High-risk human papillomavirus (HPV) is the known cause of cervical cancer.¹

Cervical cancer is preventable.^2,3

These two statements are well known to anyone working in women’s health in Aotearoa New Zealand and Australia. Australia has led the way in HPV vaccination, HPV testing, and a funded strategy to eliminate cervical cancer.^4,5 But women and people with a cervix still suffer and die from this disease. The World Health Organisation (WHO) estimates that globally around 350,000 women die every year, and the burden of disease is felt mainly by women in low- and middle-income countries with little or no screening programmes.⁶ Even in high-income countries with well organised screening programmes there remain inequities, particularly for indigenous women.

In Aotearoa NZ, wāhine Māori women and people with a cervix have more than twice the mortality rate from cervical cancer than NZ European women and people with a cervix.⁷ This is unacceptable and, quite frankly, amoral. We have the science, tools, and knowledge to change this. While this article focuses on the elimination of cervical cancer, we must not ignore that HPV causes other cancers, including anal, vulvovaginal, penile, and head and neck cancers. Further research and awareness in these areas are needed.

Te Tātai Hauora o Hine/The National Centre for Women’s Health Research Aotearoa

Our research group, Te Tātai Hauora o Hine, led by Professor Bev Lawton (2025 Kiwibank New Zealander of the year), strives to address inequities in the health of wāhine, pepī, and whānau (mothers, babies, and families), and reduce preventable harm. We have the unique capacity to work both in Kaupapa Māori (by Māori, with Māori, for Māori) and western approaches in women and children’s health.

HPV Self-testing – The Research

Since 2015, our focus has been to examine HPV self-testing (self-sampling or self-collection) and its potential role in our cervical screening programme, particularly for wāhine Māori. We have collaborated with Professor Marion Saville and Associate Professor David Hawkes of the Australian Centre for the Prevention of Cervical Cancer (ACPCC). Together, along with two other research groups in Aotearoa NZ, we undertook research examining the offer of HPV self-testing by different strategies to different populations. We met regularly with the National Screening Unit (NSU) to report progress and inform the new National Cervical Screening Programme (NCSP) in real time. This article highlights our HPV studies and the effect of the introduction of HPV self-testing as a core part of the NCSP in Aotearoa NZ.

Acceptability of HPV Self-test for Under-screened Māori Women⁸

This qualitative study examined the acceptability of self-taken vaginal HPV samples for cervical screening among an under-screened Māori population. Māori women aged over 25 years who had not been screened for ≥4 years were recruited by community-based Māori researchers to participate in hui (focus groups/interviews) in four regions of Aotearoa NZ to complete a survey. Hui involved 106 women and surveys were completed by 397 women. Most participants were enrolled in primary care (87.15%) and attended regularly (71.79%) but did not attend regular cervical screening. A desire for bodily autonomy, including whakamā (embarrassment/shyness/reticence), was the most frequently cited barrier.

Three in four women reported being likely/very likely to do an HPV self-test if offered. Nine in ten women reported being likely/very likely to attend follow up if they received a positive result. Women emphasised the importance of health literacy, cultural competence, and empathetic support. The findings indicate that, with a culturally safe implementation, many under- or never-screened Māori women would be willing to participate in screening and follow-up. One outcome of this study was a preference for the term “HPV self-test,” reflecting the autonomy they would feel being in control of their own testing.

Based on these findings, and global research showing that self-testing using a polymerase chain reaction based DNA platform is as sensitive as a clinician-collected sample, our team initiated a randomised controlled trial examining the offer of HPV self-testing to under- and never-screened Māori women.^8,9

Reaching Under- and Never-screened Indigenous Peoples with HPV Self-testing¹⁰

Te Tai Tokerau in northern Aotearoa NZ, with a high Māori and rural population, was selected due to established community and primary care links. The aim was to increase cervical screening for under- and never-screened Māori women aged 25-69 who had not screened for ≥4 years. The intervention group was offered HPV self-testing, while the control group received standard care (cervical cytology). The primary outcome was comparing the screening uptake. Of 500 eligible Māori women in the intervention group, 295 (59.0%) were screened, compared with 94 of 431 (21.8%) in the control group. Women offered self-testing were 2.8 times more likely to be screened (95% CI: 2.4-3.1, p-value <0.0001). HPV self-testing could potentially halve the number of under- or never-screened Māori women and reduce cervical morbidity and mortality.

He Tapu Te Whare Tangata (Sacred House of Humanity): Under-screened Māori Women Talk about HPV Self-testing Cervical Screening Clinical Pathways¹¹

This Kaupapa Māori qualitative study enabled under-screened Māori women to discuss HPV self-testing and cervical screening clinical pathways. The HPV self-test was perceived as empowering and supportive of bodily autonomy, although some women expressed fears or misconceptions about the technology. Women with a negative result felt reassured, while those with a positive result had fears, compounded by seeking out information online. During colposcopy, the importance of supportive, responsive care was emphasised.

HPV self-testing has the potential to improve access to cervical screening and reduce inequities for Māori. However, primary care and colposcopy services must provide sensitive, responsive care for under- and never-screened Māori women to minimise distress and potential trauma.

Globally, many studies show that offering HPV self-testing instead of a speculum examination can increase participation for under- or never-screened women.^9.10 However, few studies examined its impact in the general screening population.

Te Ara Waiora – Implementing HPV Primary Testing to Prevent Cervical Cancer in Aotearoa NZ¹²

Funded by the Health Research Council of New Zealand, Mahitahi Primary Health Entity, and the Ministry of Health NZ, a trial was established to assess the impact of a universal HPV test offer on screening participation. This cluster-randomised, non-inferiority trial recruited 14 primary care practices in Te Tai Tokerau. Practices were randomised to intervention (universal HPV self-testing) or control (speculum examination for cytology). The primary outcome was screening coverage among eligible people registered in study practices during the study period. Screening participation was significantly higher in the intervention group (35.6% [SE 2.4]) than in the control group (24.9% [2.0], with an absolute risk difference  of 10.8% [95% CI 4.7–16.9], p=0.0006) indicating not only non-inferiority, but superiority of the intervention.

Opportunities to Flip the Narrative from Burden to Action for Young Women Joining the NCSP in Aotearoa NZ¹³

Screening uptake among younger women remains low. This Kaupapa Māori qualitative part of Te Ara Waiora study explored the thoughts, experiences, and knowledge of cervical screening among women aged 18–30, including strategies to improve participation. Findings were organised into four pou (pillars): Rangatiratanga (self-determination, autonomy, sovereignty), Manaaki (support, encouragement, whanaungatanga), Kura (education, public health campaigns), and Mana Taurite (equity, access issues, system issues).

Analysis showed that the empowering and easy elements of the HPV self-test encourages young women to participate in cervical screening. However, cost remained the main barrier to access. Previous screening required a genital speculum examination. Young women recounted their mothers, aunties, cousins, and friends undertaking a cervical screen with a sense of duty and burden. HPV self-testing has changed this narrative.

Young women utilising HPV self-test can act as champions for cervical cancer elimination.

General practice also plays a critical role in championing cervical screening. This has implications for better primary care resourcing, harnessing trusted relationships to connect and support young women to screening so that they can continue to champion cervical cancer elimination. HPV self-testing in the NCSP can flip the narrative of cervical screening from burden to action.

National Cervical Screening Programme New Zealand^14.15

In September 2023, Aotearoa NZ became one of the first high-income countries to include the offer of HPV self-test as an integral part of the NCSP for anyone who was due a screen. The primary test for everyone screened is an HPV test irrespective of method of sampling. Since implementation, overall screening participation has increased from 67% in February 2023 to 75.5% in February 2026, with 81% of participants choosing HPV self-testing. Among wāhine Māori, participation has increased from 57.5% to 69.5%, and among Pasifika women from 54.1% to 75.8% over the same period. Participation has also increased across all socioeconomic deprivation indices.

The Future

Research into HPV prevention and the elimination of cervical and other HPV-related cancers continues. However, HPV vaccination rates in Aotearoa remain low < 50% for Indigenous rangatahi (young people) compared with 80% in Australia. We are learning from and working with our Indigenous Australian research colleagues in this area.

Advocacy to Eliminate Cervical Cancer in Aotearoa

Te Tātai Hauora o Hine has partnered with the New Zealand Cancer Society to advocate to policy makers, government, and the health system for the elimination of cervical cancer in Aotearoa NZ by 2035. The partnership also collaborates with non-governmental organisations like Smear Your Mea, a Māori-led health campaign launched in 2017 by the late Talei Morrison to raise awareness and increase early detection of cervical cancer.¹⁶ The WHO outlines a three-pillar global elimination strategy: vaccinate 90%, screen 70%, and treat 90%.⁶ In Aotearoa NZ, this framework has been expanded to four pillars: vaccination, screening, diagnosis, and treatment, including colposcopy diagnosis following screening.

Underlying these four pillars are the principles of innovation, transparency, accountability, monitoring and evaluation, cross-party agreement and, of course, equity.

As Professor Bev Lawton states, “Cervical cancer is now preventable, and we have the evidence, tools, and clinical knowledge to eliminate it. Building on the support from the health sector and communities, we are committed to seeing the elimination of cervical cancer through to the end. Let’s just do it, let’s make it happen.” ¹⁷