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BMC Infect Dis. 2017 Jun 23;17(1):444. doi: 10.1186/s12879-017-2539-x.

Comparing self- and provider-collected swabbing for HPV DNA testing in female-to-male transgender adult patients: a mixed-methods biobehavioral study protocol.

Author information

1
Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02215, USA. sari.reisner@childrens.harvard.edu.
2
Harvard Medical School, 25 Shattuck St, Boston, MA, 02215, USA. sari.reisner@childrens.harvard.edu.
3
Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02215, USA. sari.reisner@childrens.harvard.edu.
4
The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA. sari.reisner@childrens.harvard.edu.
5
Department of Family & Community Medicine, University of California, 2356 Sutter Street, San Francisco, CA, 94115, USA.
6
UCSF Center of Excellence for Transgender Health, 2356 Sutter Street, San Francisco, CA, 94115, USA.
7
The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
8
Johns Hopkins School of Public Health, 1340 Boylston Street, Boston, MA, 02215, USA.
9
Yale School of Public Health, New Haven, CT, USA.
10
Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA.
11
Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, USA.
12
Center for Health Equity Research (CHER), 121 S Main St, Providence, RI, 02903, USA.
13
Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
14
World Professional Association for Transgender Health, 2420 Clover St, Union City, CA, 94587, USA.
15
Harvard Medical School, 25 Shattuck St, Boston, MA, 02215, USA.

Abstract

BACKGROUND:

Cervical cancer, nearly all cases of which are caused by one of several high-risk strains of the human papillomavirus (hr-HPV), leads to significant morbidity and mortality in individuals with a cervix. Trans masculine (TM) individuals were born with female reproductive organs and identify as male, man, transgender man, or another diverse gender identity different from their female assigned sex at birth. Routine preventive sexual health screening of TM patients is recommended, including screening for cervical cancer and other sexually transmitted infections (STIs); however, as many as one in three TM patients are not up-to-date per recommended U.S.

GUIDELINES:

Among cisgender (non-transgender) women, self-swab hr.-HPV DNA testing as a primary cervical cancer screening method and self-swab specimen collection for other STIs have high levels of acceptability. No study has yet been conducted to compare the performance and acceptability of self- and provider-collected swabs for hr.-HPV DNA testing and other STIs in TM patients.

METHODS:

This article describes the study protocol for a mixed-methods biobehavioral investigation enrolling 150 sexually active TM to (1) assess the clinical performance and acceptability of a vaginal self-swab for hr.-HPV DNA testing compared to provider cervical swab and cervical cytology, and (2) gather acceptability data on self-collected specimens for other STIs. Study participation entails a one-time clinical visit at Fenway Health in Boston, MA comprised of informed consent, quantitative assessment, venipuncture for syphilis testing and HIV (Rapid OraQuick) testing, randomization, collection of biological specimens/biomarkers, participant and provider satisfaction survey, and qualitative exit interview. Participants are compensated $100. The primary study outcomes are concordance (kappa statistic) and performance (sensitivity and specificity) of self-collected vaginal HPV DNA specimens vs provider-collected cervical HPV swabs as a gold standard.

DISCUSSION:

This study addresses critical gaps in current clinical knowledge of sexual health in TM patients, including comparing alternative strategies for screening and diagnosis of cervical cancer, hr.-HPV, and other STIs. Findings have implications for improving the delivery of sexual health screening to this often overlooked and underserved patient population. Less-invasive patient-centered strategies may also generalize to other at-risk cisgender female populations that face barriers to timely and needed STI and cervical cancer screening.

TRIAL REGISTRATION:

ClinicalTrials.gov ID: NCT02401867.

KEYWORDS:

Cervical cancer; Female-to-male; HPV; Prevention; Screening; Sexually transmitted infections (STIs); Testing; Transgender

PMID:
28645254
PMCID:
PMC5481878
DOI:
10.1186/s12879-017-2539-x
[Indexed for MEDLINE]
Free PMC Article

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