Outcomes after introduction of cervical cancer screening in an opioid treatment program (OTP) by offering HPV self-collect testing to an under-screened population

Individuals with opioid use disorder (OUD) have lower cancer screening rates. Cervical cancers are preventable through screening and treatment of human papillomavirus (HPV)-related pre-cancers. HPV self-collect tests provide opportunities to expand screening access to previously unreached populations, offering advantages of privacy, autonomy, and negating a clinic requirement for gynecological services. We evaluated a novel, low-barrier model for integrating HPV self-collect screening into a brick-and-mortar OTP and its four associated mobile medication units in a major metropolitan area in Washington state. Screening was offered with self-collection kits during annual medical update visits to eligible patients (those age 25 or above with a cervix who were overdue for screening or unsure) and collected privately in the clinic restroom. HPV swabs were analyzed at the University of Washington HPV Molecular Pathology Laboratory or Labcorp and included all 14 known high-risk HPV (hrHPV) types. Screened subjects with positive results received education and recommendations for guideline concordant care. Clinic staff facilitated referrals to local providers with gynecologic services and follow-up was tracked. The study's primary outcomes were the rates of screening uptake, HPV positivity, and successful linkage to follow-up care. From June 24, 2024 through October 31st, 2025, 186 patients were evaluated including 29 (15.6%) American Indian/Alaskan Native, 2 (1.1%) Asian, 20 (10.8%) Black, 2 (1.1%) Native Hawaiian/Pacific Islander, 125 White (67.2%) and 9 (4.8%) Hispanic. The majority were current (72.9%) or former (17.6%) tobacco users. Of 168 (90.1%) eligible for screening (median age 40 years, range 22-65 years), 150 (89.3% of those eligible) completed screening. There were no failed or inconclusive test results. Of 150 resulted tests, 120 (80%) were HPV-negative, 7 (4.7%) were HPV16/18+, and 23 (15.3%) were “other” (non-16/18) hrHPV+. Patients encountered a variety of structural and social barriers in following up hrHPV+ tests. Of the 30 hrHPV+ tests, no one has been lost to follow-up and 12 (40%) patients have completed follow-up, which often required multiple coordination attempts by providers. The remainder are in various stages of referral and scheduling. Providing cervical cancer screening was feasible in an OTP using HPV self-collection and resulted in high patient uptake. This population was both under-screened and high-risk with approximately double the hrHPV positivity rate found in most U.S. screening studies. Our patient-centered model promotes health equity and provides a scalable solution to reduce the burden of cervical cancer in under-screened communities.