impact: cost to center

• If we were to give them the kit while they were here . . . Do you bill it when you give it to them? Or do you bill it when you get it back? (Focus group 1 [small, rural])
• [If] we send them out, and don’t bill for them until they’re returned, I can see that being a big cost. . . . [A] lot of them may not be returned. So, we’re never gonna be able to bill the insurance for it. (Focus group 1 [small, rural])
• I think the payment structure and the support for it would be [one of] the two questions that have to be answered. (Focus group 5 [large, rural])
• That’s something that a lot of FQHCs [federally qualified health centers] struggle with because we don’t have funding for great EHRs [electronic health records]. And to get the necessary updates and everything, you have to pay all this money. And we just can’t do it. (Focus group 1 [small, rural])

Intervention characteristics/implementation process Kit distribution in clinic [I]f they’re in for something like a rash, and then you say . . . “Take this.”. . . [T]hat’s not going along with what you’re seeing them for, and it’s . . . part of an annual GYN [gynecologic] visit that you’re not even doing at that time. (Focus group 6 [medium, rural])
Kit distribution via mail I think we would just have to be really thoughtful about that process with the mail-out, just making sure that we’re hitting all avenues as far as explaining it to the patient, maybe doing some calls until it starts becoming more of a thing that people are like, “Oh, okay.” (Focus group 5 [large, rural])
Community outreach events

• I don’t know if that’s . . . how you need to distribute this is through a community outreach type-thing. That might scare them away. (Focus group 2 [small, urban])
• At our community day . . . usually during National Health Center Week . . . only two people came. (Focus group 4 [medium, urban])

Delivering test results

• [It’s] hard to track . . . incorrect phone numbers . . . mailing addresses . . . patients just not answering their phones or calling you back. (Focus group 1 [small, rural])
• [Y]ou would be surprised [by] the lack of knowledge people have. . . . I have to go through sometimes 10 to 15 min on the telephone explaining how your Pap may be normal, but your HPV is positive. (Focus group 2 [small, urban])
• [O]ur patients — if they have a patient portal — the moment any test results electronically back to the provider, it also automatically results back to the patient portal for that patient. . . . [T]hat’s good that they’re getting access to their results, but it’s also a big issue because now they can see results, and wonder what’s going on with those results before the provider even sees them – which can raise a big issue. (Focus group 3 [large, rural])
• We have a portal that nobody uses. . . . It’s not user friendly. (Focus group 1 [small, rural])

Workflow

• [W]hat kind of support would we receive in implementing it? Because there’s not enough of us to go around as it is now. (Focus group 5 [large, rural])
• As long as the results aren’t anything weird. As long as you know what you’re reading . . . how to read it. (Focus group 2 [small, urban])

Outer setting Quality measures

• [D]oes this even satisfy our quality measures? Is this even an approved test? (Focus group 6 [medium, rural])
• [Y]our biggest challenge is . . . does [this] … meet the HRSA [Health Resources and Services Administration] requirement for cervical cancer screening[?] . . . You get a little bit longer [between screening] if you have an HPV test, but you still have to have that cervical cytology to meet that guideline. . . . [U]ntil that changes, it’s sort of a hard sell. (Focus group 5 [large, rural])

COVID-19 [W]e’ve essentially prioritized COVID vaccinations. . . . For something that doesn’t meet a UDS [Uniform Data System] measure . . . to dedicate staff time to it in the COVID season is just probably not gonna happen. (Focus group 5 [large, rural])

Table 2. Concerns About Implementing Self-Collection for HPV Testing in Federally Qualified Health Centers: Results of Focus Groups (N = 6) Conducted Among Clinical Personnel (N = 45), North Carolina, January 2020–March 2021

Abbreviations: CFIR, Consolidated Framework for Implementation Research; HPV, human papillomavirus.
a The CFIR (14) considers implementation-related factors in 5 major domains: 1) inner setting (potential facilitators and barriers that would affect willingness to implement a proposed intervention), 2) individual characteristics (perceived benefits to and potential areas of pushback against adopting a proposed intervention and appropriateness for patients’ needs), 3) outer setting (external pressures, performance metrics, or other considerations that would encourage or discourage efforts to improve a proposed intervention among patients), 4) intervention characteristics (resources needed to implement a proposed intervention), and 5) implementation process (how staffing, scope of practice, and workflows may need to change to allow implementation).

Table 3.  

CFIR constructa and theme Illustrative quotes on benefits of HPV self-collection
Chief executive officers Senior-level administrators Chief medical officers
Individual characteristics/inner setting
Increase screening rates and care access

• I’d be very interested . . . in anything that can be done that would help us get the community healthier or . . . identify problems. (ID 005)
• I think being as creative and innovative as possible to make sure . . . how can we be unique and inviting self-collecting screenings for our patients. (ID 010)

• [Y]ou’d have a really good promise of increasing those testing rates if it’s something that's simple . . . [and] not costly. (ID 024)
• [L]ife is so hard on a lot of women because they have a hundred and one things that they’re doing. So, having something like this where they can simply do it at home or do a quick bathroom test, and some people are just terrified to come and do that. . . . Sometimes there is no woman in the clinic for months . . . [T]hat particular patient doesn’t feel comfortable going to the male physician. (ID 012)

• [I]t would definitely help our cervical screening rates. (ID 013)
• [F]or the target population that we would miss at those annual visits, that are not gonna come in regardless, there may be more an opportunity for them to follow up hopefully with those self-collection and need to come in, and are understanding kind of the urgency. (ID 022)
• [It] gives women more options to do cervical cancer screening, and . . . result in a higher percentage of women who are due for it, getting it. (ID 001)

Acceptability [I]f the tests were shown to be reliable and accurate and easy for patient use and cost-effective for both the center and the patient . . . [providers] would be on board with getting it done and wanting . . . it here and using it . . . a lot. (ID 008) [For] support inside, of course, you definitely have the CMO [chief medical officer] and our clinical director on board and provider staff and . . . the entire clinical department which involves providers and nurses. (ID 013)
Identify issues earlier [R]educe the risk of developing cancer or catching it early enough to prevent it or treat it. (ID 010) [W]e’d be able to pick up on the HPV. . . if we let the patient take it home as long as they would return it. (ID 006)
Promote patient inclusion in their own health and well-being

[O]pportunity to engage the patient so they see that they are an active participant in their own health. (ID 019)

• [P]eople can have a choice on what they feel like is the best [screening] option for them. (ID 001)
• [O]pportunity to have a conversation for the need for a more invasive test. And . . . a more shared decision about continuing on with the next step. (ID 022)

Implementation process/inner setting
Feasibility/workflow

• Probably not a lot [of change needed]. . . . [Y]ou could probably work that in with regular workflow. (ID 023)
• [T]he physicians that work in federally qualified health centers . . . are about educating their patients about that annual Pap smear [Papanicolaou test]. . . . I can see them easily incorporating [self-collection] into their discussion with their patients. (ID 023)

[W]e have the staffing to where we wouldn’t need to add additional staff. (ID 008)

• [W]e’ve been doing more telehealth. . . . So, we're already sending patients home with FIT [fecal immunochemical test) kits to do in their home. . . . [T]hat initiation was really quite easy. And I can see the HPV self-collection being just as easy and maybe even easier. (ID 009)
• I don’t actually think it would be very hard at all to start doing this in our clinics. (ID 001)

Able to operate at a support-level staff [Y]ou might even have your CMA [certified medical assistant] help with that, so they could be trained to instruct more, and it doesn’t have to be a provider. (ID 023) A lot of times, we can have the nurses help. . . . [I]f the nurse was the one seeing the patient, we can see a lot of women during the day. (ID 012) [T]hat can be done on more of a support staff level. It doesn’t necessarily have to really involve the physician if we have standing orders. Unlike . . . cytology where I have to do the procedure. (ID 009)
Intervention characteristics/implementation process
Kit distribution in clinic

• [I]f it’s in clinic, [it’s] less of an administrative burden. (ID 003)
• [S]end them to the bathroom or they can do it right there in the exam room as the provider leaves and then get it from them after they’re done. . . . I don’t . . . perceive a whole lot of barriers to it all. (ID 003)
• The provider and the nursing staff could educate the patient on how to do a self-collection test, . . . show them a diagram of the anatomy, and explain how to do the collection on that diagram. [T]hat patient would be right there in the office and can maybe even have a staff person present in the room while the patient self-collects and if having any problems or questions, the staff person can be right there in the room to help. (ID 014)

When the provider actually hands them one in the office and says, “You don’t want to get your Pap smear but this is a good other option,” and they walk them through it, we find we get the best results that way. So, if it’s actually sitting here in my office that I can actually hand a patient, that’s the best way to get it to them. . . . And they’ll go ahead and potentially just do it and deal with it . . . . [W]hen a provider talks to them, right then, there’s more of an urgency they feel. (ID 004) [O]ur goal is really to look at the quality and screening for every visit. And, so, any visit where they’re there, I can say, “[I]t looks like you’re due . . . for your cervical cancer screening, so why don’t I send this home with you, and this is what you do. You can mail it back, and we’ll let you know the results.”. . . [B]ut, in general, I also give them an opportunity to do the Pap smear with us if they prefer that. . . . [T]hey can have a choice. (ID 001)
Inner setting
Financial impact: funding [I]f we internally took this on as an improvement issue, as we are concerned about our cervical cancer screening rates, and we set it as a goal to improve, then we would dedicate resources to it . . . use our revenue . . . our profit. (ID 015)

Table 3. Benefits of Implementing Self-Collection for HPV Testing in Federally Qualified Health Centers: Results of Key Informant Interviews Conducted Among Chief Executive Officers, Senior-Level Administrators, and Chief Medical Officers (N = 18), North Carolina, May–September 2021

Abbreviations: —, no relevant quotes; CFIR, Consolidated Framework for Implementation Research; HPV, human papillomavirus.
a The CFIR (14) considers implementation-related factors in 5 major domains: 1) inner setting (potential facilitators and barriers that would affect willingness to implement a proposed intervention), 2) individual characteristics (perceived benefits to and potential areas of pushback against adopting a proposed intervention and appropriateness for patients’ needs), 3) outer setting (external pressures, performance metrics, or other considerations that would encourage or discourage efforts to improve a proposed intervention among patients), 4) intervention characteristics (resources needed to implement a proposed intervention), and 5) implementation process (how staffing, scope of practice, and workflows may need to change to allow implementation).

Table 4.  

CFIR constructa and theme Illustrative quotes on concerns about HPV self-collection
Chief executive officers Senior-level administrators Chief medical officers
Individual characteristics/inner setting
Acceptability [I]f the FDA [US Food and Drug Administration] would approve some collection, I would hope the government would add that self-collection as an acceptable method within cervical screening measure and then the other insurance companies would also follow suit and accept it as well. (ID 014)

• [I]t would just really depend a lot on giving providers the proper information to educate their patients . . . making sure that we knew as much about the collection process, and the reliability of the test. (ID 001)
• Not today . . . there would need to be . . . more of a structure and understanding of the role for it . . . more . . . education on how it works . . . the sensitivities and specificities of the test, and how it would fit in with some of the . . . standard of care. (ID 022)

Are kits complementary or competitive? Papanicolaou test (Pap smear) replacement

• [P]robably more in competition. . . .[W]hat’s the point of doing a self-collection if you’re doing a Pap anyway? . . . [Y]ou can easily assess for HPV with the Pap [co-testing] as well. . . . [I]t would be just a waste to do both. (ID 014)
• [Replacing the Pap smear is] . . . what you don’t want to happen because there’s so much there that needs to be seen and . . . evaluated. (ID 023)

[C]omplementary if administered correctly . . . if you’re dealing with a patient who doesn’t want to even engage in sexual health and women’s health care. That’s barrier number one, and then you’re gonna add a more complex component of . . . a self-swab, and the patient doesn’t even want to have the exam, period. . . . [Y]ou can’t go from nothing to “now I want you to engage and do it yourself” overnight. (ID 019)

• A little bit in competition with one another. . . . Our Pap smears, now they automatically do HPV. . . . [M]aybe if you had a patient who didn’t want to do a Pap smear but would do a self-collection. (ID 006)
• [T]here may be a misconception of, “Well, this is all I have to do. I don’t necessarily need to follow up with [a Pap smear or] anything else.” (ID 022)

Accuracy and reliability [I]f their HPV was positive on self-collection, I’d say they’d need to undergo a dedicated pelvic exam by a health care provider and then also undergo a formal Pap smear as well . . . either with the PCP [primary care provider] . . . or GYN [gynecologist]. (ID 014) Yes [patient needs to be rescreened in clinic after positive HPV self-collection result] . . . whatever pertinent processes that are the best practices for positivity should ensue. (ID 019)

• [I]f they’re positive, they need a follow up — a Pap smear and a self-collection. (ID 022)
• [I]f somebody self-collects and their HPV’s negative, that doesn’t necessarily mean that those cells at the cervix would be normal. (ID 022)
• [Y]es [patient needs to be rescreened after positive HPV self-collection result]. . . . [I]t depends on their history. . . . [H]ave they had a history of dysplasia? HPV in the past that’s been consistent? (ID 018)Is that self-collection picking up higher-risk HPV or . . . just any type of HPV? (ID 022)
• [Patients who have positive test results from HPV self-collection kit] should need to be [rescreened] . . . just to make sure that those results were correct. (ID 006)
• [A]ssuming our specificity is good . . . we would move forward with next steps . . . as long as the test itself was statistically good, then I don’t think we’d repeat it. (ID 009)

Reduction in direct patient–provider communication [M]ake sure that folks were getting the rest of their preventative care too. Some of which will only be done if they’re in the office. (ID 009)
Financial impact
Billing/cost

• [We] have to look at the expense of the kits, how much it actually cost [and] factor that into how do we generate revenue to cover that? (ID 010)
• If we had to pay for those kits . . . [it would] reduce our ability to be able to be a participant. . . . [O]ur payer mix is very one-sided as far as Medicaid and self-pay patients. (ID 005)
• [W]ho’s paying for the test? . . . . How much does this test cost? If it’s a hundred dollars . . . that’s gonna be a problem if nobody’s paying for it. We could end up trying to get grants for it and do the same things that we do as a community health center to get these things into the hands of patients that can’t afford them. (ID 003)

[O]nce it’s approved, is that screening tool that BCCCP [Breast and Cervical Cancer Control Program] would pay for? You know, or is there a grant that pays for this for so long until data can be figured out? (ID 004) [B]udget-wise, our patients don’t pay anything out of pocket for their laboratories outside of their copay. . . . [W]e need just to think about from a budget perspective, how this looks versus our current cytology plus HPV and . . . if we needed to adjust that. (ID 009)
Number of patients seen in a day [I]f you [are] looking at [a] decrease [of] one, two, three, four, five patients a day, you [are] looking at close to an average of two hundred dollars, two hundred and fifty dollars per patient that comes through . . . [T]he price of the kit might be . . . cost-prohibitive for us . . . [F]inancially, we just have to be careful because we operate pretty close to our budget. (ID 005)
Intervention characteristics/implementation process
Kit distribution via mail [I]f we had to mail these out and do it . . . that will add an administrative burden to it. . . . If we had to send it out, find out who they are, mail it to them. You know, sometimes the address is incorrect. (ID 003)
Delivering test results [P]hone numbers change like the wind here . . . so the big barrier is getting ahold of patients to get that documented back to see what’s going on . . . even addresses have changed. (ID 006)
Workflow

• [F]rom the health center standpoint . . . [we] would have to do some training with the staff about it. In terms of billing and coding and that kind of thing. (ID 014)
• [There would need to be] administrative training around the EHR [electronic health record]. (ID 010)

• [O]n behalf of community health centers . . . we are overwhelmed with staff who have to wear multiple hats. (ID 015)
• [T]he clinical workflow will become more expansive and again addressing health literacy, hesitancy, education, and ensuring equity in approach. (ID 019)

• Right this very moment . . . staffing shortages . . . that might be worth a conversation to revisit. (ID 018)
• Staff, cultural work would have to be done with staff and providers. (ID 018)
• [Train staff] specifically just for the self-collection. (ID 022)
• [S]taffing would just be a real issue as far as the tracking and things of that nature. (ID 013)

Table 4. Concerns About Implementing Self-Collection for HPV Testing in Federally Qualified Health Centers: Results of Key Informant Interviews Conducted Among Chief Executive Officers, Senior-Level Administrators, and Chief Medical Officers (N = 18), North Carolina, May–September 2021

Abbreviations: —, no relevant quote; CFIR, Consolidated Framework for Implementation Research; HPV, human papillomavirus.
a The CFIR (14) considers implementation-related factors in 5 major domains: 1) inner setting (potential facilitators and barriers that would affect willingness to implement a proposed intervention), 2) individual characteristics (perceived benefits to and potential areas of pushback against adopting a proposed intervention and appropriateness for patients’ needs), 3) outer setting (external pressures, performance metrics, or other considerations that would encourage or discourage efforts to improve a proposed intervention among patients), 4) intervention characteristics (resources needed to implement a proposed intervention), and 5) implementation process (how staffing, scope of practice, and workflows may need to change to allow implementation).

CME / ABIM MOC

Self-Collection for Primary HPV Testing: Perspectives on Implementation From Federally Qualified Health Centers

  • Authors: Amanda Le, MPH; Catherine Rohweder, PhD, MPH; Stephanie Wheeler, PhD, MPH; Jennifer Lafata, PhD; Randall Teal, MA; Kara Giannone, MPH; MaryShell Zaffino, MD; Jennifer Smith, PhD, MPH
  • CME / ABIM MOC Released: 10/19/2023
  • Valid for credit through: 10/19/2024, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care clinicians, gynecologists, and other healthcare professionals who treat and manage women at risk for cervical cancer.

The goal of this activity is for members of the healthcare team to be better able to evaluate potential benefits of human papillomavirus self-collection from the perspective of federally qualified health center clinical staff and leadership.

Upon completion of this activity, participants will:

  • Assess the characteristics of human papillomavirus self-collection kits
  • Evaluate the potential benefits of human papillomavirus self-collection from the perspective of federally qualified health center clinical staff and leadership
  • Evaluate the potential liabilities of human papillomavirus self-collection from the perspective of federally qualified health center clinical staff and leadership
  • Distinguish the preferred means of mode of delivery for human papillomavirus self-collection kits


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Amanda Le, MPH

    Department of Public Health Leadership
    Gillings School of Global Public Health
    University of North Carolina
    Chapel Hill, North Carolina

  • Catherine Rohweder, PhD, MPH

    Center for Health Promotion & Disease Prevention
    University of North Carolina
    Chapel Hill, North Carolina

  • Stephanie Wheeler, PhD, MPH

    Center for Health Promotion & Disease Prevention
    University of North Carolina
    Lineberger Comprehensive Cancer Center
    University of North Carolina
    Chapel Hill, North Carolina

  • Jennifer Lafata, PhD

    Lineberger Comprehensive Cancer Center
    University of North Carolina
    Division of Pharmaceutical Outcomes and Policy
    Eshelman School of Pharmacy
    University of North Carolina
    Chapel Hill, North Carolina

  • Randall Teal, MA

    Lineberger Comprehensive Cancer Center
    University of North Carolina
    Connected Health Applications and Interventions (CHAI-Core)
    University of North Carolina
    Chapel Hill, North Carolina

  • Kara Giannone, MPH

    Lineberger Comprehensive Cancer Center
    University of North Carolina
    Connected Health Applications and Interventions (CHAI-Core)
    University of North Carolina
    Chapel Hill, North Carolina

  • MaryShell Zaffino, MD

    Blue Ridge Health
    North Carolina

  • Jennifer Smith, PhD, MPH

    Lineberger Comprehensive Cancer Center
    University of North Carolina
    Department of Epidemiology
    Gillings School of Global Public Health
    University of North Carolina
    Chapel Hill, North Carolina

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: Boehringer Ingelheim; GlaxoSmithKline; Johnson & Johnson

Editor

  • Ellen Taratus

    Editor
    Preventing Chronic Disease
    Atlanta, Georgia

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


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Interprofessional Continuing Education

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Preventing Chronic Disease. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0  AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC

Self-Collection for Primary HPV Testing: Perspectives on Implementation From Federally Qualified Health Centers

Authors: Amanda Le, MPH; Catherine Rohweder, PhD, MPH; Stephanie Wheeler, PhD, MPH; Jennifer Lafata, PhD; Randall Teal, MA; Kara Giannone, MPH; MaryShell Zaffino, MD; Jennifer Smith, PhD, MPHFaculty and Disclosures

CME / ABIM MOC Released: 10/19/2023

Valid for credit through: 10/19/2024, 11:59 PM EST

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Abstract

Introduction

Primary testing for high-risk human papillomavirus (HPV) by self-collection could result in higher rates of cervical cancer screening. Federally qualified health centers (FQHCs) in the US serve a large proportion of women who have low income and no health insurance and are medically underserved — risk factors for being insufficiently screened for cervical cancer. Although the implementation of self-collection for HPV testing is not yet widespread, health care entities need to prepare for its eventual approval by the US Food and Drug Administration. We conducted focus groups and interviews among clinical and administrative staff and leadership to gather data on key logistical concerns that must be addressed before implementing self-collection for HPV testing in FQHCs.

Methods

We identified focus group and interview participants from 6 FQHCs in North Carolina. We conducted focus groups with clinical and administrative staff (N = 45) and semistructured interviews with chief executive officers, senior-level administrators, chief medical officers, and clinical data managers (N = 24). Transcripts were coded by using codebooks derived from research questions and notes taken during data collection. Themes emerged on implementation of self-collection for HPV testing. We applied the constructs from the Consolidated Framework for Implementation Research (CFIR) to themes to identify domains of potential barriers and facilitators to implementation.

Results

Clinical personnel reported that offering self-collection for HPV testing is acceptable and feasible and can increase cervical cancer screening rates. Uncertainties emerged about accuracy of results, workflow disruptions, financial implications, and effects on clinic quality measures.

Conclusion

Implementing self-collection for HPV testing was considered feasible and acceptable by participants. However, important health service delivery considerations, including financial implications, must be addressed before integrating self-collection for HPV testing into the standard of care.