Introduction Objective: to assess acceptability and adherence to cervical cancer screening algorithms based on self-collected HPV testing among hard-to-reach women in Colombia

Methods a randomized trial with three arms included: 1) HPV and pap-smear samples collected by clinicians in one visit and followed by colposcopy/biopsy and treatment; 2) HPV self-collection followed by colposcopy/biopsy and treatment; and 3) HPV self-collected followed by ablative treatment. Women 30 to 65 years without history of cervical cancer screening in the previous 3-years were invited to participate. Invitation and sample collection were planned by home visits and by mail. Acceptability was defined as percentage of women tested among invited, and adherence as percentage of women compliant with the diagnostic and treatment workup among HPV-positive women

Results No women could be recruited as planned given the low efficacy for home visits and mail/post. Alternative strategies were implemented including invitation by phone call, in-person invitation in health centers, and screening campaigns. Two hundred and fifteen women were included. The patients recruited in arms 1, 2 and 3 were 68, 72, and 75, respectively. 4.7% of women of the target population were reached by call, and 21.1% of women attending the screening campaigns were eligible. Acceptability was 74.4%, 94.7%, and 92.8% with the phone calls, in-person invitation, and screening campaigns respectively. the compliance with the diagnostic work-up was 100.0% and 53.3% in arms 1 and 2. Treatment compliance was not assessable

Conclusion/Implications HPV self-collection is highly acceptable; however, coverage of hard-to-reach populations is challenging for scenarios without organized programs