Psychosocial Impact of Inclusion of HPV Test in the Clinical Management of Abnormal Pap Smears among Women in Medellin, Colombia
METHODS: Pragmatic clinical trial. Women with ASC-US were randomly assigned to one of 3-arms (Pap smear, colposcopy, HPV). Participants received information on the procedures and completed a questionnaire at baseline and 2 weeks after receiving the results of the triage tests to assess self-esteem, anxiety, and the HIP (HPV Impact profile) scale which measures seven domains: cancer/fertility concerns, emotional/sexual impact, self-image, partner issues/transmission, interactions with doctors, and control/life impact. HIP score less than 40 indicated little/no impact. Paired t-test and One way ANOVA were performed.
RESULTS: 232 participants (61, 90, and 81 in Pap smear, colposcopy and HPV arms respectively) have completed both questionnaires. There was no difference in the socio-demographic variables between arms. Preliminary results showed that in none of the arms, anxiety scores changed significantly after receiving the triage results. All the other scores, but sexual impact score in the HPV arm improved significantly at follow-up. The composite HIP scale at baseline and follow-up for the Pap smear arm was 42.3 (±14.62) and 27.9 (±15.570); 38.1 (±16.48) and 26.6 (±15.13) for the colposcopy arm, and 39.1 (±15.61) and 29.6 (±16.213) for the HPV arm. HPV positive women had higher anxiety and HIP scores than HPV negative women.
CONCLUSIONS: Even though the three arms appeared to have similar psychosocial impacts immediately after the triage tests, women with an HPV positive test presented worst scores than women with an HPV negative test. Therefore, it is recommended that introduction of HPV testing as a triage strategy should include education about the condition and support to overcome the psychosocial impact that it appears to have.