Practitioners support and intention to adopt universal access to self-collection in Australia's National Cervical Screening Program.

OBJECTIVE: Primary care practitioners are crucial to engaging people in Australia's national cervical screening program. From July 2022, practitioners have been able to offer all screen-eligible people the choice to collect their own self-collected sample; an option introduced to increase equity. This study explored how practitioners are intending to incorporate universal access to self-collection into their clinical care. METHODS: Semi-structed interviews with 27 general practitioners, nurses, and practice managers from 10 practices in Victoria, Australia conducted between May and August 2022. Interviews were deductively coded, informed by the Consolidated Framework for Implementation Research. The Diffusion of Innovations theory was used to categorise intention to provide self-collection. RESULTS: Participants were supportive of universal access to self-collection, citing benefits for screen-eligible people and that it overcame the limited adaptability of the previous policy. Most participants' practices (n = 7, 70%) had implemented or had plans to offer the option for self-collection to all. Participants deliberating whether to provide universal access to self-collection held concerns about the correct performance of the self-test and the perceived loss of opportunity to perform a pelvic examination. Limited time to change practice-level processes and competing demands within consultations were anticipated as implementation barriers. CONCLUSIONS: The extent to which self-collection can promote equity within the program will be limited without wide-spread adoption by practitioners. Communication and education that addresses concerns of practitioners, along with targeted implementation support, will be critical to ensuring that self-collection can increase participation and Australia's progression towards elimination of cervical cancer.

The Implementation Experience of COVID-19 Rapid Antigen Testing in a Large-Scale Construction Project in Victoria, Australia.

The coronavirus (COVID-19) pandemic has caused major disruptions to industries and workplaces. Rapid Antigen Tests (RATs) for COVID-19, which allow individuals to self-administer tests and receive timely results without laboratory testing, provide the opportunity for surveillance testing of asymptomatic individuals in non-medical settings. However, the literature offers few lessons regarding how to create enabling conditions for effective and sustainable implementation in a workplace setting. Guided by the RE-AIM framework, we assessed factors associated with the adoption, implementation, and maintenance of mandatory RAT in a large-scale construction project in Victoria, Australia. We used a mixed methods approach involving site observation, worker surveys (n = 30), and interviews with 51 site workers and managers to understand the implementation experience. Factors which facilitated adoption included easy, non-invasive testing procedure; sense of workplace safety; and strong backing by management and acceptance by workers that RATs helped limit COVID-19-related lost days of work. Gaps in knowledge and adherence to testing protocols, logistical challenges (test kit supply, observation of test results), and low appetite for long-term, mandatory testing emerged as challenges for effective implementation and sustainability. As RAT becomes normalized in a range of workplace settings, strategies will be required to support the sustainability of implementation, including longer-term acceptability of surveillance testing and adherence to testing protocols. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-023-00085-4.

Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence.

PURPOSE: Although cervical cancer is a disease of inequity, it can be eliminated as a public health problem through vaccination, screening, and treatment. Human papillomavirus vaginal self-collection cervical screening is a high-performance test that can increase reach of screening. This review describes the different contexts and models of care used to pilot or implement self-collection within the Asia-Pacific, measures the extent that implementation outcome measures are reported and, where available, summarizes key implementation findings. METHODS: A scoping review was conducted by searching five databases of the peer-reviewed literature on June 20, 2022. Two researchers assessed eligibility and extracted data independently to the model of care used and the Conceptual Framework for Implementation Outcomes. A mixed-method consolidation of findings (quantitative: count and frequencies; qualitative: content analysis) was undertaken to narratively report findings. RESULTS: Fifty-seven articles, comprising 50 unique studies from 11 countries and two special autonomous regions, were included; 82% were conducted in trials. The implementation of self-collection was conducted in low- (2%), lower-middle- (32%), upper-middle- (32%), and high-income (35%) settings, with 10 different delivery models used; 80% delivered through practitioner-supported models with diversity in how samples were processed, and treatment was offered. Acceptability (73%) and appropriateness (64%) measures were most reported, followed by adoption (57%), feasibility (48%), and fidelity (38%). Only 7% of articles reported implementation cost or penetration measures. No articles reported sustainability measures. CONCLUSION: The literature confirms that self-collection cervical screening has been implemented within the Asia-Pacific region, with evidence demonstrating that it is acceptable and appropriate from the user's perspective. Well-designed, high-quality implementation trials and real-world evaluations of self-collection that report the breadth of implementation outcomes can support the progression toward the elimination of cervical cancer.