Professor Bev Lawton
Screening for high-risk human papillomavirus (HPV) with appropriate subsequent treatment in combination with a programme of vaccination against HPV could prevent nearly all cervical cancers.
In New Zealand, the National Cervical Screening Programme (NCSP) has been extremely successful at reducing cervical cancer cases and deaths; however, the health outcome improvements are not shared equally across the population, and methods to increase participation in the screening programme are needed.
Self-testing to obtain a sample for HPV is as effective as sampling by a doctor or nurse (the traditional Pap smear exam) and has been shown internationally to improve cervical screening participation, but the acceptability and uptake for women in New Zealand who did not participate in the national screening programme was unknown.
Research funded by the HRC from teams led by Professor John Potter (Massey University) and Professor Bev Lawton ONZM (Ngāti Porou), Victoria University of Wellington, have been instrumental in the National Screening Unit’s plans to introduce HPV testing into the National Cervical Screening Programme.
Professor Potter and team conducted a community-based randomised controlled trial to investigate whether self-sampling increases screening participation among un- or under-screened Māori, Pacific, and Asian women in Auckland.
“This research has led directly to improvements in the uptake of screening for the human papillomavirus (HPV), the main cause of cervical cancer. Self-testing for HPV is now the preferred option for about 82% of New Zealand women undergoing cervical screening.”
In a complementary study, Professor Lawton led a community-based randomised control trial in partnership with primary care and Māori communities, that compared usual care with an HPV self-testing programme for Māori women in rural or small urban environments. Women were opportunistically offered screening through community outreach at clinics, community centres, or home, by a trusted kaiāwhina, nurse, or doctor.
Professor Potter’s work showed that self-sampling was greatly preferred over a standard Pap smear (a healthcare provider collected sample) in the group of non-European women who were currently least served by the screening programme.
Professor Lawton found a nearly three times increase of uptake of screening in un- or under-screened Māori women who were offered HPV self-testing compared to the control group.
“This research has directly addressed barriers to access for communities of women with high health needs,” says Professor Lawton.
“The evidence generated directly informed the major change to the National Cervical Screening Programme seen in September 2023 with the introduction of the new HPV test and new option of self-swabbing.”
Between September 2023 and September 2025, 794,000 people had their HPV screening check, with approximately 82% using self-tests1. The introduction of HPV self-testing has seen the number of HPV tests returned increase from approximately 30,000 per month before launch of self-testing to 50,000 per month after launch. Since September 2023, overall HPV screening coverage has increased by 11%, with relative increases of 19% for Māori and 34% for Pasifika2.
The HPV test detecting presence of cervical cancer-causing HPV strains is now the primary screening test, replacing the traditional speculum Pap smear exam that collects cells for viewing under a microscope.
1 Te Whatu Ora Health New Zealand
2 Te Whatu Ora Health New Zealand and National Kaitiaki Group
The HRC has funded six contracts to a total of $5.1 million in HPV self-testing and follow up treatment since 2016.