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Background <p>Cervical cancer screening guidelines in the United States have evolved with the introduction of human papillomavirus (HPV)-based modalities, including co-testing in 2012 and primary HPV testing in 2018, in addition to Pap-only screening. However, adoption of these modalities in federally qualified health centers (FQHCs) has been underexplored. We examined longitudinal patterns of HPV-based cervical cancer screening adoption (e.g., proportion screened with co- and primary HPV testing) across three FQHC systems in Washington and Idaho and explored factors associated with receipt of HPV-based modalities.</p> Methods <p>Using electronic health record data, we identified the first routine cervical cancer screening among 11,316 individuals from 2012–2022 across 25 clinics within three FQHCs. Screening modality at the screening was classified as Pap-only, co-testing, or primary HPV testing. We quantified the proportion of each screening modality by year and FQHC from 2012–2022 and used multivariable logistic regression to estimate associations of factors (age, race, ethnicity, rurality, insurance status, primary care visits, and FQHC) with HPV-based screening for 2012–2018 and 2018–2022 guideline periods.</p> Results <p>The proportion of up-to-date screening in 2022 was 34.0%, 22.7%, and 37.6% for FQHCs A, B, and C, respectively. Among individuals receiving their first routine screening from 2012–2022, 59.1% underwent Pap-only, 38.8% co-testing, and 2.0% primary HPV testing, respectively. Pap-only was nearly universal in 2012 but declined to 57.0% by 2022, while co-testing increased to 41.0%. Primary HPV testing remained &lt; 7.0% across all years and FQHCs. During the 2012–2018 guideline period, odds of co-testing (vs. Pap-only) were higher among Hispanic (aOR = 1.56; 95% CI, 1.35–1.80) and Black (aOR = 1.64; 95% CI, 1.18–2.28) individuals and screened at FQHC C (aOR = 4.21; 95% CI, 3.41–5.22). Odds were lower among rural (aOR = 0.20; 95% CI, 0.17–0.24) and uninsured patients (aOR = 0.51; 95% CI, 0.44–0.58). From 2018–2022, odds of co-testing were higher among individuals aged 40–59 and Black, lower at FQHC B (aOR = 0.48; 95% CI, 0.37–0.63), and higher at FQHC C (aOR = 1.34; 95% CI, 1.06–1.68).</p> Conclusions <p>Adoption of HPV-based screening modalities increased over time and varied by patients' rurality, race, and ethnicity. Lower adoption in some organizations may reflect limited capacity/resources for adopting newer screening modalities, which could impact equitable access to screening.</p>

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Predictors of routine HPV-based cervical cancer screening adoption in federally qualified health centers within a multi-state practice research network 2012–2022: retrospective observational study

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  • 发表日期：

    2026年7月21日

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  • Michelle B. Shin,
  • Connor R. Volpi,
  • Warren Szewczyk,
  • Peggy A. Hannon,
  • Paula Lozano,
  • Jennifer Tsui,
  • Allison M. Cole

摘要

Background

Cervical cancer screening guidelines in the United States have evolved with the introduction of human papillomavirus (HPV)-based modalities, including co-testing in 2012 and primary HPV testing in 2018, in addition to Pap-only screening. However, adoption of these modalities in federally qualified health centers (FQHCs) has been underexplored. We examined longitudinal patterns of HPV-based cervical cancer screening adoption (e.g., proportion screened with co- and primary HPV testing) across three FQHC systems in Washington and Idaho and explored factors associated with receipt of HPV-based modalities.

Methods

Using electronic health record data, we identified the first routine cervical cancer screening among 11,316 individuals from 2012–2022 across 25 clinics within three FQHCs. Screening modality at the screening was classified as Pap-only, co-testing, or primary HPV testing. We quantified the proportion of each screening modality by year and FQHC from 2012–2022 and used multivariable logistic regression to estimate associations of factors (age, race, ethnicity, rurality, insurance status, primary care visits, and FQHC) with HPV-based screening for 2012–2018 and 2018–2022 guideline periods.

Results

The proportion of up-to-date screening in 2022 was 34.0%, 22.7%, and 37.6% for FQHCs A, B, and C, respectively. Among individuals receiving their first routine screening from 2012–2022, 59.1% underwent Pap-only, 38.8% co-testing, and 2.0% primary HPV testing, respectively. Pap-only was nearly universal in 2012 but declined to 57.0% by 2022, while co-testing increased to 41.0%. Primary HPV testing remained < 7.0% across all years and FQHCs. During the 2012–2018 guideline period, odds of co-testing (vs. Pap-only) were higher among Hispanic (aOR = 1.56; 95% CI, 1.35–1.80) and Black (aOR = 1.64; 95% CI, 1.18–2.28) individuals and screened at FQHC C (aOR = 4.21; 95% CI, 3.41–5.22). Odds were lower among rural (aOR = 0.20; 95% CI, 0.17–0.24) and uninsured patients (aOR = 0.51; 95% CI, 0.44–0.58). From 2018–2022, odds of co-testing were higher among individuals aged 40–59 and Black, lower at FQHC B (aOR = 0.48; 95% CI, 0.37–0.63), and higher at FQHC C (aOR = 1.34; 95% CI, 1.06–1.68).

Conclusions

Adoption of HPV-based screening modalities increased over time and varied by patients' rurality, race, and ethnicity. Lower adoption in some organizations may reflect limited capacity/resources for adopting newer screening modalities, which could impact equitable access to screening.