Psychosocial impact of inclusion of HPV test on the management of women with atypical squamous cells of undetermined significance: a study within a randomised pragmatic trial in a middle-income country

Abstract

Objective: To assess the psychosocial impact of human papillomavirus (HPV) testing, colposcopy, and Pap-smear, as triage strategies after a Pap-smear with atypical squamous cells of undetermined significance (ASCUS). We also sought to evaluate the psychosocial impact based on the results of the strategies. Methods: Nested within a randomised pragmatic trial, which compared an immediate colposcopy, repeat Pap-smear, and high risk HPV test, we enrolled 675 women between 2012 and 2014. Participants completed surveys at enrollment, two weeks after triage test results, and 1 year thereafter to assess cervical cancer and HPV knowledge, self-esteem, anxiety and HPV impact (HIP). Results: Knowledge, self-esteem, anxiety and HIP improved with no differences among arms. At the baseline, 31.4% and 32.7% of the participants had state anxiety and trait anxiety, respectively, which decreased to 10.7% and 13.3% in the last survey. Compared to HPV-negative women, HPV-positive women in the second survey had worse HIP scores (HPV–: M 22.9 [SD: 15.20]; HPV+: M 35.9 [SD: 19.91]; p < 0.001), trait anxiety (HPV–: M 15.4 [SD 12.73]; HPV+: M 22.9 [SD 13.29]; p = 0.001), and state anxiety (HPV-: M 10.7 [SD 11.25]; HPV+: M 21.4 [SD 14.81]; p < 0.001). Conclusions: HPV testing as a triage strategy for women with ASCUS does not differ from colposcopies or Pap-smears in terms of psychosocial outcomes.

Highlights

• HPV testing is suitable as a triage strategy for women with ASCUS.

• Women with ASCUS need education and access to psychosocial support.

• HPV-positive women as well as women with public health insurance are more in need of psychosocial support.

Keywords:

• Atypical squamous cells of the cervix
• triage
• human papillomavirus
• psychosocial factors

ClinicalTrials.gov Identifier:

• NCT02067468

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Committee for Research Development (CODI, for the term in Spanish) at the Universidad de Antioquia; Fondo de Investigación Docente of the Facultad Nacional de Salud Pública, Universidad de Antioquia; additionally, ASCUS-COL was supported by the Departamento Administrativo de Ciencia, Tecnología e Innovación Colombiano (COLCIENCIAS) (Grant 1115-459-21657).