Landmark New Zealand Study Shows HPV Self-Testing Drives Higher Cervical Screening Rates

A groundbreaking cluster-randomised trial conducted in Northland primary care practices has revealed that clinics offering human papillomavirus (HPV) self-testing achieve substantially higher screening coverage compared to traditional clinician-taken methods. The study, published in The Lancet Regional Health – Western Pacific, reported a 10.8% absolute increase in screening rates, with intervention clinics reaching 35.6% coverage versus 24.9% in control sites. This finding underscores the potential of self-testing to address longstanding gaps in New Zealand's National Cervical Screening Programme (NCSP), particularly among priority populations like Māori women.

Led by Professor Bev Lawton from Te Tātai Hauora o Hine – National Centre for Women's Health Research Aotearoa at Victoria University of Wellington, the research highlights how simple shifts in screening delivery can enhance participation without compromising safety. With nearly 43% of participants identifying as Māori, the trial's diverse cohort reflects Northland's demographics, making the results highly relevant for equity-focused health strategies.

Understanding HPV and Cervical Cancer in the New Zealand Context

Human papillomavirus (HPV), a common sexually transmitted infection, causes over 95% of cervical cancers worldwide. In New Zealand, cervical cancer disproportionately affects Māori and Pacific women, with incidence rates up to nine times higher in Pacific Islands compared to Australasia. Prior to 2023, the NCSP relied on clinician-performed cytology every three years for women aged 25-69, achieving coverage of around 67% – well below the 80% target needed for elimination goals.

The transition to HPV primary screening in September 2023 introduced self-testing options: a vaginal swab performed by the individual either in-clinic or at home. This innovation aligns with global WHO strategies for cervical cancer elimination by 2030, emphasizing accessible, non-invasive tools to boost uptake.

Study Design: Cluster-Randomised Approach in Real-World Clinics

From February 2022 to September 2023, 14 practices in Te Tai Tokerau Northland were randomised 1:1 to intervention or usual care arms, stratified by size and rurality. Intervention sites implemented community engagement, clinician training, and a universal self-test offer during any visit. If declined, clinician sampling was available as fallback. Usual care continued speculum-based cytology.

Of 22,511 eligible individuals (mean age 47.7 years), screening coverage served as the primary outcome, analysed via intention-to-treat with mixed models. The trial demonstrated superiority (risk difference 10.8%, 95% CI 4.7-16.9, p=0.0006) and non-inferiority to the -10% margin.

Key Results: Consistent Gains Across Demographics

Self-test uptake was robust, with intervention practices screening 35.6% of eligible attendees versus 24.9% in controls. Gains were evident across ages, ethnicities, and deprivation levels, critical for Māori (43.4% of cohort) who face historical barriers like access and cultural discomfort with speculums.

• Absolute risk difference: 10.8%
• Intervention coverage: 35.6% (SE 2.4)
• Control coverage: 24.9% (SE 2.0)
• No safety issues reported

Companion implementation research in metropolitan Auckland clinics corroborated feasibility, with 37.9% self-testing rates despite lower uptake in priority groups, emphasising need for return reminders.

Equity Focus: Empowering Underserved Māori and Pacific Women

New Zealand's screening inequities are stark: Māori coverage lags at 60-65%, Pacific at similar lows. Self-testing addresses barriers like embarrassment, time constraints, and rural distances by empowering individuals with privacy and convenience. The Northland trial's Māori-majority cohort showed broad benefits, aligning with prior acceptability studies from University of Otago and Massey University.

Post-rollout, 81% of screened individuals chose self-tests, driving national coverage from 66.9% (Sep 2023) to 73.6% (Mar 2025).

Clinician and Patient Perspectives: High Acceptability

Interviews and surveys from Auckland clinics revealed clinicians valued the opportunistic model for engaging overdue patients, though challenges included kit returns (61% from home-testers). Patients reported feeling 'empowered and shame-free'. Training mitigated concerns, with 96% follow-up for positive results.Read the full BMC Primary Care study.

National Rollout Success and Ongoing Challenges

Since September 2023, HPV self-testing has transformed the NCSP, with coverage nearing 74%. Health New Zealand reports 'flooded' referrals from increased positives, straining colposcopy services. Targets remain 80%, requiring sustained promotion.

Barriers persist for Pacific and underscreened groups, where home-return rates lag, suggesting need for nurse callbacks and community hubs.

New Zealand Universities' Pivotal Role in HPV Research

This work exemplifies NZ higher education's impact on public health. Victoria University of Wellington's Te Tātai Hauora o Hine led coordination, University of Auckland's National Institute for Health Innovation provided trial expertise, while University of Otago and Massey contributed Māori health and pathology insights. Professor Lawton's advocacy, from pilot acceptability trials to national policy, earned her Kiwibank New Zealander of the Year honours.

Such collaborations between unis, Health NZ, and iwi position NZ as a global leader in equitable screening.

Global Implications and Lessons for Other Nations

WHO endorses self-testing for hard-to-reach groups; NZ's data supports universal offers, potentially averting millions of speculums annually. Trials in Australia and UK echo 10-20% uptake boosts. For low-resource settings, mailed kits show promise.RNZ coverage of the study.

Future Directions: Sustaining Momentum Toward Elimination

To hit 80%, integrate digital reminders, iwi-led outreach, and expanded vaccination (free to age 26). Universities plan Pacific elimination initiatives ($5.1M funded). Challenges: colposcopy capacity, Pacific returns. Solutions: telehealth, subsidised transport.

Photo by Athithan Vignakaran on Unsplash

• Enhance return rates with SMS nudges
• Train more Māori clinicians
• Monitor via NCSP registry

Actionable Insights for Healthcare Providers and Policymakers

Clinics: Appoint champions, train opportunistically, stock kits. Policymakers: Fund follow-up infrastructure. Women: Book via free NCSP, self-test privately.NCSP self-test guide. This research not only saves lives but elevates NZ's health research profile globally.