Does mailing unsolicited HPV self-sampling kits to women overdue for cervical cancer screening impact uptake of other preventive health services in a United States integrated delivery system?
Menée aux Etats-Unis sur la période 2014-2016 auprès de 16 590 femmes n'ayant subi aucun test Pap depuis au moins 3 ans (âge : 30-64 ans), cette étude analyse l'effet, sur leur recours à d'autres services de prévention (mammographie, dépistage du cancer colorectal, dépistage de la dépression, vaccin contre la grippe), d'un envoi postal d'un kit non sollicité d'auto-échantillonnage du papillomavirus humain (HPV) pour augmenter le dépistage du cancer du col de l'utérus
Women overdue for cervical cancer screening often have other preventive care gaps. We examined whether mailing unsolicited human papillomavirus (HPV) self-sampling kits to increase cervical cancer screening impacted receipt of other preventive services women were due for: mammography, colorectal cancer (CRC) screening, influenza vaccination, depression screening, and diabetic HbA1c monitoring. From 2014 to 2016, 16,590 underscreened women were randomized to receive a mailed kit or usual care Pap reminders within Kaiser Permanente Washington. We used logistic regression to estimate odds ratios (ORs) of preventive services receipt within 12-months between the intervention vs. control arms, and within the intervention arm (comparing those returning a kit vs. attending Pap vs. nothing), adjusting models for demographic variables. There were no significant between-arm differences in uptake of any of the preventive services: intervention vs. control: mammography OR = 1.01 (95% confidence interval:0.88–1.17), CRC screening OR = 0.98 (0.86–1.13), influenza vaccination OR = 0.99 (0.92–1.06), depression screening OR = 1.07 (0.99–1.16), HbA1c OR = 0.84 (0.62–1.13). Within the intervention arm, preventive services uptake was higher in women who completed cervical cancer screening vs. did not, with stronger effects for women who attended Pap: Pap vs. nothing: mammography OR = 11.81 (8.11–17.19), CRC screening OR = 7.31 (5.57–9.58), influenza vaccination OR = 2.06 (1.82–2.32), depression screening OR = 1.79 (1.57–2.05), HbA1c OR = 3.35 (1.49–7.52); kit vs. nothing: mammography OR = 2.26 (1.56–3.26), CRC screening OR = 5.05 (3.57–7.14), influenza vaccination OR = 1.67 (1.41–1.98), depression screening OR = 1.09 (0.89–1.33), HbA1c OR = 1.23 (0.57–2.65). Mailing HPV self-sampling kits to underscreened women did not negatively impact uptake of other preventive services. However, overall preventive service uptake was the highest among women who attended in-clinic cervical cancer screening.
Preventive Medicine 2021