At-Home Self-Collection Testing Could Expand STI and HPV Screening for Underserved Women
Researchers from the UNC School of Medicine, the Gillings School of Global Public Health, and the UNC Lineberger Comprehensive Cancer Center have published new findings showing that at-home self-collection testing could play a major role in improving screening for sexually transmitted infections (STIs) and human papillomavirus (HPV), especially among women who are often missed by traditional health care systems.
The study, published in JAMA Network Open, focuses on a simple but impactful idea: mailing women self-collection kits that allow them to test themselves at home for HPV and several common STIs, instead of requiring clinic visits. The results suggest this approach could help close long-standing gaps in preventive care, particularly for low-income and under-screened women.
Who the Study Focused On
The research included 327 low-income women living across 22 counties in North Carolina. All participants were overdue for cervical cancer screening, making them part of a population that public health programs consistently struggle to reach.
Many women in this group face overlapping barriers to care, including limited access to clinics, transportation challenges, work and caregiving responsibilities, and discomfort with in-person pelvic exams. These same barriers often affect both cervical cancer screening and STI testing, which is why the researchers chose to evaluate a combined testing approach.
Each participant received a mailed self-collection kit that allowed them to collect cervicovaginal samples at home. The samples were then tested for high-risk HPV and several common STIs, including chlamydia, gonorrhea, and trichomoniasis.
Key Findings From the Testing
The results revealed a significant burden of undiagnosed infections:
- Nearly one in six participants tested positive for at least one non-HPV STI
- A similar proportion tested positive for HPV
- About 2% of participants tested positive for both HPV and another STI
These findings highlight how much infection may go undetected when women are unable or unwilling to access clinic-based screening. Importantly, many of the women who tested positive reported no recent symptoms, reinforcing the role of routine screening in identifying infections early.
Risk Factors Identified in the Study
The researchers also analyzed demographic and behavioral factors associated with higher STI risk. Several patterns stood out clearly.
Women were more likely to test positive for an STI if they:
- Identified as non-Hispanic Black
- Reported having two or more sexual partners in the past year
- Were single, rather than married or partnered
- Were current smokers
These factors align with broader public health research showing that structural inequities, access barriers, and social determinants of health strongly influence STI risk and detection rates. The findings reinforce the need for screening strategies that are designed specifically for populations facing systemic disadvantages.
Follow-Up Care Remains a Challenge
Among participants who tested positive for HPV or another STI, about two-thirds successfully received follow-up care. While this shows that home testing can effectively identify infections, it also highlights a remaining challenge: connecting people to treatment after diagnosis.
The researchers note that mailing self-collection kits is only one part of the solution. Strong systems for follow-up communication, treatment referrals, and patient navigation are essential to ensure that positive test results translate into better health outcomes.
Strong Acceptance From Participants
One of the most encouraging findings from the study was how positively participants viewed the self-collection approach.
More than 80% of women said they would prefer future screening that tests for both HPV and STIs at the same time using a single at-home kit. This high level of acceptance suggests that combined testing is not only feasible, but also aligned with patient preferences.
The convenience of home testing, combined with the privacy it offers, appears to reduce many of the psychological and logistical barriers associated with clinic-based exams.
Why Combined HPV and STI Screening Matters
Women who are under-screened for cervical cancer often face the same obstacles that limit access to STI testing. By combining both screenings into one self-collection kit, health systems may be able to maximize outreach while minimizing burden on patients.
This streamlined approach could:
- Increase overall screening rates
- Identify multiple health risks in a single step
- Reduce missed opportunities for preventive care
- Improve early detection of infections linked to long-term complications
HPV is a known cause of cervical cancer, while untreated STIs can lead to pelvic inflammatory disease, infertility, pregnancy complications, and increased HIV risk. Detecting these conditions earlier can significantly improve outcomes.
How This Fits Into Broader Research
This study builds on earlier research from the same group showing that mailing HPV self-collection kits nearly doubles cervical cancer screening rates among under-screened women compared to standard outreach methods.
Other studies have also demonstrated that self-collected HPV samples are highly accurate, with strong agreement between home-collected and clinician-collected specimens. As testing technology continues to improve, confidence in home-based screening methods has grown.
Cost-effectiveness analyses suggest that mailed self-collection programs can be a practical investment for health systems, especially when they reach populations that rarely engage with traditional care.
Public Health Implications
The findings arrive at a time when public health agencies are increasingly exploring alternative screening models to address widening health disparities. At-home self-collection testing represents a shift toward patient-centered preventive care, where services are designed around people’s real-world constraints rather than ideal clinic attendance.
By reducing reliance on in-person visits, this approach could be especially valuable in rural areas, underserved communities, and settings with limited health care infrastructure.
While challenges remain around follow-up and treatment access, the study makes a strong case that self-collection testing is a powerful entry point for engaging women who have historically been left out of routine screening programs.
What Comes Next
Researchers emphasize that further work is needed to improve systems that support follow-up care, ensure timely treatment, and integrate self-collection testing into existing health care frameworks. However, the evidence so far suggests that one-step, combined testing platforms could become a key tool in reducing disparities in women’s health.
As health systems look for scalable and equitable solutions, at-home self-collection testing may represent a future where preventive care is simpler, more accessible, and more responsive to women’s needs.
Research paper: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2843541
