Improving Cervical Cancer Outcomes in Disadvantaged Populations: Using HPV Self-Sampling to Increase AccessibilitY, Equity, and Participation in Scotland’s National Cervical SCREENing Programme- AYE-SCREEN

Background Cervical cancer is preventable and curable with human papillomavirus (HPV) vaccination and screening. It is also a disease of inequity. In 2020, the World Health Assembly adopted the global strategy for elimination of cervical cancer. The target is <​4 cases per 100,000 people by 2099.

In Scotland, the least deprived are estimated to reach this target by 2032-36, while the most deprived will not reach it until 2057- 61.

The greatest disparity is seen in those born before 1990, who were never offered HPV vaccination and where increasing screening coverage is the key to prevention. Most cervical cancers occur in people who are under-screened.

Reasons why people do not attend screening include embarrassment, fear, and practical difficulties such as time, cost, and access to screening. Self-sampling for HPV could help overcome these barriers. It allows individuals to take their own sample at a time and place of their choice.

The Scottish Government would like to include HPV self-sampling in their Screening Programme for non-attenders, however, large-scale implementation studies are lacking in Scotland, especially among the most disadvantaged and most rural/remote populations.

Aims The AYEScreen Programme aims to determine to what extent offering self-sampling to non-attenders from the most disadvantaged and rural/remote populations can increase accessibility, equity, and participation in Scotland's Cervical Screening Programme, whilst examining the most (cost) effective, pathways for a Scotland-wide implementation.

Methods Work-package 1 will assess the acceptability of self-sampling.

This will include interviews with people and primary-care professionals living in areas with high socio-economic disadvantage and rural/remote locations.

Work-package 2 will offer a self- sampling kit to individuals who are overdue for screening when attending their GP for other reasons, or they will be invited by a nurse or text message to order a self-sampling kit by post. Uptake of these options will be compared to uptake in the usual cervical screening programme.

A questionnaire will be included with the self-sampling kits to understand more about the women who choose/refuse self-sampling and their previous barriers to participation.

Work-package 3 will evaluate the value for money of the different self-sampling options using a mathematical model, previously used by other countries, including England.

How results will be used The results will be used to generate evidence on the acceptability, (cost)effectiveness, and implementation of possible self-sampling pathways for non-attenders in Scotland. This will help the Scottish Government improve equity in their national Cervical Cancer Elimination strategy.