Clinician and patient experiences with opportunistic offer of HPV self-testing in Aotearoa New Zealand primary care clinics: interview and survey findings

Background To support the introduction of human papillomavirus (HPV) self-testing in the New Zealand National Cervical Screening Programme, an implementation study of opportunistic self-test offer was undertaken in primary care clinics, with a home testing option and centralised follow-up. We aimed to explore the experience of study clinicians and participants. Methods Primary care clinicians trained to offer the self-test were invited to semi-structured interviews exploring their perception of receptivity to the opportunistic offer of self-testing, and challenges and enablers to implementation. Thematic analysis was undertaken on transcripts. Participants (aged 30-69 years) were sent a link to an online follow-up survey after HPV result notification. Survey results were analysed using descriptive statistics with thematic analysis of free text responses. Participant recruitment and data collection occurred between November 2021 and January 2024. Results Of the 40 clinicians trained to offer self-testing, 12 primary care clinicians from six Auckland ethnically diverse primary care sites completed an interview. ‘Positive reception’ was the strongest theme with clinicians reporting that overwhelmingly, participants were receptive to the HPV self-test offer. The four enabler themes were: ‘supportive practice systems’, ‘importance of the discussion’, ‘testing options for women’ and ‘specialised support and consistency’. Key challenge themes in implementing opportunistic self-testing were ‘competing demands’and ‘communicating what it’s all about’. Of the 3524 study participants, 394 responded to the online survey. Most (93%) found the amount of information they received about HPV self-testing ‘about right’ and were comfortable about doing the self-test opportunistically (86%). Considering their next cervical screening, more respondents preferred home-based self-testing options than self-testing at a clinic (46% versus 37%). Conclusion Offering the HPV self-test opportunistically to people due for screening when they visited their GP for another reason was generally well received and feasible for clinic staff. The choice to take kits home for sampling was an enabler of participation. Supportive systems and resources for clinicians will be important if opportunistic HPV self-testing is offered more widely in primary care, including further consideration of a central specialist team to provide follow-up and support for home testing, and potentially for participants with HPV detected. Trial registration This study did not reach the ICJME or WHO criteria for clinical trial registration.