High-Risk Human Papillomavirus (HPV) Infection and Cervical Cancer Prevention in Britain: Evidence of Differential Uptake of Interventions from a Probability Survey

Background: The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) provides an opportunity to explore high-risk human papillomavirus (HR-HPV), and uptake of cervical screening and HPV vaccination in the general population. Methods: Natsal-3, a probability sample survey of men and women aged 16-74, resident in Britain, interviewed 8869 women in 2010-12. We explored risk factors for HR-HPV (in urine from 2569 sexually-experienced women aged 16-44), non-attendance for cervical screening in the past 5 years and non-completion of HPV catch-up vaccination. Results: HR-HPV was associated with increasing numbers of lifetime partners, younger age, increasing area-level deprivation and smoking. Screening non-attendance was associated with younger and older age, increasing area-level deprivation (age-adjusted odds ratio 1.91, 95% confidence interval, 1.48 to 2.47 for living in most vs. least deprived two quintiles), Asian/Asian British ethnicity (1.96, 1.32 to 2.90), smoking (1.97, 1.57 to 2.47) and reporting no partner in the past 5 years (2.45, 1.67 to 3.61 vs. 1 partner) but not with HR-HPV (1.35, 0.79 to 2.31). Lower uptake of HPV catch-up vaccination was associated with increasing area-level deprivation, non-white ethnicity, smoking and increasing lifetime partners. Conclusions: Socio-economic markers and smoking were associated with HR-HPV positivity, non-attendance for cervical screening and non-completion of catch-up HPV vaccination. Impact: The cervical screening programme needs to engage those missing HPV catch-up vaccination to avoid a potential widening of cervical cancer disparities in these cohorts. As some screening non-attenders are at low-risk for HR-HPV, tailored approaches may be appropriate to increase screening among higher-risk women.