Grant: CIHR-ICR / Cancer Research Society Partnership - Res. Gr. Cancer Prev.

Background: Cervical cancer is a known outcome of oncogenic Human Papillomavirus (HPV), a common sexually transmitted infection. The use of HPV testing is recognized as the most effective screening method for cervical cancer prevention. Worldwide, cervical cancer prevention programs (including Ontario) have, or are, transitioning from cytology screening to HPV testing as a primary screening method. Current State of Knowledge: With the integration of primary HPV testing forthcoming, it is estimated that there will be a 2.3-13.1% increase in colposcopy referrals, which in Ontario, would mean an additional 2,300-13,000 colposcopy appointments annually. Colposcopy is an examination of the cervix through visual inspection and in some instances includes a colposcopic-direct biopsy to assess for absence or presence of cervical intraepithelial lesions. Approximately 85-90% of individuals referred to colposcopy will be low risk for the development of cervical cancer. As a consequence, primary HPV testing will lead to less access or longer wait times for those who need timely care - primarily those who are at a high risk of having cervical precancer. While colposcopy is an important tool in cervical cancer prevention, it also has harms such as pain, anxiety, unnecessary biopsies and interventions. Therefore, there is an urgent need for real-world strategies and clinical utility data to reduce unnecessary over-utilization of colposcopy services by low-risk patients to not only decrease the burden of future appointments on colposcopy but also potentially reduce burden, stress, and anxiety in individuals who require this procedure. The use of HPV self-collection may be of value in the colposcopy episode of care to identify those at elevated risk of cervical cancer. Alongside the colposcopy exam, HPV test results provide crucial information needed for risk stratification. Currently, results of the HPV test are not available to the practitioner during the episode of colposcopy care and therefore the practitioner cannot provide discharge or follow-up instructions at the time of the colposcopy appointment. The utilization of HPV-DNA tests (self-collected) completed prior to the colposcopy appointment can provide critical information to the clinician - at the time of the clinical encounter - which would allow the clinician to close out the episode of care at the time of the appointment. In addition, HPV self collection has shown to be an acceptable method in primary screening and a valuable tool to increase engagement with the screening program. While the use HPV self-collection has been examined during the colposcopy appointment, it is crucial to understand how to best integrate the timing of HPV self-collection safely into current colposcopy care pathways and to determine feasibility, adherence, and acceptability. Purpose: The aim of this study is to examine physician and patient feasibility, adherence, and acceptability of utilizing HPV self collection at home prior to attendance at colposcopy.