The impact of the universal choice of self-collection on cervical screening participation in Australia's National Cervical Screening Program: A population-based interrupted time series analysis.

OBJECTIVES: In July 2022, Australia's National Cervical Screening Program introduced vaginal self-collection for human papillomavirus testing as a screening option. We evaluated the policy impact on cervical screening rates in Victoria, Australia, and compared use of clinician-versus self-collection by practice location. STUDY DESIGN: Interrupted time series. METHODS: Using de-identified electronic medical records of age-eligible women (n = 267,127) from general practices (n = 69) contributing data to the Patron Primary Care Data repository. Interrupted time series analysis using segmented Poisson regression models estimated the slope change in monthly cervical screening rates per 100 women before (December 2017-June 2022) and after policy change (July 2022-June 2023). We described collection method by metropolitan versus regional/rural location. RESULTS: Monthly screening rates per 100 women decreased before policy change (incident rate ratio [IRR]: 0.98; 95% confidence interval [CI]: 0.97, 0.98) and increased after policy change (IRR: 1.10; 95% CI: 1.08, 1.12). Self-collection screening per 100 women increased monthly after policy change (IRR: 1.22; 95% CI: 1.16, 1.29), compared to clinician-collection (IRR: 1.06; 95% CI: 1.08, 1.12). The use of self-collection after policy change was higher amongst regional/rural practices. CONCLUSIONS: Universal access to self-collection resulted in modest increases in cervical screening, though direct attribution to the policy cannot be confirmed. Ongoing implementation challenges may explain variation observed between metropolitan and regional/rural practices.