Cervical Cancer Screening With Human Papillomavirus Self-Collection Testing in an Opioid Treatment Program

Importance Individuals with opioid use disorder and substance use disorder have lower cervical cancer screening rates than the general population. Human papillomavirus (HPV) self-collection testing provides opportunities to expand screening access to previously unreached patient populations. Objectives To assess the feasibility and uptake of incorporating HPV self-collection testing for cervical cancer screening into routine care for patients with opioid use disorder and substance use disorder, and to track the rates of high-risk HPV and guideline concordant follow-up care in this population. Design, Setting, and Participants This prospective cohort study was conducted from June 24, 2024, through December 31, 2025, at We Care Daily Clinics, a federally certified opioid treatment program (OTP) and American Indian Health Facility in Auburn, Washington. Eligible patients were 25 years or older, had a cervix, and were either overdue for cervical cancer screening or unsure of their last screening. Intervention Screening using self-collection kits was offered during the patient’s annual wellness visit, and self-collection occurred privately in the clinic restroom. Samples were analyzed for 14 high-risk HPV types at a laboratory. Screened patients with HPV-positive results received education and recommendations for guideline-concordant care. OTP staff facilitated patient referrals to local clinicians for gynecologic services, and follow-up was tracked. Main Outcomes and Measures The primary outcomes were the rates of HPV self-collection testing uptake, HPV positivity, and successful linkage to follow-up care. Results A total of 194 patients (median [range] age, 41 [25-65] years) were evaluated. Of 174 patients (89.7%) eligible for cervical cancer screening, 158 (90.8%) completed HPV self-collection testing. There were 0 unsatisfactory test results, and 128 patients (81.0%) had HPV-negative results, 7 (4.4%) had HPV-16– or HPV-18–positive results, and 23 (14.6%) had positive results for other high-risk HPV types (non–HPV-16 or HPV-18 types only). Of the 30 patients with HPV-positive test results, 2 (6.7%) were lost to follow-up and 12 (40.0%) completed follow-up to date, which often required multiple coordination attempts by clinicians. The remaining 16 of 30 patients (53.3%) are currently actively engaged in various stages of referral and scheduling. Conclusions and Relevance In this cohort study, incorporation of cervical cancer screening into an OTP using HPV self-collection testing was feasible with high patient eligibility and uptake.