Structural barriers to care have driven down cancer screening rates among immigrants and patients with limited English proficiency. U.S. cancer screening schedules may differ from practices in immigrants’ home countries, and language barriers also make it more difficult for clinicians to counsel patients and explain what cancer screening involves.
Cervical cancer screening presents even more challenges. Pelvic exams can be uncomfortable, requiring patients to undress. Often, patients have to arrange childcare or take time off from work. For these reasons, “there’s less screening in non-English-speaking and immigrant groups for cervical cancer,” according to Nina Kvaratskhelia, MD, a family physician at the Hansjörg Wyss Wellness Center at Jefferson Health in Philadelphia.
Dr. Kvaratskhelia and her colleagues at Jefferson Health have been working to bridge those care gaps through an innovative “self-collection” screening program to help Southeast Asian women living in underserved areas of Philadelphia.
In August, the project led by Dr. Kvaratskhelia was awarded one of the inaugural AMA Community Health Impact Lab micro grants The $1 million AMA initiative supports 20 physician-led projects, with each awardee receiving $50,000 to address pressing community health challenges through innovative, scalable, community-centered solutions.
In addition to the project led by Dr. Kvaratskhelia at Jefferson Health, the inaugural awardees represent projects spanning rural and urban communities across 17 U.S. states and address a wide range of health priorities, including maternal health, food as medicine, mental health, firearm-injury prevention, access to care, and pediatric health.
"These inaugural recipients demonstrate the unique role physicians can play leading projects in partnership with others that improve health and drive positive change in in their community," said AMA President Willie Underwood III, MD, MSc, MPH. “From expanding access to preventive care and maternal health services to addressing mental health, nutrition and chronic disease, these physician-led initiatives reflect the innovation and collaboration needed to improve health outcomes across a variety of communities with demonstrated health needs.”
The project at Jefferson Health uses a real-world approach, pairing human papillomavirus (HPV) self-sampling kits with co-designed multilingual audiovisual patient-education materials that will be disseminated at community events and the EHR patient portal. Jefferson Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The goal of the project is to improve cervical cancer screening among under-screened populations, focusing on English and Burmese language speakers. Community partners such as the Southeast Asian Mutual Assistance Association Coalition (SEAMAAC) will encourage patients to participate, while tracking user-experience metrics and kit-return rates to measure impact.
HPV self-collection can help bypass many of the structural barriers associated with traditional screening, while providing a more trauma-informed option, said Dr. Kvaratskhelia. Patients don’t have to undress for an exam and can collect the sample themselves in the privacy of a bathroom or clinic room with the door closed, she explained.
How the AMA grant will help
Dr. Kvaratskhelia divides her work between research and clinical care, spending half her time at the Wyss Wellness Center, which mainly serves Southeast Asian immigrants and refugees. It’s in the same building as SEAMAAC, which partnered with Jefferson Health to establish the clinic.
She provides basic cancer screenings and gynecologic care, including cervical cancer screening, and has already begun using HPV self-sampling in her own practice.
The AMA micro grant will help her expand HPV self-collection into a community setting, thereby providing an opportunity to develop ways to deliver this care outside of the usual practice setting, “which is really exciting,” she said.
The goal is to find creative ways to provide care and “meet patients where they’re at,” she added.
Another exciting thing about the project is the emphasis on involving community organizations from the beginning. The AMA was intentional about requiring applicants to have a letter of support from a collaborating organization as part of the application process, “which was awesome,” Dr. Kvaratskhelia said.
The HPV screening project is a new initiative with SEAMAAC, she clarified. With the AMA funding, her team will be able to host community events that offer HPV self-collection and self-sampling, as well as compensate community members for their time in both developing and executing the project.
Growing support for HPV self-collection
Growing evidence supports a shift toward primary HPV screening and, increasingly, patient-collected vaginal samples as an effective way to expand cervical cancer screening.
Dr. Kvaratskhelia said she is comfortable offering HPV self-collection as an equivalent option to physician-collected testing when PCR-based HPV testing is used. “When I look at the sensitivity and the specificity, if it's an HPV PCR-based sample, it is about the same as physician-collected,” she said. “It’s virtually the same when you do PCR testing.”
Self-collection may also help patients avoid unnecessary follow-up procedures. About one in 10 people will test positive for HPV, she said, meaning the other nine may be able to avoid an unnecessary Pap smear and the potential consequences of additional testing.
She pointed to the American Cancer Society’s 2020 cervical cancer screening guideline update, which used mathematical modeling to compare primary HPV testing with cytology alone and HPV/cytology co-testing. The modeling found that primary HPV screening produced comparable or slightly better projected cervical cancer mortality outcomes while reducing some screening-related harms. The findings helped support the move toward primary HPV screening as the preferred approach.
Evidence also shows that patient-collected HPV samples can perform as well as clinician-collected cervical samples when using validated PCR-based assays. A 2026 JAMA® clinical guidelines synopsis showed that patient-collected vaginal specimens are essentially equivalent to clinician-collected cervical specimens for detecting high-risk HPV and cervical precancer.
Major health organizations are increasingly recognizing the potential of self-collection. In 2022, the World Health Organization endorsed HPV self-sampling, and the U.S. Preventive Services Task Force’s draft updated recommendations include clinician- or patient-collected primary high-risk HPV screening every five years for women ages 30 to 65. While the American Cancer Society prefers clinician-collected cervical specimens, self-collected vaginal specimens are an acceptable option for average-risk individuals who are between 25 and 65 years old.
Explaining the process to patients
The Food and Drug Administration approved HPV self-collection for use in clinical settings in the U.S. in 2024. However, the approach remains relatively new and underused. This is partly due to clinician skepticism and the fact that patients don’t know about it, said Dr. Kvaratskhelia.
One of the first objectives of Dr. Kvaratskhelia’s AMA-supported project is to work with community members to develop an educational tool about HPV self-sampling, such as a video.
The team has identified community members who are enthusiastic about participating and plans to develop the tool collaboratively. The initial versions will be in English and Burmese, based on input from community partners about the needs of the people they serve. Rather than simply adapting existing materials, the team aims to have community members provide feedback throughout the process.
“We're going to work with them and co-develop this educational tool based off some resources that are already out there but also getting their feedback along the way to what would make it relevant to people—that they would hear and understand,” she explained.
The educational tool will be paired with the HPV self-collection kits.
Follow up after testing is essential
Having a clear follow-up pathway critical for any screening program. You don’t want to give someone an abnormal result and just say “good luck” to them, said Dr. Kvaratskhelia.
Generally, there are three possible outcomes. Patients with a normal result would be rescreened in a few years. Those with HPV 16 or 18, which are considered higher-risk types, would be referred directly for a colposcopy. Patients who test positive for other high-risk HPV types would first receive a Pap test. Dr. Kvaratskhelia said she performs those Pap tests in her office. The team also has close relationships with ob-gyns to ensure patients who need colposcopy are linked to appropriate care.
Partnerships with the swab and laboratory providers, along with grant funding, will allow patients who are uninsured to receive the testing at no cost, whereas those with insurance will use it to cover testing.
Validating the project’s results
Dr. Kvaratskhelia shared that project leaders will be using the Program Sustainability Assessment Tool to assess its progress. This includes herself, Munjireen Sifat, PhD, MPH, a PhD researcher from the Sidney Kimmel Comprehensive Cancer Center who helped develop the project, and members of the SEAMAAC.
The team will be measuring how many people complete the HPV self-collection kits and return them, as well as evaluating the effectiveness of the educational video through user surveys.
The goal, said Dr. Kvaratskhelia, is to determine whether the project is “doing what we actually set out to do” and whether it is happening successfully.
